Antibiotic Resistance 101: How Antibiotic Misuse on Factory Farms Can Make You Sick

8/9/2019 Antibiotic Resistance 101: How Antibiotic Misuse on Factory Farms Can Make You Sick

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How Antibiotic Misuse on Factory Farms Can Make You S


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Execuive Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Inroducion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

How Indusrial Agriculure Makes Anibioic Resisance Worse . . . . . . . . . . . . . . . 4

Beyond Survival of he Fites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

How Anibioic-Resisan Baceria Spread . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

From Mea o Consumers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Anibioic-Resisan Foodborne Illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

From Livesock o Farmers and he Environmen . . . . . . . . . . . . . . . . . . . . . . . . . 12

INFOGRAPHIC:How Anibioic Misuse on Facory Farms Can Make You Sick . . . . . . . . . . . . . . . 10

Tackling Anibioic Resisance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

The European Union’s Experience Ending Nonherapeuic Use o Anibioics . . . 13

How Anibioics Are Regulaed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

The Food and Drug Adminisraion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Volunary Guidance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Previous FDA Regulaion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Congress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Recommendaions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Endnoes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17


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2 Food & Water Watch • foodandwaterwatch.org

Anibioics are criical ools in human medicine. Medical

auhoriies are warning ha hese lie-saving drugs are

losing heir effeciveness, and here are ew replacemen

drugs in he pipeline.1 Baceria evolve in response o he

use o anibioics boh in humans and in animals. The

developmen o anibioic resisance is hasened by he useo low doses o anibioics a indusrial arms. For decades,

he drugs have been used rouinely no o rea sick

animals, bu or disease prevenion and growh promoion,

a pracice known as nonherapeuic use.2

Boh in he Unied Saes and worldwide, agriculure uses

vasly more anibioics han human medicine,3 and agricul-

ure uses drugs rom every major class o anibioics used

in human medicine.4 The Food and Drug Adminisraion

(FDA) repored in 2011 ha 80 percen o anibioics in he

Unied Saes are sold or agriculural purposes.5

Anibioic-resisan (AR) baceria can spread rom arm

animals o humans via ood, via animal-o-human ranser

on arms and in rural areas, and hrough conaminaed

wase enering he environmen. The mos commonly

affeced populaions are hose wih under-developed or

compromised immune sysems: pregnan women, children,

he elderly and people wih cerain healh condiions. Bu

increasingly, AR baceria have he poenial o affec anyone.

Anibioic resisance has become a global problem.6 People

ge sicker rom hese inecions, as i akes muliple rounds

o increasingly sronger anibioics o sop he inecion,

allowing he inecion o progress urher han i migh

oherwise. Fewer drug opions can make i harder or

docors o rea paiens wih allergies o some anibioics

and make i more likely or paiens o require sronger

drugs given inravenously.7

The Ceners or Disease Conrol and Prevenion (CDC)

esimaes ha a leas 2 million Americans each year

experience AR inecions, leading o a leas 23,000 deahs.

Approximaely 22 percen o hose inecions originae

rom oodborne pahogens.9 Muliple sudies have ound

AR baceria in reail mea and ish producs, including he

ederal governmen’s Naional Animicrobial Resisance

Monioring Sysem (NARMS),10 and AR baceria have

caused noable oodborne illness oubreaks.11

The livesock indusry sill minimizes is role in anibi-

oic resisance,12 bu he evidence is clear. Several DNA

analyses o AR baceria poin o livesock as he source.

The CDC, American Public Healh Associaion, American

Medical Associaion, American Academy o Pediarics,

Inecious Disease Sociey o America and World Healh

Organizaion all agree ha nonherapeuic uses o anibi-

oics in livesock pose a hrea o human healh.13


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Antibiotic Resistance 101 • How Antibiotic Misuse on Factory Farms Can Make You Sick 3

Despie he urgency o his growing public healh hrea,

neiher Congress nor he FDA has aken sufficien seps o

resric he nonherapeuic use o anibioics in livesock.

The FDA currenly insiss ha volunary guidance o

indusry will solve he problem, ciing lack o resources as

an impedimen o wihdrawing curren drug approvals or

nonherapeuic uses, despie having resriced cerain uses

o paricular anibioics.14

Food & Waer Wach recommends ha:

• Congress should pass he Preservaion o Anibio-

ics or Medical Treamen Ac (PAMTA)/Prevenion

o Anibioic Resisance Ac (PARA), which would

ban nonherapeuic uses o anibioics in livesock,

hereby avoiding he cumbersome drug-by-drug

process currenly required o he FDA o achieve he

same goal. Ciy councils across he counry have

passed resoluions urging Congress o pass PAMTA,

and more are joining heir ranks.

• Congress also should pass legislaion o grealy

improve available public daa on anibioic use in

livesock.

• The FDA should assess he impac o is volunary

sraegy and sar he regulaory process now o

wihdraw drug approvals or injudicious uses. The

FDA also should srongly enorce he exising bans

on cerain uses o anibioics.

• The FDA should address he Governmen Accoun-

abiliy Office (GAO)’s recommendaions o improve

daa collecion on he use o anibioics and hedevelopmen o anibioic resisance.15 NARMS

mus be broadened o allow he FDA o ideniy and

respond rapidly o emerging resisance.

• Governmen agencies should collaborae o increase

research on anibioic resisance, including he

mechanisms o resisance emergence, spread and

remediaion as well as alernaive means o preven-

ing illness in livesock.

• The U.S. Deparmen o Agriculure (USDA) should

provide raining and echnical assisance o livesockproducers ha are ransiioning away rom non-

herapeuic anibioic use. The USDA should address

conrac sipulaions ha require livesock producers

o use eed wih anibioics already added.


