Effect of hospitalization on the antibiotic resistance of fecal Enterococcus faecalis of surgical patients over time.

The prevalence of antibiotic resistant Enterococcus faecalis was determined in fecal samples of 263 patients admitted to the surgical wards of three university-affiliated hospitals on admission, at discharge, and at 1 and 6 months after discharge. A slight increase in the prevalence of antibiotic resistance of E. faecalis was found at discharge for the antibiotics tested compared to those on admission, vancomycin excepted. At 6 months after discharge, the prevalence of resistance for amoxicillin (0%), ciprofloxacin (3%), erythromycin (47%), and oxytetracycline (60%) decreased to the level on admission (respectively 0%, 8%, 45%, and 64%). Gentamicin resistance was the same at discharge (10%) as 1 month later (12%), but decreased 6 months after discharge (8%) to the level on admission (7%). In conclusion, hospitalization resulted in the study population in a slight increase in the prevalence of resistant fecal E. faecalis isolates at discharge, which decreased again (slowly) to the level on admission 6 months after discharge. Thus, the influence of hospitalization on the prevalence of antibiotic resistance in the extramural situation disappears between 1 and 6 months after discharge in this population.

The prevalence of antibodies against B. burgdorferi, an indicator for Lyme borreliosis in dogs? A comparison of serological tests.

Five serological tests for the detection of IgM and IgG antibodies to Borrelia burgdorferi, the causative microorganism of Lyme borreliosis (LB), were compared in 1177 sera from Dutch dogs: 401 healthy working hunting dogs, 100 healthy city pet dogs, 629 city dogs suspected of having LB with various clinical symptoms, and 47 hunting dogs with intermittent lameness. The results of the in-house species-independent enzyme immunoassay (i.e. an EIA which can be used to test serum samples from different animal species) showed a strong agreement (kappa: 0.78-0.81) with those of an experimental and a commercially available EIA (Genzyme Virotech, Rüsselsheim, Germany) for the detection of canine IgG antibodies to B. burgdorferi. Furthermore, the sensitivity of the in-house EIAs for the detection of antibodies to B. burgdorferi was independent of the antigenic heterogeneity, as demonstrated by the results of sera from dogs suspected of LB with various clinical symptoms: lameness (n = 60), and neurological (n = 60) and skin disorders (n = 52). Because of its high sensitivity for IgM antibodies, the indirect assay (Diagast, Pessac, France) proved to be an interesting tool for the detection of an acute Lyme infection in dogs. However, in this study a positive serological result could not be linked to any clinical symptom that has been related to LB in dogs. Results showed no difference in seroprevalence between dogs considered at high or at low risk of a B. burgdorferi infection. It was concluded that LB is an uncommon disease in the Dutch dog population despite the fact that many of Dutch dogs are infected with B. burgdorferi. Because of this low prevalence, the use of any immunoassay to support the clinical diagnosis of LB in dogs might be of limited value. Nevertheless, the species-independent EIA could be valuable in seroepidemiological studies when sera of several different animal species need to be tested.

Genetic characterization of glycopeptide-resistant enterococci of human and animal origin from mixed pig and poultry farms.

Glycopeptide resistant enterococci (GRE) isolated from animals and humans were characterised using both AFPL typing and genetic characterisation of the glycopeptide resistance transposon Tn1546. All isolates were collected in 1997 when the glycopeptide avoparcin was still being used as growth promoter. All investigated animal isolates were from mixed pig and poultry farms in the Netherlands and the human isolated from the farmers of these farms. A total of 24 isolates were investigated. AFLP and Tn1546 typing revealed that both pig and poultry related enterococcal and vanA transposon genotypes were found among the human isolates indicating spread of glycopeptide resistance from both pig and poultry to the farmers. These findings contradict previous finding that showed that GRE recovered from the general population were genotypically undistinguishable from GRE isolated from pigs but are in line with other studies that demonstrated spread of GRE from poultry to farmers in poultry farms.

Hospitalization, a risk factor for antibiotic-resistant Escherichia coli in the community?

