Integrated food chain surveillance system for Salmonella spp. in Mexico.

Few developing countries have foodborne pathogen surveillance systems, and none of these integrates data from humans, food, and animals. We describe the implementation of a 4-state, integrated food chain surveillance system (IFCS) for Salmonella spp. in Mexico. Significant findings were 1) high rates of meat contamination (21.3%-36.4%), 2) high rates of ceftriaxone-resistant S. Typhimurium in chicken, ill humans, and swine (77.3%, 66.3%, and 40.4% of S. Typhimurium T isolates, respectively), and 3) the emergence of ciprofloxacin resistance in S. Heidelberg (10.4%) and S. Typhimurium (1.7%) from swine. A strong association between Salmonella spp. contamination in beef and asymptomatic Salmonella spp. infection was only observed in the state with the lowest poverty level (Pearson r = 0.91, p<0.001). Pulsed-field gel electrophoresis analysis of 311 S. Typhimurium isolates showed 14 clusters with 102 human, retail meat, and food-animal isolates with indistinguishable patterns. An IFCS is technically and economically feasible in developing countries and can effectively identify major public health priorities.

Nontyphoidal Salmonella from human clinical cases, asymptomatic children, and raw retail meats in Yucatan, Mexico.

BACKGROUND: We report the results of a 3-year Salmonella surveillance study of persons with diarrhea; asymptomatic children; and retail pork, poultry, and beef in Yucatan, Mexico. METHODS: Isolates were characterized according to serotype, antimicrobial susceptibility, and genetic relatedness with pulsed-field gel electrophoresis. RESULTS: Salmonella Typhimurium was the most common serotype found in ill humans (21.8% of isolates), followed by Salmonella Agona (21% of isolates). Salmonella Enteritidis was a minor serotype (4.2% of isolates). Asymptomatic children carried S. Agona (12.1% of isolates), Salmonella Meleagridis (11.6% of isolates), Salmonella Anatum (8% of isolates) and S. Enteritidis (5.8% of isolates). A high percentage of retail meat samples contained Salmonella; it was most commonly found in pork (58.1% of samples), followed by beef (54% of samples) and poultry (39.7% of samples). Resistance to oral drugs used for the treatment of salmonellosis was observed for ampicillin (14.6% of isolates were resistant), chloramphenicol (14.0% of isolates), and trimethoprim-sulfamethoxazole (19.7% of isolates). Resistance to ceftriaxone emerged in 2002 and was limited to the serotype S. Typhimurium. Twenty-seven percent of the isolates were resistant to nalidixic acid, and none were resistant to ciprofloxacin. Multidrug resistance was most common among isolates of serotypes S. Typhimurium and S. Anatum. Pulsed-field gel electrophoresis showed that strains found in retail meats were genetically identical to strains found in both asymptomatic children and ill patients. CONCLUSIONS: Our study found a high prevalence of Salmonella in retail meats and persons with enteric infection; many of these isolates were resistant to clinically important antimicrobials. A random selection of isolates from people and retail meat showed genetic relatedness, which suggests that, in Yucatan, considerable transfer of Salmonella occurs through the food chain.

Public health and policy.

Antimicrobial agent usage data are essential for focusing efforts to reduce misuse and overuse of antimicrobial agents in food producing animals because these practices may select for resistance in bacteria of animals. Transfer of resistant bacteria from animals to humans can lead to human infection caused by resistant pathogens. Resistant infections can lead to treatment failures, resulting in prolonged or more severe illness. Multiple World Health Organization (WHO) reports have concluded that both antimicrobial resistance and antimicrobial usage should be monitored on the national level. The system for collecting antimicrobial usage data should be clear and transparent to facilitate trend analysis and comparison within and among countries. Therapeutic, prophylactic and growth promotion use should be recorded, along with route of administration and animal species and/or production class treated. The usage data should be compared to resistance data, and the comparison should be made available in a timely manner. In the United States, surveillance of antimicrobial resistance in foodborne bacteria is performed by the National Antimicrobial Resistance Monitoring System (NARMS) for enteric bacteria, however, the United States still lacks a mechanism for collecting antimicrobial usage data. Combined with antimicrobial resistance information from NARMS, antimicrobial usage data will help to direct education efforts and policy decisions, minimizing the risk that people will develop antimicrobial resistant infections as a result of eating food of animal origin. Ultimately mitigation strategies guided by usage data will be more effective in maintaining antimicrobial drugs for appropriate veterinary use and in protecting human health.

Impact of antimicrobial resistance on regulatory policies in veterinary medicine: status report.

Increasing resistance to antimicrobial agents is of growing concern to public health officials worldwide. The concern includes infections acquired in hospitals, community infections acquired in outpatient care settings, and resistant foodborne disease associated with drug use in food-producing animals. In the United States, a significant source of antimicrobial-resistant foodborne infections in humans is the acquisition of resistant bacteria originating from animals. The US Food and Drug Administration's (FDA's) goal in resolving the public health impact arising from the use of antimicrobial drugs in food-producing animals is to ensure that significant human antimicrobial therapies are not compromised or lost while providing for the safe use of antimicrobials in food animals. The FDA's approach to the problem is multipronged and innovative. The strategy includes revision of the pre-approval safety assessment for new animal drug applications, use of risk assessment to determine the human health effect resulting from the use of antimicrobials in food animals, robust monitoring for changes in susceptibilities among foodborne pathogens to drugs that are important both in human and veterinary medicine, research, and risk management.