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Introduction

Anibioics are criical ools in human medicine. Medical

auhoriies are warning ha hese lie-saving drugs are

losing heir effeciveness, and here are ew replacemen

drugs in he pipeline.16 Over ime, baceria have developed

and coninue o develop resisance o anibioics. Far more

anibioics are given o livesock han o people,17 and he

livesock aking hem are usually no sick. This pracice,

designed o preven inecion and promoe aser growh,

acceleraes he developmen o anibioic-resisan (AR)

baceria, hreaening human healh.18

All species evolve in response o heir environmen,

including baceria. Baceria reproduce rapidly, encouraging

aser adapaion. Anibioics kill baceria, bu i a ew

baceria wihsand he reamen, hese baceria will no

only survive, bu reproduce and pass on he rais ha

allow hem o resis anibioics. This process is more

commonly known as “survival o he ites.” In he case o

baceria and anibioics, he “ites” are hose ha survive

exposure o anibioics. Thus, any use o anibioics o

some degree leads o resisance.19

Given his ineviable rend, i is imporan o mainain heeffeciveness o anibioics or as long as possible. Ani-

bioics are a resource ha should be used wisely. When

your docor prescribes anibioics, you are old o ake he

whole prescripion, even i you sar o eel beter beore

you are done. The poin is o ensure ull reamen and

no leave baceria behind ha develop resisance o ha

paricular drug, which would require even sronger anibi-

oics o igh.20

Similarly, public healh campaigns work o educae people

abou no using anibioics o rea problems caused by

viruses, like a cold or he lu. Because anibioics don’ killviruses, docors don’ wan anibioics o be used when

hey have no chance o working and will only increase he

hrea o resisance in baceria in he body ha happen o

be exposed.21 The livesock indusry, however, uses anibi-

oics much differenly han human medicine, in a way ha

conribues o he emergence o AR baceria.

How Industrial Agriculture Makes

Antibiotic Resistance Worse

Alhough livesock producers do use anibioics o reasick animals, he ar more common usage is or “nonhera-

peuic” purposes, including disease prevenion and

growh promoion.* In he 1950s, researchers discovered

ha a small, consan dose o anibioics helped animals

grow aser. Livesock producers began using eed wih

“Our findings underscore he poenialpublic healh risks of widespreadanibioic use in food animal producion.

Saph hrives in crowded and unsaniarycondiions. Add anibioics o haenvironmen and you’re going o creaea public healh problem.” 28

⋯ DR. LANCE PRICE, DIRECTOR OF

THE TRANSLATIONAL GENETICS RESEARCH

INSTITUTE’S CENTER FOR FOOD MICROBIOLOGY

AND ENVIRONMENTAL HEALTH


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anibioics mixed in, boh o promoe aser growh and

as an atemp o preven inecions in densely packed

and unsaniary concenraed animal eeding operaions

(CAFOs).23 These nonherapeuic doses are jus a racion

o he amouns ypically used o rea inecions.

Imagine aking a racion o a regular dose o anibioics

every day even when you are healhy. Does ha make

sense given he advice we hear rom docors o ake heull course o anibioics and o ake anibioics only when

needed o rea bacerial inecions? Could you imagine

including a low dose o anibioics in your ood, aken

wihou even consuling a docor? Tha’s essenially wha

happens in modern livesock producion. And i creaes

condiions ha promoe he developmen o AR baceria.

Treamen o sick animals requires jus a ew animals

o receive medicine or a shor ime and is less likely o

conribue o resisance. Nonherapeuic uses mean ha

an enire herd or lock o animals receives small doses

or an exended period. This pracice kills baceria haare suscepible o he drug, leaving he AR baceria o

survive and reproduce. The use o even one anibioic in

his manner can selec or resisance o muliple classes o

anibioics, because he geneic rai ha allows baceria o

survive exposure o one anibioic is ofen linked o rais

ha allow i o survive ohers.24

Boh in he Unied Saes and worldwide, agriculure uses

vasly more anibioics han human medicine, and agricul-

ure also uses drugs rom every major class o anibioics

used in human medicine.25

Esimaes differ on preciselyhow many anibioics are used in agriculure in general,

and or nonherapeuic purposes in paricular. There is no

cenralized sysem or collecing such daa, as he pharma-

ceuical indusry is no eager o share business inormaion

ha i wans o keep conidenial,26 and even some live-

sock producers may no know jus how much anibioics

is in he pre-mixed eed ha heir conracs wih mea

companies require hem o use.27

The bes esimaes o anibioic use come rom he Foodand Drug Adminisraion (FDA). The FDA repored in 2011

ha 80 percen o anibioics in he Unied Saes are sold

or agriculural purposes.28 The FDA also repors ha 70

percen o anibioics used in livesock are sold or use in

eed, 24 percen or use in waer and only 4 percen or

use as injecion.29 Scieniic evidence makes clear ha

puting medicine in eed makes dosing imprecise and no

as effecive or disease reamen.30 In oher words, he

anibioics used in eed and waer are mos likely used or

nonherapeuic purposes.

The mechanisms o AR and is spread are complicaed.Many drugs used or nonherapeuic purposes are also

used or disease reamen, boh in veerinary and human

medicine, and many AR genes are already widespread.31

Evidence ying nonherapeuic anibioic use in livesock

and AR comes in differen orms. A sudy comparing

srains o Saphyloccocus in poulry rom he 1970s and

2006 ound much higher levels o resisance o eigh

anibioics in he more recen srains.32 In he Unied

Saes, Spain and he Neherlands, researchers ound

eigh- o sixeen-old increases in AR Campylobacer wihin

jus hree years o he inroducion o he anibioic class

luoroquinolone in poulry.33

Alhough evidence ying nonherapeuic anibioic use in

livesock and AR has been largely circumsanial, a 2011

experimen offered direc evidence. This highly conrolled

rial ook pigles rom he same liter and raised hem in

wo groups under he same condiions, excep ha one

group was given low doses o anibioics in he eed. 34 Afe

only wo weeks, he reaed pigles developed signiicanly

higher levels o AR Escherichia coli . The AR E. coli in

he reaed pigles carried a higher variey o AR genes,including some ha conerred resisance o drugs no used

in he sudy.35

Beyond Survival of the Fittest

Nonherapeuic anibioic use selecs or AR baceria,

bu he sory doesn’ end here. AR baceria reproduce,

becoming more numerous, bu hey also share genes wih

oher baceria in he environmen and in people.