OBJECTIVE: The impact of hospitalization on the prevalence of resistant Escherichia coli in the intestinal flora of patients admitted to the surgical wards of three Dutch university-affiliated hospitals was analysed prospectively. METHODS: Faecal samples were obtained on admission to the hospital, at the time of discharge, and 1 and 6 months after discharge. All samples were examined for resistance to nine antibiotic agents. RESULTS: For the total patient population, no significant differences in the prevalence of resistance were observed at the different sampling intervals, except for a significant decrease in cefazolin resistance between the time of discharge and 6 months after discharge (10% to 3%, P < 0.05). This decrease was mainly observed in patients from the university hospital Maastricht (azM), in which a significant decrease from 17% to 6% was detected (P < 0.05). Moreover, despite dissimilarities in patient characteristics and the marked variations in antibiotic use, no significant differences in the prevalence of antibiotic resistance were observed between the three hospitals, except for the overall higher prevalence of cefazolin-resistant E. coli in azM patients (P < 0.05). CONCLUSION: In this study, hospitalization did not seem to have any substantial effect on the prevalence of antibiotic-resistant E. coli at the different time intervals. However, as our study population consisted of surgical patients with a relatively moderate antibiotic use, and the prevalence of antibiotic resistance was only analysed for faecal E. coli, further investigation should be encouraged, as the understanding of the interaction between different resistance reservoirs is important for directing future intervention studies.

Influence of population density on antibiotic resistance.

Antibiotic consumption and population density as a measure of crowding in the community were related to the prevalence of antibiotic resistance of three cities in three different countries: St Johns in Newfoundland (Canada), Athens in Greece and Groningen in The Netherlands. Antibiotic consumption was expressed in DDD (defined daily dose), as DID (DDD/1000 inhabitants/day) and as DSD (DDD/km(2)). The prevalence of antibiotic-resistant Escherichia coli and enterococci was determined in faecal samples of healthy volunteers. In both Newfoundland (28 DID) and Greece (29 DID) the overall consumption of antibiotics was more than three times higher compared with that of The Netherlands (9 DID). The lowest prevalence of resistant E. coli against the majority of antibiotics tested was found for the samples from Newfoundland and was significant (P < 0.05) for cefazolin, oxytetracycline and trimethoprim. A poor correlation between the number of DID and the prevalence of resistance was observed [the Pearson correlation coefficient (Pcc) ranged between -0.93 and 0.87]. However, when population density was taken into consideration and antibiotic consumption was expressed in DSD, a strong correlation was observed (and Pcc ranged between 0.86 and 1.00). This study suggests that population density is an important factor in the development of antibiotic resistance and warrants special attention as a factor in resistance epidemiology.

Antibiotic usage and resistance in different regions of the Dutch community.

Regional differences of antibiotic use and antibiotic resistance in the fecal indicator bacteria Escherichia coli and enterococci were determined in different cities in the south, west, and north of The Netherlands. In 1999, differences in antibiotic consumption were observed between the different regions: 11.19, 10.84, and 7.16 DDD (defined daily dosage) per 1,000 inhabitants per day, respectively. No significant regional differences were found in the prevalence of antibiotic resistance for both E. coli and enterococci. However, the differences in antibiotic consumption observed might lead to changes in antibiotic resistance in the near future. Surveillance of antibiotic use and antibiotic resistance is strongly recommended to control the development of antibiotic resistance because it provides epidemiological data to set up and control antibiotic guidelines.

Antibiotic resistance of faecal enterococci in poultry, poultry farmers and poultry slaughterers.

The prevalence of resistance in enterococci to antibiotics, commonly used for therapy in poultry or as antimicrobial growth promoters (AMGPs), was determined in faecal samples of two chicken populations: broilers in which antibiotic and AMGP use is common and laying-hens with a low antibiotic usage. In addition faecal samples were examined from three human populations: broiler farmers, laying-hen farmers and poultry slaughterers. MICs of an extended panel of antibiotics for a randomly chosen gentamicin- or vancomycin-resistant enterococcal isolate from each faecal specimen were also determined. The prevalence of resistance for all antibiotics tested was higher in broilers than in laying-hens. Resistance in faecal enterococci of broiler farmers was for nearly all antibiotics higher than those observed in laying-hen farmers and poultry slaughterers. The overall resistance in broilers was correlated with the resistance in broiler farmers and in poultry slaughterers. No correlation between the results obtained in the laying-hens with any of the other populations was found. The 27 gentamicin-resistant isolates all showed high-level resistance to gentamicin and two of these isolates, both Enterococcus faecium, were resistant to all antibiotics tested, except vancomycin. The 73 vancomycin-resistant enterococci (VRE) isolated from the five populations belonged to four different species and in all isolates the vanA gene cluster was detected by blot hybridization. The pulsed-field gel electrophoresis (PFGE) patterns of these vancomycin-resistant enterococci were quite heterogeneous, but Enterococcus hirae isolates with the same or a closely related PFGE pattern were isolated at two farms from the broiler farmer and from broilers. Molecular characterization of vanA-containing transposons of these isolates showed that similar transposon types, predominantly found in poultry, were present. Moreover, similar vanA elements were not only found in isolates with the same PFGE pattern but also in other VRE isolated from both humans and chickens. The results of this study suggest transmission of resistance in enterococci from animals to man. For VRE this might be clonal transmission of animal strains, but transposon transfer seems to occur more commonly.