Antimicrobial susceptibilities of Escherichia coli strains from a turkey operation.

OBJECTIVE: To measure minimum inhibitory concentrations (MIC) of 17 antimicrobials for Escherichia coli isolates from a turkey operation and assess whether small samples provide precise estimates of geometric mean MIC. DESIGN: Prospective study. SAMPLE POPULATION: 105 clinical isolates from birds and 1,104 fecal isolates from 20 flocks (poults and finisher hens). PROCEDURE: A Mueller-Hinton broth dilution panel was used to measure MIC, and MIC of fecal and clinical isolates were compared. We drew random samples of 5,10, 15, 20, 25, 30, 35, 40, and 45 isolates from each finisher flock and between 100 and 105 isolates from 5, 7, 10, and 20 flocks. Antimicrobial usage was determined for enrolled flocks. RESULTS: Six of 12 poult and 18 of 20 finisher flocks had been treated with antimicrobials, often for respiratory illnesses consistent with colibacillosis. All birds received gentamicin at the hatchery. More fecal than clinical isolates were resistant to ampicillin; however, more clinical isolates were resistant to ciprofloxacin, gentamicin, and sulfamethoxazole. Precise estimates of geometric mean MIC for flocks were obtained when > or = 15 fecal isolates were obtained per flock and, for the operation, when 105 isolates were obtained from > or = 7 flocks. CONCLUSION AND CLINICAL RELEVANCE: Antimicrobial usage was common and may have contributed to the resistance patterns of isolates. With a modest allocation of laboratory resources, producers can monitor antimicrobial susceptibilities of clinical and fecal E coli to manage risks of antimicrobial usage and resistance.

Human health impact from antimicrobial use in food animals.

There is accumulating evidence that the use of antimicrobials in food-producing animals has adverse human health consequences. The use of antibiotics in food animals selects for resistant pathogens and resistance genes that may be transferred to humans through the consumption or handling of foods of animal origin. Recent studies have demonstrated that antimicrobial-resistance among foodborne bacteria may cause excess cases of illness, prolonged duration of illness, and increased rates of bacteremia, hospitalization, and death. The continued availability of safe and effective antimicrobials for humans and animals depends upon the responsible use of these products.

A linear model for managing the risk of antimicrobial resistance originating in food animals.

A linear population risk model used by the U.S. Food and Drug Administration (FDA) Center for Veterinary Medicine (CVM) estimates the risk of human cases of campylobacteriosis caused by fluoroquinolone-resistant Campylobacter. Among the cases of campylobacteriosis attributed to domestically produced chicken, the fluoroquinolone resistance is assumed to result from the use of fluoroquinolones in poultry in the United States. Properties of the linear population risk model are contrasted with those of a farm-to-fork model commonly used for microbial risk assessments. The utility of the linear population model for the purpose for which it was used by CVM is discussed.

Recalls of Foods and Cosmetics by the U.S. Food and Drug Administration.

Recalls of foods and cosmetics from the marketplace are an expeditious and effective method of removing violative products, particularly those that present a danger to health. Recalls are undertaken through a cooperative effort by industry and the U.S. Food and Drug Administration (FDA). Foods and cosmetics recalled from the period 1 October 1991 through 30 September 1992 were reviewed to determine the kinds of products recalled and the reasons for recall. A total of 230 recalls, involving 569 foods and cosmetics, occurred during the study period. Twenty-eight percent of the recalls were designated class I, defined as a situation in which there is a reasonable probability that the use of, or exposure to, a violative product will cause serious adverse health consequences. The problems for which foods or cosmetics were most often recalled were misbranding and microbial contamination (37% and 25% of recalls, respectively). A recognized illness or injury was reported to have occurred in association with 32 food products and one cosmetic. This study indicates that recalls of foods and cosmetics are common and that various groups, including industry, consumers, state regulatory agencies, and the FDA, recognize problems leading to recall.

Risk factors for fecal quinolone-resistant Escherichia coli in Mexican children.

We determined the prevalence of, and risk factors for, fecal quinolone-resistant Escherichia coli (QREC) in 324 children from Yucatan, Mexico. QREC was higher in children with recent Salmonella infection (100%) than in children with diarrhea (61%) or healthy children (54%) (P = 0.007). Multivariate analysis identified recent hospitalization of a family member (P = 0.011, odds ratio [OR] = 5.1) and carriage of Salmonella (P = 0.004, OR = 3.7) as independent risk factors for QREC.

Introduction; The history of public health and veterinary public service; Historic and future perspectives of the American College of Veterinary Preventive Medicine; Blue ribbon task force report on the future of Food Safety and Inspection Service veterinarians: public health professionals for the 21st century; The National Antimicrobial Resistance Monitoring System (NARMS) for enteric bacteria,1996- 1999: surveillance for action; Public health education of veterinarians and veterinary students for the future; Ten great veterinary public health/preventive medicine achievements in the United States, 1901 to 2000.

Historically, veterinary medicine has made its greatest contributions in the public sector and in settings other than direct care of the individual patient. So why are so many of us unaware of our profession's achievements in this arena? My introduction to veterinary preventive medicine and public health was through military service. My obligation to serve a two-year doctor draft in the United States Air Force became an adventure for my family and me, rather than an unwelcome intrusion on my ultimate desire to return to private clinical practice. The operative words are private and clinical. Why was I unaware of the opportunities available to those of us educated in this discipline sometimes referred to as comparative medicine?