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Mos AR genes in baceria are locaed on mobile pieces

o DNA known as plasmids. Baceria can share plasmids,

even across species. So, no only do AR baceria become

more common in response o selecive pressure by repro-

ducing more copies o hemselves, bu hey also can share

he resisance genes wih neighboring baceria.36 These

DNA swaps, known as “horizonal gene ranser,” allow

boh aser spread o AR genes and easier acquisiion o

resisance o muliple drugs by muliple ypes o baceria.37

The gene sharing can occur among he baceria in animal

digesive racs and hen coninue as baceria rom he

animal spread via wase ino he environmen.38 The

resisance gene, in a way, akes on a lie o is own, no

longer ied o a speciic species o baceria bu persising

in he larger microbial environmen. The collecive effec

is known as “reservoirs o resisance,” in which resisance

genes are widespread in he environmen and can be

acquired by baceria hrough horizonal gene ranser.39

Once AR genes have developed and spread, hey areexceedingly hard o conrol. Researchers have gone so ar

as o call some baceria “highly promiscuous” because o

how easily hey spread AR rais.40 Eliminaing nonhera-

peuic uses o anibioics removes he selecive pressure

ha allows AR baceria o hrive in livesock operaions,

bu may no sop he spread o already exisen AR

baceria.41

Le’s be clear: nonherapeuic anibioics selec or resis-

ance genes in baceria ha would no become so preva-

len oherwise, and hese AR baceria make heir way inohe human populaion. I is no jus ha AR baceria make

people sick, alhough hey do, bu ha hrough horizonal

gene ranser, he resisance genes perpeuae hemselves

in good baceria in humans as well. These good baceria

orm reservoirs o resisance genes ha are available o

bacerial pahogens.

Even occasional ransmission o humans can have a signii-

can negaive impac because o how resisance genes

spread.42 I is basically impossible o race AR baceria

direcly rom a livesock operaion o a sick person, 43 bu

scieniic undersanding o bacerial evoluion demon-

sraes ha pracices driving resisance in livesock havear-reaching effecs by increasing he overall reservoir o

resisance. Recen evidence suggess ha anibioic use in

agriculure may affec resisance paterns in baceria ha

live naurally in he human digesive rac.44

Sudies o AR bacerial DNA over ime indicae ha

livesock reaed wih nonherapeuic doses o anibioics

are he likely origin or some AR baceria in humans. E.

coli ha is resisan o ciproloxacin, a drug rom he class

luoroquinolones once used nonherapeuically in poulry,

is very similar in humans and chickens and is more

commonly ound in chicken han in oher meas in whichhe drug is no used. This evidence poins o poulry as he

source o he AR baceria, no medical use o he drugs in

humans.45 Tesing o E. coli rom urinary rac inecions in

people across muliple saes reveals i o be very similar

o AR E. coli in livesock, suggesing ha he source was

common in ood.46

Geneic analysis o mehicillin-resisan Saphylococcus

aureus (MRSA) indicaes ha he srain ha is associaed

wih livesock originaed in humans, ranserred o pigs

where i acquired resisance o eracycline and mehicillin,and hen jumped back o humans.47 This research required

he paricipaion o 20 insiues sudying 89 genomes rom

humans and animals over 19 counries, a complicaed and

painsaking effor.48

How Do I Find Meat Raised Without Antibiotics?

1. Buy organic. Organic livestock in the United States must be raised without antibiotics.52

2. Look for a label stating that the meat has been raised without antibiotics. The USDA allows companies to use

this label if the companies provide documentation of their practices.53

does not necessarily mean that antibiotics were not used.54

3. Buy directly from the farmer, which allows you to ask the farmer directly about his or her practices.

Buying meat raised without antibiotics is no guarantee that the meat will be free of AR bacteria, and consumers

produced without antibiotics helps prevent the further emergence of AR bacteria by supporting producers who do not

use nontherapeutic antibiotics.


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Oherwise-healhy people can carry AR baceria or years

wihou realizing i, and hose same AR baceria can pose

grave danger as an inecion.49 Wheher i is hrough a

persisen oodborne illness, urinary rac inecion or

inecion in a hospial, AR baceria make hemselves

known in paiens whose illnesses jus do no clear up,leading o round afer round o escalaing reamens.

Anibioic resisance has become such a serious problem

ha here are ew or no reamen opions in some cases,50

and pharmaceuical companies are no producing new

reamens as enough o keep up wih he need. 51 In he

ace o such a complex problem, much more effor mus be

direced a rying o slow he developmen o resisance a

is source.

How Antibiotic-Resistant

Bacteria SpreadReservoirs o AR baceria persis in livesock and in he

environmen around arms. Illness-causing baceria are

relaively common in mea. Consumers encouner hese

baceria while handling raw mea and eaing i under-

cooked. Tha’s why he U.S. Deparmen o Agriculure

(USDA) reminds consumers o cook mea o cerain

emperaures and educaes abou cross-conaminaion.55

Tess o reail mea samples have ound anibioic resis-

ance among he baceria responsible or oodborne

illnesses. DNA ess o AR baceria rom sick people and

livesock reveal he likelihood o an agriculural source. AR

baceria can spread rom livesock no jus o humans bu

o rodens and lies as well. The baceria eser in waselagoons, and ha wase is hen ofen used as erilizer,

poenially conaminaing soil, waerways and crops.