Effects of flavophospholipol on resistance in fecal Escherichia coli and enterococci of fattening pigs.

A "plasmid-curing effect" of multiresistant Escherichia coli by flavophospholipol, an antibiotic used as an antimicrobial growth promoter (AMGP) in animal feeds, has been reported to occur in vitro and in vivo under experimental conditions. In this study, the effect of flavophospholipol under field conditions was studied. The prevalence and degree (proportion of resistant strains to the total numbers present per gram of feces) of resistance of indicator bacteria, E. coli and enterococci, was determined in fecal samples from three groups of pigs that were fed a commercial finisher feed without any AMGP. Group A was the negative control group without any AMGP, group B received the same feed with 9 mg of flavophospholipol/kg of feed (study group), and group C received the same feed with 15 mg of avoparcin/kg (positive control). Fecal samples from each pig were collected at the start and at the end of the study and assessed for the prevalence and degree of resistance against antibiotics commonly used either for therapy in pig medicine or as an AMGP. Before the start of the study, all pigs were colonized with multiresistant E. coli by mixing three resistant pig isolates through their feed after disturbance of the colonization resistance of the intestinal flora by a 3-day course of lincomycin and spectinomycin. At the end of the study, the overall prevalence and degree of resistance of E. coli in the fecal flora had increased significantly in groups A and C but remained at the same level as at the start of the study in group B. The prevalence of vancomycin resistance was 44 and 41% in groups A and B, respectively, but only very low numbers of vancomycin-resistant enterococci (VRE) per gram of feces were found. In the avoparcin-fed group, the prevalence was 72%, and in 57% of the samples, more than 50% of all enterococci present were vancomycin resistant. The prevalence of resistant Enterococcus faecalis increased only in the flavophospholipol-exposed group, from 23% before the start of the study to 43% at the end of the study. It was concluded that flavophospholipol effectively suppressed the augmentation and dissemination of multiresistant E. coli in the intestinal flora of fattening pigs. Avoparcin use strongly selected for VRE carriage and excretion. Therefore, as neither flavophospholipol nor any related molecule is used therapeutically, no cross-resistance with therapeutic antibiotics exists and no transmissible resistance has been shown; the major decrease in resistance in intestinal E. coli of flavophospholipol-fed animals seemed to outweigh the small increase in the risk of transfer of flavophospholipol-resistant E. faecalis from animals to humans via the food chain.

[Human health aspects of antibiotic use in food animals: a review]. / Volksgezondheidsaspecten van antibioticumgebruik bij nutsdieren: een overzicht.

Antibiotic use not only selects for resistance in pathogenic bacteria, but also in the commensal flora of exposed individuals. Veterinary surgeons regularly prescribe antibiotics for food animals to treat bacterial infections just as doctors do for human patients. In addition, however, animal feeds contain added antibiotics not for therapy but for economic reasons: to enhance the growth rate of these animals. Several of the antibiotics used as growth promoters are analogues of and fully cross resistant with important antibiotics used in human medicine. As a result of this high exposure to antibiotics, the prevalence of resistant bacteria in the faecal flora of these animals is high. These resistant bacteria can be directly and indirectly, via foods of animal origin, transferred to humans and either colonize the human intestinal tract or exchange their resistance genes with commensal bacteria of humans. As the intestinal flora functions as a reservoir of resistance genes for pathogenic bacteria and because many bacterial species of the intestinal flora are potential pathogens, the efficacy of antibiotic therapy in human medicine may be jeopardized.

Antibiotic resistance of faecal Escherichia coli in poultry, poultry farmers and poultry slaughterers.

The percentage of faecal samples containing resistant Echerichia coli and the proportion of resistant faecal E. coli were determined in three poultry populations: broilers and turkeys commonly given antibiotics, and laying hens treated with antibiotics relatively infrequently. Faecal samples of five human populations were also examined: turkey farmers, broiler farmers, laying-hen farmers, broiler slaughterers and turkey slaughterers. The MICs of antibiotics commonly used in poultry medicine were also determined. Ciprofloxacin-resistant isolates from these eight populations and from turkey meat were genotyped by pulsed-field gel electrophoresis (PFGE) after SmaI digestion. The proportion of samples containing resistant E. coli and the percentages of resistant E. coli were significantly higher in turkeys and broilers than in the laying-hen population. Resistance to nearly all antibiotics in faecal E. coli of turkey and broiler farmers, and of turkey and broiler slaughterers, was higher than in laying-hen farmers. Multiresistant isolates were common in turkey and broiler farmers but absent in laying-hen farmers. The same resistance patterns were found in turkeys, turkey farmers and turkey slaughterers and in broiler, broiler farmers and broiler slaughterers. The PFGE patterns of the isolates from the eight populations were quite heterogeneous, but E. coli with an identical PFGE pattern were isolated at two farms from a turkey and the farmer, and also from a broiler and a broiler farmer from different farms. Moreover, three E. coli isolates from turkey meat were identical to faecal isolates from turkeys. The results of this study strongly indicate that transmission of resistant clones and resistance plasmids of E. coli from poultry to humans commonly occurs.

Dogs as sentinels for human Lyme borreliosis in The Netherlands.

Serum samples from hunters (n = 440), their hunting dogs (n = 448), and hunters without dog ownership (n = 53) were collected in The Netherlands at hunting dog trials and were tested for antibodies against Borrelia burgdorferi by a whole-cell enzyme-linked immunosorbent assay. Additionally, 75 healthy pet dogs were tested. The results of this study indicate that the seroprevalence among hunting dogs (18%) was of the same order as the seroprevalence among pet dogs (17%) and hunters (15%). The seropositivity of a hunting dog was not a significant indicator of increased risk of Lyme borreliosis for its owner. No significant rise in seroprevalence was found in dogs older than 24 months. This indicated that seropositivity after an infection with B. burgdorferi in dogs is rather short, approximately 1 year. In humans this is considerably longer but is also not lifelong. Therefore, the incidence of B. burgdorferi infections among dogs was greater than that among hunters, despite a similar prevalence of seropositivity among hunters and their hunting dogs. Because no positive correlation was observed between the seropositivity of a hunter and the seropositivity of the hunter's dog, direct transfer of ticks between dog and hunter does not seem important and owning a dog should not be considered a risk factor for Lyme borreliosis.

Serodiagnosis of Lyme borreliosis using detection of different immunoglobulin (sub)classes by enzyme-linked immunosorbent assay and Western blotting.

To improve the performance of enzyme-linked immunosorbent assays for the serodiagnosis of Lyme borreliosis, the prevalence of several immunoglobulin classes and subclasses against various antigens of Borrelia burgdorferi was investigated by Western blotting. The sera of 40 early Lyme borreliosis patients (ELB), 27 late Lyme borreliosis patients (LLB), 62 healthy controls and 140 non-Lyme borreliosis patients were used. Detection of IgG1 versus total IgG was found to be more sensitive in detecting Borrelia burgdorferi antigens, especially flagellin (41 kD) protein, but did not improve the performance of Western blotting. The use of IgG1 detection showed an increase in sensitivity and specificity for the early Lyme borreliosis patient group compared to the standard IgG and IgM detection method by enzyme immunoassays using purified Borrelia burgdorferi flagellum. However, in an enzyme immunoassay using a total sonicate, sensitivity in detecting early Lyme borreliosis and late Lyme borreliosis with IgG1 remained lower compared to the detection of early Lyme borreliosis by IgM antibodies and late Lyme borreliosis by total IgG antibodies.

Human health hazards associated with the administration of antimicrobials to slaughter animals. Part II. An assessment of the risks of resistant bacteria in pigs and pork.