From Meat to Consumers

Muliple sudies have ound AR baceria in reail mea and

ish producs.56 In oher words, when you buy mea a he

grocery sore, here’s a decen chance ha i has AR baceria

on i. Wheher he baceria are AR or no, handling raw

mea and undercooking can lead o oodborne illness.57 The

FDA saed in 2012, “In regard o animicrobial drug use in

animals, he Agency considers he mos signiican risk ohe public healh associaed wih animicrobial resisance o

be human exposure o ood conaining animicrobial-resis-

an baceria resuling rom he exposure o ood-producing

animals o animicrobials.”58

In 1996, he FDA, Ceners or Disease Conrol and Preven-

ion (CDC) and USDA parnered o creae he Naional

Animicrobial Resisance Monioring Sysem (NARMS).59

70%

60%

50%

40%

30%

20%

10%

Figure 1. AR Salmonella in NARMSRetail Meat Samples

SOURCE FIG. 1 and 2:

Ground Turkey Chicken Breasts

70%

60%

50%

40%

30%

20%

10%

Figure 2. AR E. Coli in NARMSRetail Meat Samples

GroundTurkey

ChickenBreasts

PorkChops

GroundBeef


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Among oher uncions, NARMS collecs samples o

baceria rom chicken breass, ground urkey, ground bee

and pork chops and measures he presence o he drug-

suscepible and AR oodborne pahogens Campylobacer ,

Salmonella , Enerococcus and E. coli .60 Because o he

variey o anibioic classes and species o baceria, i can

be hard o gaher an overall picure o he AR problem

rom he sampling daa.

Food & Waer Wach has analyzed he 2011 NARMS

daa o esimae how widespread AR baceria were in he

reail mea samples colleced. AR Salmonella was presen

in 9 percen o chicken breas samples and 10 percen o

ground urkey samples. The presence o AR E. coli in he

samples colleced varied widely: 66 percen in ground

urkey, 53 percen in chicken breass, 15 percen in pork

chops and 9 percen in ground bee.61

The vas majoriy o Enerococcus ound in each ype o

mea conained a leas one AR rai. Enerococcus was

also highly prevalen in all ypes o mea esed, leadingo a high overall risk o encounering AR Enerococcus .62

The prevalence o AR rais among Salmonella samples

ranged rom 44 percen in ground bee o approximaely

75 percen in ground urkey, chicken breass and pork chops.

The presence o AR rais in E. coli samples varied widely:

87 percen in ground urkey, 75 percen in chicken breass,

48 percen in pork chops and 21 percen in ground bee.63

Among he repor’s oher key indings, nearly hal o he

Salmonella samples rom chicken breass and hal o hose

rom ground urkey were resisan o hree or more classeso anibioics. Salmonella resisance o hird-generaion

cephalosporins has shown a decade-long increase in reail

poulry. Beween 2002 and 2011, his ype o resisance

more han ripled rom 10 percen o 33.5 percen in

samples rom chicken breass and nearly ripled rom

8.1 percen o 22.4 percen in ground urkey.64 This increase

led he FDA o ban cerain nonherapeuic uses o cepha-

losporins. Among he Enerococcus samples, here was no

resisance o vancomycin and linezolid, wo drugs used

in human medicine bu no agriculure,65 bu he vas

majoriy o Enerococcus samples were resisan o oheranimicrobial drugs.66

The NARMS surveillance sysem does no include any

orms o Saphylococcus , alhough his bacerium has been

ound in he ood supply. MRSA was once considered

endemic only o hospials, bu one srain o MRSA, ST398,

has been ound in ood producion animals, in people who

work wih hose animals and in reail mea.67 A sudy o

reail meas in ive U.S. ciies ound S. aureus in jus under

hal o he samples. Nearly all he S. aureus ound was

resisan o one anibioic, and hal o he S. aureus ound

was muli-drug resisan.68 The researchers recommended

ha “mulidrug-resisan S. aureus should be added o he

lis o animicrobial-resisan pahogens ha rouinely

conaminae our ood supply.”69

Several sudies have linked AR baceria in reail meas olivesock sources. In a sudy o AR E. coli rom differen

ypes o mea across a wide geographic range, he anibioic-

suscepible and AR E. coli rom each ype o mea resembled

oher samples rom he same species and varied grealy

wih samples rom oher species.70 This inding indicaes

ha livesock are he likely source o he baceria, wih he

AR baceria developing rom drug-suscepible E. coli under

selecion pressure wihin each species o livesock.71

A sudy o ground meas in hree grocery sores rom hree

differen chains in he Washingon, D.C., area ound ha

20 percen o he samples conained Salmonella .84 percen o he baceria were resisan o one anibioic,

and jus over hal were resisan o hree or more anibi-

oics.72 The indings included a paricularly virulen srain

ha has been he culpri o previous oubreaks o ood-

borne illness.73 The commonaliy o AR baceria in all he

ypes o ground meas indicaes he presence o a reservoir

ha can affec people.74

No all livesock are raised using nonherapeuic anibi-

oics. U.S. organic sandards require ha livesock no be

reaed wih anibioics,75 and some companies markemea “raised wihou anibioics.”76 Because AR baceria

are so widespread in he environmen, i is possible or

livesock raised wihou anibioics o carry AR baceria.

Sudies have ound ha Enerococcus faecium and Campy-

lobacer were less likely o be anibioic resisan in organic

chicken and chicken raised wihou anibioics compared

o convenional chicken.77

A sudy of reail meas in five U.S. ciies found S. aureus in jus under half of hesamples. Nearly all he S. aureus foundwas resisan o one anibioic; half of heS. aureus found was muli-drug resisan.


11/23


Sudies o MRSA have ound mixed resuls, wih some

sudies inding a difference beween MRSA levels in conven-

ional mea and mea “raised wihou anibioics,” and one

sudy inding no difference. Tha sudy, however, cied he

possibiliy ha processing equipmen or workers carryingMRSA conaminaed he mea “raised wihou anibioics.”78

I is clear, however, ha raising livesock wihou anibioics

does no add o he reservoir o resisance.

Antibiotic-Resistant Foodborne Illness

The CDC esimaes ha a leas 2 million Americans each

year experience AR inecions, leading o a leas 23,000

deahs.79 Approximaely 22 percen o hose AR inec-

ions originae rom oodborne pahogens.80 Since 2011,

he Unied Saes has experienced hree major oodborne

illness oubreaks rom AR baceria.