Risks for the consumer regarding the acquisition of resistant bacteria and/or resistance genes via the consumption of pork are discussed. In general, Salmonella spp. and Escherichia coli that originate from animals do not easily transfer their resistance genes to the resident intestinal flora of humans. The prevalence of resistant E. coli in humans seems more associated with being a vegetarian (odds ratio (OR) 1.89) than with the consumption of meat and meat products. Other risk factors are treatment with antimicrobials (OR 2-5), becoming hospitalized (OR 5.93), or working in a health setting (OR 4.38). In the Netherlands, annually an estimated 45,000 people (0-150,000) become a carrier of resistant E. coli and/or resistance genes that ori ginate from pigs, while an estimated 345,000 persons (175,000-600,000) become a carrier of resistant E. coli and/or resistance genes that originate from hospitals, e.g. other patients. Any problems with resistant Salmonella spp. that stem from pigs are, in fact, an integral part of the total problem of food-borne salmonellosis. Sometimes there are outbreaks of a specific multi-resistant clone of S. typhimurium that causes problems in both farm animals and humans. The probability that in the next 30 years there is no or maximally one outbreak of a specific clone that originates from pig herds is estimated at about 75%. Antimicrobials used as a growth promoter can have a measurable influence on the prevalence of resistant bacteria. The likely chain of events regarding avoparcin and the selection and dissemination of resistance against vancomycin in the enterococci gives the impression that the impact of the use of antimicrobials in animals on the prevalence of resistance in humans is largely determined by whether resistance genes are, or become, located on a self-transferable transposon. Furthermore, consumer health risks of antimicrobials used in slaughter pigs are mainly determined by the selection and dissemination of bacterial resistance and much less by the toxicological properties of any residues in pork. It is also concluded that most of the problems with resistant bacteria in humans are associated with the medical use of antimicrobials, and that the impact of particularly the veterinary use of antimicrobials is limited. However, the impact of antimicrobials used as a feed additive appears to be much greater than that of antimicrobials used for strictly veterinary purposes. The use of antimicrobials as a feed additive should therefore be seriously reconsidered.

Human health hazards associated with the administration of antimicrobials to slaughter animals. Part I. An assessment of the risks of residues of tetracyclines in pork.

This article describes the assessment of consumer risks of residues of tetracyclines in slaughter pigs in the Netherlands. The assessed risks were toxic and allergic reactions, and the disturbance of the consumers' intestinal flora. Toxic and allergic reactions in humans and animals have only been observed at therapeutic doses, affecting between an estimated 1 in 5,000 and one 1 in 140,000 individuals exposed. Residues of tetracyclines in pigs are closely associated with treatment with injectable formulations. Established Maximum Residue Levels (MRLs) do not reflect actual consumer risks in case a limit is violated incidentally. For example, when the established MRLs for tetracyclines in meat are exceeded with a factor 400, 40,000, and 200,000, respectively, the actual risk of an adverse drug reaction for the consumer following a single consumption of this meat is maximally 1 in 3 million, 1 in 300,000, and 1 in 8,000, respectively. At the current estimated low levels of incidental exposure via pork, the annual risk of negative health effects for a random consumer is estimated at maximally 1 in 33 million. The annual risk that a temporary disturbance of the intestinal flora may also result in a facilitated infection with certain enteropathogens, such as Salmonella spp., is estimated at 1 in 45 million. It is concluded that the current microbiological risks of pork are greater than the risks of residues of tetracyclines as such, and that the control of the microbiological risks of pork should therefore be given first priority.

Novel test lead designs for sacral nerve stimulation: improved passive fixation in an animal model.

PURPOSE: To evaluate the ability of two novel coiled test stimulation lead designs to reduce or eliminate undesired migration and concomitant loss or attenuation of responsiveness to sacral nerve stimulation (SNS) associated with standard percutaneous nerve evaluation (PNE) leads. MATERIALS AND METHODS: The two novel leads (Coiled Leads 1 and 2) and a standard PNE lead were inserted bilaterally in sacral foramina of female goats. At various times thereafter threshold voltage responses were measured. Prior to lead removal, distance of lead migration was evaluated by x-ray imaging and the force necessary to displace the leads measured. Thereafter, as the leads were being removed, the force necessary for removal was also measured. RESULTS: Migration was consistently either nil or minimal for both coiled leads. In contrast, migration of the standard lead occurred in all cases and was substantial in magnitude. A significant linear association was evident between the migration distance of the standard lead and the corresponding voltages needed to evoke a response. The forces necessary to displace Coiled Lead 1 and Coiled Lead 2 were both significantly higher (p <0.01) than those for the standard lead. In some cases comparatively high forces were needed for removal of Coiled Lead 1 but not Coiled Lead 2. CONCLUSIONS: Coiled lead designs appear to offer a potentially promising alternative to standard leads for PNE, allowing a wider range of patients to be correctly identified as candidates for sacral root neuromodulation. Coiled Lead 2 merits further investigation in human subjects.

Antimicrobial resistance in pig faecal samples from the Netherlands (five abattoirs) and Sweden.

The prevalence and degree of antibiotic resistance of faecal indicator bacteria, Escherichia coli and enteroccoci, were determined in 1321 faecal samples collected from pigs at five abattoirs in The Netherlands and in 100 samples from Swedish pigs. In the Dutch samples a high prevalence of resistance was observed in E. coli for three commonly used antibiotics in pig medicine, amoxycillin (70-94%), oxytetracycline (78-98%) and trimethoprim (62-96%). Also, the prevalence for chloramphenicol (55-67%) and neomycin (38-67%) was relatively high. For the other compounds tested the prevalence was less than 10%. The percentage of samples with a high degree of resistant E. coli showed the same tendency in all Dutch abattoirs although significant differences between the abattoirs were observed. The percentage of Swedish samples with a high degree of resistant E. coli was significantly lower for all antibiotics except nitrofurantoin, gentamicin, flumequin and ciprofloxacin. All enterococci were susceptible to amoxycillin and high-level resistance to gentamicin was observed in 4-6% of the Dutch samples. A high prevalence of resistance and a high degree of resistance was found for erythromycin and oxytetracycline. The prevalence of resistance to dalfopristin-quinupristin ranged from 6 to 8% and for vancomycin from 24 to 46%. Significant differences between the abattoirs were found for all compounds tested except amoxycillin. In the Swedish population both the prevalence and degree of resistance in enterococci were significantly lower except for amoxycillin and gentamicin. This point prevalence study showed that the prevalence and degree of antibiotic resistance in indicator bacteria, E. coli and enterococci, in faecal samples from pigs differed between two countries and reflected differences in antibiotic usage in pigs. To analyse the differences observed between the slaughterhouses, additional information about the farms of origin and antibiotic consumption is necessary.

Epidemiology of resistance to antibiotics. Links between animals and humans.

An inevitable side effect of the use of antibiotics is the emergence and dissemination of resistant bacteria. Most retrospective and prospective studies show that after the introduction of an antibiotic not only the level of resistance of pathogenic bacteria, but also of commensal bacteria increases. Commensal bacteria constitute a reservior of resistance genes for (potentially) pathogenic bacteria. Their level of resistance is considered to be a good indicator for selection pressure by antibiotic use and for resistance problems to be expected in pathogens. Resistant commensal bacteria of food animals might contaminate, like zoonotic bacteria, meat (products) and so reach the intestinal tract of humans. Monitoring the prevalence of resistance in indicator bacteria such as faecal Escherichia coli and enterococci in different populations, animals, patients and healthy humans, makes it feasible to compare the prevalence of resistance and to detect transfer of resistant bacteria or resistance genes from animals to humans and vice versa. Only in countries that use or used avoparcin (a glycopeptide antibiotic, like vancomycin) as antimicrobial growth promoter (AMGP), is vancomycin resistance common in intestinal enterococci, not only in exposed animals, but also in the human population outside hospitals. Resistance genes against antibiotics, that are or have only been used in animals, i.e. nourseothricin, apramycin etc. were found soon after their introduction, not only in animal bacteria but also in the commensal flora of humans, in zoonotic pathogens like salmonellae, but also in strictly human pathogens, like shigellae. This makes it clear that not only clonal spread of resistant strains occurs, but also transfer of resistance genes between human and animal bacteria. Moreover, since the EU ban of avoparcin, a significant decrease has been observed in several European countries in the prevalence of vancomycin resistant enterococci in meat (products), in faecal samples of food animals and healthy humans, which underlines the role of antimicrobial usage in food animals in the selection of bacterial resistance and the transport of these resistances via the food chain to humans. To safeguard public health, the selection and dissemination of resistant bacteria from animals should be controlled. This can only be achieved by reducing the amounts of antibiotics used in animals. Discontinuing the practice of routinely adding AMGP to animal feeds would reduce the amounts of antibiotics used for animals in the EU by a minimum of 30% and in some member states even by 50%.