• Foster Farms Chicken: A major oubreak o AR

Salmonella Heidelberg rom a company called Foser

Farms sickened 574 people over he course o over

a year, mainly in Caliornia.81 The USDA issued a

public healh aler abou producs rom hree Foser

Farms plans in Ocober 2013 afer 278 people in 18

saes had allen ill wih Salmonella Heidelberg. Ye

he plans remained open, and no recall was issued.82

Foser Farms inally issued a recall o 170 differen

producs in July 2014,

83

despie he iniial oubreakhaving occurred several monhs beore. Deailed

violaion repors rom he wo plans conneced o

he oubreak reveal ha he plans were receiving a

violaion every oher day beween Ocober 2013 and

March 2014. One plan was closed briely in January

or “egregious insaniary condiions,” including he

presence o cockroaches.84

• Cargill Ground Turkey: In he ace o an illness

oubreak caused by AR Salmonella , Cargill volun-

arily recalled 36 million pounds o ground urkey in

Augus 2011, and an addiional 185,000 pounds he

nex monh.85

This recall, he hird larges mea recallin he USDA’s records, represened several monhs’

worh o producion rom one plan in Arkansas. I

ook several monhs or he cluser o illnesses o be

raced back o he plan.86 In oal, 136 people across

34 saes were ineced, yielding 37 hospializaions

and one deah.87 A disproporionae number o people

ineced were hospialized due o he baceria’s ani-

bioic resisance.88

• Hannaford Ground Beef: Anoher illness oubreak

involved an AR Salmonella srain, his ime ied o

ground bee rom he Hannaord grocery sore chain

in New England. This oubreak was smaller, wih

20 inecions and 8 hospializaions repored.89 The

srain causing he oubreak was resisan o muliple

classes o drugs, including cephalosporins, he drugs

o choice o rea Salmonella inecions in children.90

The naure o our concenraed ood sysem is such ha

mea is aggregaed rom many sources hrough a igh

processing sream beore disribuion o reailers and

consumers across he counry, offering more poins or

poenial cross-conaminaion.91 In he Hannaord oubreak,limied records kep by he reailer prevened he USDA rom

racing he conaminaion back o he supplier, alhough

Hannaord officials claim ha hey ollowed indusry san-

dards.92 Clearly, srong ood saey pracices are paricularly

imporan o preven AR baceria oubreaks, which cause

more serious illnesses. Bu i is also criical o preven he

emergence and spread o AR baceria among livesock o

minimize AR baceria’s enry ino he ood supply.


12/23

Antibiotic Resistance 101 • How Antibiotic Misuse on Factory Farms Can Make You SickFood & Water Watch • foodandwaterwatch.org

6

AR bacterial infections have becomeincreasingly common. Doctors are

concerned that some antibiotics nolonger work to treat sick people.

AR bacteria in livestock can spread tofarmers, farmworkers, meat plant workers

and the general population.

4

5Consumers encounter AR bacteriawhile handling raw meat and eatingundercooked meat.

3

Waste is stored in lagoons and used as fertilizer.AR bacteria in the waste contin ue to reproduceand share genes with other bacteria in soil,streams, ponds and groundwater, creating“reservoirs of resistance.”

Factory farms use feed that’s pre-mixedwith antibiotics to promote faster animalgrowth and prevent infections.

1

The digestivetract containsmany bacteria.

Low doses ofantibiotics killsome bacteria.

AR bacteriasurvive andreproduce,

passing alongthe resistance

genes.

AR bacteria alsoshare resistancegenes with otherbacteria through“horizontal gene

transfer.”

antibiotics

susceptible bacteria

dead susceptible bacteria

resistant bacteria

Giving low doses of antibiotics togroups of animals over extended time

periods fuels the development ofantibiotic-resistant (AR) bacteria.

2

HOW ANTIBIOTIC MISUSE ON FACTORY FARMS CAN MAKE YOU SICK


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From Livestock to Farmers

and the Environment

AR baceria in livesock do no jus remain here, bu

spread o armers, armworkers and rural residens.93 As

early as 1976, researchers ound ha AR baceria spread

rapidly in he inesines o chickens raised using nonhera-

peuic anibioics. Farmers on he same poulry operaions

developed higher levels o AR baceria in heir inesinal

racs as well, compared o heir neighbors.94 Muliple

sudies have ideniied he similar srains o AR baceria in

armers and heir livesock.95 This rend has coninued as

new srains o AR baceria hreaen he human populaion.

Srains o MRSA, or insance, have now been ound no

only in pigs bu also in he people ha raise hem. 96 One

srain o MRSA has been ound in boh pigs and he

people ha raise hem, bu no in neighbors who do no

raise pigs.97 Researchers have ound srong evidence ha

his srain o MRSA originaed in humans, migraed o

pigs where i acquired anibioic resisance, and now isinecing humans again.98 Two sudies have ound arm-

workers and pigs carrying he same srains o MRSA on

convenional livesock arms, bu no on arms ha do no

use anibioics in raising livesock.99

A sudy o poulry workers ound he presence o a srain

o E. coli resisan o genamicin, an anibioic commonly

used in chickens, o be 32 imes higher in he workers

compared o oher members o he communiy. Hal o

he poulry workers carried he AR srain, compared o

3 percen o he neighboring populaion.100 Researchers

have even ound an increased likelihood o rural residens

experiencing MRSA skin inecions i hey live near ields

reaed wih swine manure.101

In large livesock operaions, manure is colleced in

lagoons.102 The ecal baceria also collec in hese lagoonsand hen spread ino he environmen when he wase is

applied o land as erilizer. Fecal baceria can survive or

weeks or even monhs ouside he animal.103 Wih ha

amoun o ime o live and reproduce, i is no surprising

ha AR baceria spread ino he environmen. Mos o

he anibioics ed o livesock are also excreed in wase,

adding an addiional low-level exposure o baceria in he

lagoon and in he environmen, perpeuaing he urher

developmen o AR baceria.104 Several sudies have ound

DNA maches beween AR baceria in he soil and waer

and in manure lagoons.105

Manure sorage isel does no consiue a orm o rea-

men, and reamen is necessary o reduce baceria.

Unlike chemical polluans, baceria reproduce. Thus, rea-

men ha only parially eliminaes bacerial conaminaion

can be rendered ineffecive when he baceria simply grow

back. Neiher lagoon sorage nor anaerobic digesion,

a process used o conver livesock wase ino energy,

signiicanly decreases he presence o AR genes.106 Poulry

liter has also been ound o harbor muliple-drug-resisan

E. coli and anibioic residues.

107

Mos livesock wase sored in lagoons is applied o nearby

ields as erilizer, inroducing AR baceria ino he local

environmen.108 The AR baceria no only spread, bu share

genes wih naurally occurring baceria in local ields,

sreams, ponds and even groundwaer. These baceria are

adaped o heir environmen, jus as he ecal baceria are

adaped o living in he digesive racs o livesock, and

may carry on reproducing wih hese new rais.109 Thus,

AR baceria rom livesock conribue o a reservoir o

anibioic resisance in rural environmens.

Oher opporuniies or AR baceria o spread include

wind, he ranspor o livesock, and even lies and oher

animals. Researchers have ound higher concenraions o

AR baceria downwind o hog aciliies a ew weeks afer

hogs received a dose o nonherapeuic anibioics.110 Even

vehicles carrying livesock leave baceria — AR and oher-

wise — in he air behind hem.111 Flies atraced o livesock

wase also pick up and may disperse AR baceria.112


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Tackling Antibiotic Resistance

Alternatives to Nontherapeutic

Uses of Antibiotics

By ar he bes way o preven he spread o AR baceria

is o preven heir developmen in he irs place. I is

also more effecive o ake acion when AR baceria irs

emerge, raher han wai unil he rai becomes wide-spread and hreaens animal or human healh.113 Once AR

rais spread via horizonal gene ranser hroughou he

ecosysem, he AR rai may be virually impossible o

eradicae and may persis or many years.114 Eliminaing

nonherapeuic uses o anibioics, however, can make a

difference in reducing he prevalence o AR baceria.115

Animals can be raised successully wihou nonherapeuic

anibioic use. The European Union (EU) has banned

nonherapeuic use o anibioics or growh promoion.116

Some anibioics no longer work as growh promoers or

yield a resul so sligh ha he addiional proi does no even

cover he cos o he anibioics, yielding a ne loss.117 U.S.

organic sandards require ha livesock no be adminisered

anibioics.118 Companies such as Chipole, Niman Ranch and

Applegae Farms have made mea raised wihou anibioics

much more visible in grocery sores and resaurans.119

Raising livesock wihou nonherapeuic anibioic use

requires changes in herd managemen, including lowering

animal densiy and changing nuriional programs.120

Animals crowded ino CAFOs may ace increased sressand poor hygiene, which aciliaes he spread o paho-

gens and slows animal growh. In oher words, minimizing

livesock sress and maximizing hygiene can provide

growh-promoion and inecion-prevenion beneis

wihou he nonherapeuic use o anibioics. Oher aler-

naives o nonherapeuic anibioic use include vaccines

and probioics, he use o less-harmul baceria o compee

wih AR baceria in he digesive rac.121

The European Union’s Experience

Ending Nontherapeutic

Use of Antibiotics

The EU has aken a differen pah han he Unied Saes

on anibioics used or growh promoion in livesock. In

1986, Sweden became he irs EU counry o ban he use

o anibioics as growh promoers. Sweden’s livesockproducers aced increases in livesock disease immediaely

afer he ban, bu he governmen also devoed money o

research and exension services or armers, and is daa

showed no decrease in producion due o he ban.122

The EU banned he use o medically imporan anibioics

or growh promoion and esablished an EU-wide AR

monioring sysem in 1999, ollowed by a phase-ou o all

anibioics used or growh promoion by 2006.123 Following

hese decisions, prevalence o AR baceria has declined in

livesock, mea and people in he EU.

124

Even as ew as woyears o changed pracices can resul in improvemens in

he level o resisance in baceria in livesock and mea.125

Denmark, he nex counry o implemen such a ban

on growh-promoion uses, reduced anibioic use while

increasing hog producion. Hog arms experienced a brie

spike in herapeuic anibioic use in swine afer he ban.126

Ye, beween 1992 and 2008, pig armers in Denmark

increased producion by nearly 40 percen, while heir use

By far he bes way o preven hespread of AR baceria is o preven heir

developmen in he firs place. I is alsomore effecive o ake acion when ARbaceria firs emerge, raher han waiunil he rai becomes widespread andhreaens animal or human healh.


15/23


o anibioics per pig dropped by 50 percen.127 One produc-

ion change is ha armers now leave pigles wih heir

mohers longer, as newborn pigles are very suscepible o

inecion. Exensive governmen racking boh o anibi-

oic use in animals and humans and o resisance in AR

baceria has been key o Denmark’s success.128

The Neherlands offers anoher example in which govern-

men racking o anibioic use aciliaed signiicandecreases in use. Besides banning nonherapeuic uses,

he Duch governmen racks all anibioic use on arms by

veerinarians and even enorces ines or overuse.129 In he

Neherlands, sales o anibioics or veerinary purposes

have decreased by 58 percen since 2009, surpassing he

governmen goal o a 50 percen reducion, and anibioic

resisance rends in animals have improved.130 Noe ha,

in he same ime period, sales o anibioics or agriculure

increased by 16 percen in he Unied Saes,131 a very poor

record o anibioic sewardship.

In he case o he drug vancomycin, he Unied Saesand he EU ook differen approaches ha affec raes

o anibioic resisance in human illnesses. EU docors

ound increasing raes o vancomycin-resisan inecions

in hospial paiens during he 1990s. Researchers ound

he same resisance paterns in AR baceria in mea and

manure.132 The EU responded by resricing vancomycin

use in agriculure, and raes o vancomycin-resisance in

people ell. The Unied Saes never approved vancomycin

or nonherapeuic uses in livesock, and, while resisance

o he drugs does exis in Enerococcus inecions in U.S.

hospials, he problem has never been as grea as he poin

reached in he EU.133

The EU’s experience managing anibioic use in livesock

and poulry demonsraes he imporance o seting srong

policies and collecing sufficien daa o rack progress in

boh anibioic use and he prevalence o resisance. The

policies o he Unied Saes leave much o be desired.

How Antibiotics Are Regulated

The Food and Drug Administration

Federal governmen recogniion o anibioic resisance goes

back decades, bu acion o address he problem has been

inermiten and slow. As ar back as 1970, an FDA Task

Force recommended limiing he use o medically impor-

an anibioics in animal eed.134 In 2004, he Governmen

Accounabiliy Office (GAO), he invesigaive oversigh

agency ha works or Congress, criicized he FDA or

collecing insufficien deails abou anibioic use in live-

sock, such ha he FDA doesn’ even have enough inorma-

ion o measure he effeciveness o policy changes.135

The FDA insiss ha indusry volunary effors will solve

he problem, ciing he agency’s lack o resources as an

impedimen o creaing new regulaions.136 Ye he FDA has

successully regulaed speciic uses o cerain classes o

anibioics in he pas, despie indusry pressure.

Voluntary Guidance

The FDA’s Cener or Veerinary Medicine (CVM)

publishes non-binding Guidance o Indusry in place o

regulaion on opics o ineres.137 In Guidance o Indusry

209, released in 2012, he FDA recommended “limiing

medically imporan animicrobial drugs o uses in

ood-producing animals ha are considered necessary or

assuring animal healh,” a raher broad deiniion ha did

litle o change anibioic use.138

The cenerpiece o he FDA’s curren anibioic policy,

Guidance or Indusry 213 (Guidance 213), relies on phar-maceuical companies changing drug labels o remove

growh-promoion uses or medically imporan anibioics

and o require ha medically imporan anibioics used

in eed and waer be used only under he oversigh o a

veerinarian.139

Mos anibioics in eed were approved originally or

muliple purposes, including over-he-couner sales or

growh promoion.140 Using medically imporan anibioics

or growh promoion is perhaps he mos injudicious use

o anibioics in livesock, as is using anibioics wihouveerinary oversigh.


16/23


Thus ar, all o he pharmaceuical companies ha make

drugs ha all under Guidance 213’s parameers have agreed

o he changes.141 However, he FDA’s iniial draf regulaion

o “veerinary oversigh” lef open poenial loopholes.142

The FDA has declared ha i will re-evaluae he siuaion

in 2016, hree years afer inalizing Guidance 213, and hen

deermine wheher o ake urher regulaory acion.143

Even wih ull compliance, Guidance 213 leaves open acrucial loophole. The FDA sill approves o he use o

anibioics or disease-prevenion purposes, even hough

hose pracices mirror how anibioics are used or growh

promoion.144

Food & Waer Wach analyzed he FDA’s lis o drug

producs affeced by Guidance 213 o deermine he

exen o overlapping uses. Each drug has a lis o “label

indicaions,” or reasons he drug can be used in cerain

condiions. The FDA’s lis includes 217 medically impor-

an anibioics wih growh-promoion indicaions. O

hose drugs, 63 percen also have disease-prevenionindicaions, meaning ha he drugs can coninue o be

used nonherapeuically, which will coninue o promoe

he developmen o anibioic resisance.

O he remaining drugs used or growh promoion, 59 can

sill be used or “disease conrol” in healhy animals. Tha

leaves only 23 drugs — 11 percen — wih no approved

nonherapeuic uses under ull implemenaion o Guid-

ance 213. To pu i anoher way, 89 percen o he drugs

ha are losing growh-promoion uses sill can be given o

healhy animals or oher reasons, leading o he spread oanibioic resisance.145

I seems unlikely ha Guidance 213 will be effecive in

signiicanly reducing anibioic resisance levels due o

agriculural uses. Two o he larges manuacurers o

veerinary pharmaceuicals have prediced ha he FDA’s

decision will have a minimal impac on sales.146 Advocacy

groups have already complained o he FDA ha he

pharmaceuical companies Novaris and Elanco coninue

o adverise anibioic eed addiives as being useul in

making livesock gain weigh aser, alhough he drugs are

no longer supposed o be used or growh promoion.147

The FDA has claimed ha any acion i akes requiresindusry cooperaion and ha changing regulaions is

cumbersome and expensive. Ye, or wo speciic classes o

anibioics, luoroquinolones and cephalosporins, he FDA

has managed o ake acion, calling ino quesion he claim

ha regulaion is no easible.

Previous FDA Regulation

In he mid-1990s, he FDA approved a class o anibioics

called luoroquinolones or nonherapeuic uses in poulry.

Prior o he approval, NARMS ound no resisance o hese

drugs in Campylobacer , a common ype o baceria inpoulry. By 1999, however, nearly 20 percen o Campy-

lobacer were resisan o hese drugs. In he ace o such

rapid developmen o resisance, he FDA proposed wih-

drawal o he approval o all uses o luoroquinolones in

chicken in 2000. The pharmaceuical indusry responded

wih legal acion, delaying he FDA’s inal wihdrawal deci-

sion unil 2005 while resisance coninued o increase.153

Meanwhile, a 2012 sudy ound luoroquinolones in eaher

meal, a byproduc o chicken processing made rom

eahers, suggesing ha producers and eed companies

may no all be ollowing he ban.154

In 2012, he FDA made a similar decision in inalizing a

ban on cerain speciic nonherapeuic uses o cephalospo-

rins.155 Cephalosporins play an imporan role in reaing

oodborne illnesses in humans, especially children, as well

Tetracyclines and PenicillinsIn 2014, the FDA backed away from an innovative proposal dating back to 1977 that would have withdrawn approvals for

nontherapeutic uses of penicillins and tetracyclines, two classes of medically important antibiotics.148 For 34 years, the

FDA kept the proposal open. All the while, these drugs, which are commonly used to treat human infections, were addedto livestock feed and water, often without prescriptions.149 After failing to respond to two citizen petitions in 1999 and

150

In the spring of 2012, federal district court Judge Theodore Katz issued two rulings indicating that the FDA’s voluntary

revisit the withdrawal process begun in 1977 for penicillins and tetracyclines, but also to undergo a broader re-evalua-

tion of nontherapeutic uses of antibiotics.151 Unfortunately, rather than follow the rulings, the FDA appealed and won. In

his dissent to the appeals court’s decision, Judge Robert Katzman argued, “ Today’s decision allowed the FDA to openly

152


17/23


as in reaing pneumonia and skin and sof issue inec-

ions.156 The FDA had issued a similar order in 2008, bu

revoked i afer receiving a negaive reacion, including

hreas o legal acion, rom he livesock and pharmaceu-

ical indusries.157 The 2012 ban covers a narrower range o

uses, leaving excepions or older cephalosporins and hose

used wih veerinary prescripions.158

In is decision, he FDA repored increased anibioicresisance o cefiour, one common cephalosporin.

Governmen monioring in 2009 ound cefiour-resisan

Salmonella in 14.5 percen o samples rom catle,

4.2 percen rom swine, 12.7 percen rom chickens and

12.4 percen rom urkeys, whereas i had been minimally

presen in poulry in 1997.159 Oher researchers have noed

ha broad-specrum use o cephalosporin in livesock

promoes he developmen o MRSA.160

Congress

Congress, oo, could ac o reduce nonherapeuic uses

o anibioics in livesock. Since 2003, several members

o Congress have inroduced legislaion o limi he use

o medically imporan anibioics in healhy livesock:

he Preservaion o Anibioics or Medical Treamen Ac

(PAMTA). As a microbiologis, sponsor Represenaive

Louise Slaugher (D-NY) has relevan experise on his

issue. She has saed: “I an animal is sick, hen by all

means we should make hem well, bu he rouine use o

anibioics on healhy animals in order o promoe growh

is dangerous. I would be like a moher giving heir son or

daugher anibioics every morning in heir Cheerios. We’re

wasing our precious anibioics.”163

As o he end o 2014, PAMTA, now also known as he

Prevenion o Anibioic Resisance Ac (PARA) in he

Senae, had no received a commitee hearing or voe. More

han 300 organizaions have expressed suppor or he bill.164

Over 30 organizaions have lobbied on PAMTA over heyears, wih organizaions represening he mea, livesock

and pharmaceuical indusries all voicing opposiion.165

Recommendations

The developmen and spread o AR baceria are compli-

caed processes, and effors o reverse hese processes are

equally difficul. Bu one hing is abundanly clear: he

bes way o address he issue o anibioic resisance is o

preven he developmen o AR baceria in he irs place,

which means ending he nonherapeuic use o anibioics

in livesock.

The FDA coninues o pursue volunary iniiaives wih an

indusry ha has resised atemps o regulae nonhera-

peuic anibioic use or decades. Relying on indusry

effors is simply no enough o address his problem.

Food & Waer Wach recommends ha:

• Congress should pass he Preservaion o Anibioics

or Medical Treamen Ac (PAMTA)/Prevenion o

Anibioic Resisance Ac (PARA), which would ban

nonherapeuic uses o anibioics in livesock, here-by avoiding he cumbersome drug-by-drug process

currenly required o he FDA o achieve he same

goal. Ciy councils across he counry have passed

resoluions urging Congress o pass PAMTA, and

more are joining heir ranks.

• Congress also should pass legislaion o grealy

improve available public daa on anibioic use in

livesock.

Who Supports PAMTA?More than 300 agricultural, consumer, health

and environmental organizations, including:

American Academy of Pediatrics

American Medical Association

American Nurses Association

American Public Health Association

Infectious Disease Society of America

Keep Antibiotics Working Coalition

National Catholic Rural Life Conference

National Organic Coalition

National Sustainable Agriculture Coalition

Union of Concerned Scientists161

Who Opposes PAMTA?

American Farm Bureau Federation

American Feed Industry Association

American Meat Institute

American Veterinary Medical Association

National Cattlemen’s Beef Association

National Chicken Council

National Milk Producers Federation

National Pork Producers Council

National Turkey Federation

United Egg Producers162


18/23


• The FDA should assess he impac o is volunary

sraegy and sar he regulaory process now o

wihdraw drug approvals or injudicious uses. The

FDA also should srongly enorce he exising bans on

cerain uses o anibioics.

• The FDA should address he GAO’s recommendaions

o improve daa collecion on he use o anibio-

ics and he developmen o anibioic resisance.166

NARMS mus be broadened o allow he FDA o iden-

iy and respond rapidly o emerging resisance.

• Governmen agencies should collaborae o increase

research on anibioic resisance, including he mech-

anisms o resisance emergence, spread and remedia-

ion as well as alernaive means o prevening illness

in livesock.

• The USDA should provide raining and echnical assis-

ance o livesock producers ha are ransiioning away

rom nonherapeuic anibioic use. The USDA should

address conrac sipulaions ha require livesock

producers o use eed wih anibioics already added.

3 -

Heidelberg

-

Typhimurium

-

-

-

Endnotes


19/23


21

-

-

surface water and groundwater impacted by a concentrated swine feeding

-

-

-

35

-

-

drugresistant, uropathogenic

-

-

-

65

from retail meats -

from retail

-

-

Heidelberg

-

products due to possible


20/23


-

in pigs and farm

-

is present

-

-

-

and isolated

-

115 See

-

-

-

123

-

-

-

-

-


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species and the

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-


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23/23

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Documents

Antibiotic Resistance 101: How Antibiotic Misuse on Factory Farms Can Make You Sick