Antimicrobial Resistance: Implications for the Food System Microorganisms have an inherent ability to evolve—to mutate and adapt to environmental stressors─allowing them to survive otherwise lethal conditions.

IFT convened a panel of internationally renowned experts to address the concern that the use of antimicrobials in food production, manufacturing, and elsewhere may lead to the emergence of foodborne pathogens that are resistant to antimicrobials, thus compromising the ability to subsequently control them, whether in production agriculture, food processing, or human medicine.

August 2, 2006

ABSTRACT

The safety of food worldwide remains challenged by the potential for emergence of new pathogens and re-emergence of known pathogens. Microorganisms have an inherent ability to evolve–to mutate and adapt to environmental stressors–allowing them to survive otherwise lethal conditions. The Institute of Food Technologists (IFT),1 the 22000-member nonprofit scientific and educational society, convened a panel of internationally renowned experts to address the concern that the use of antimicrobials in food production, manufacturing, and elsewhere may lead to the emergence of foodborne pathogens that are resistant to antimicrobials, thus compromising the ability to subsequently control them, whether in production agriculture, food processing, or human medicine. The outcome of the panel's deliberations is presented in this Expert Report. IFT's objective for this Expert Report is to increase the understanding–among IFT members, senior policy officials, and other interested groups–of the state of the science on the public health impact of the use of antimicrobials in the food system, and development and control of antimicrobial resistance. This report is the fourth Expert Report produced by IFT.


DIGITAL OBJECT IDENTIFIER (DOI) 10.1111/j.1541-4337.2006.00004.x

Introduction

The availability of antibiotics to treat infectious diseases has radically improved human and animal well being, and to a minor degree, plant health. Paradoxically, this very success threatens the future utility of antibiotics. The discovery of penicillin in 1940 ushered in the era of "modern medicine." Numerous antimicrobials, including most structural classes of antibiotics were discovered during 1920 to 1970. Chemical modification of many of these compounds led to new entities with superior activities. Because of the great success in antibiotic discovery, by the late 1970s, many proclaimed that the war on infectious diseases had been won, leading ultimately to de-emphasis of antibiotic discovery during the 1980s and a decline in the 1990s. At the same time, however, widespread antibiotic resistance was emerging and resulting in impaired treatment of human diseases (Neu 1992). As the genomes of bacteria, especially pathogens, have become increasingly available, the prospect of using them to identify new targets for antibiotic discovery has renewed interest in such investigations between the public sector and large pharmaceutical and biotechnology companies. Many of the larger companies and much of the public sector, however, have redirected research efforts toward noninfectious disease targets.

All uses of antibiotics in human medicine and animal husbandry create selective pressure that favors emergence of antibiotic resistance among microorganisms, which could undermine the effectiveness of the antibiotics and potentially give rise to a "postantibiotic" era. The selection for antibiotic-resistant bacteria in agricultural production environments and the subsequent impact on animal and human health has become a major concern and is the subject of many reports (Table 1). This document focuses on the use of antimicrobial agents to control bacteria in the food system; other microorganisms are considered as well, however. This document builds upon the IFT Scientific Status Summary "Resistance and Adaptation to Food Antimicrobials, Sanitizers, and Other Process Controls" (IFT 2002a), to inform readers about the various types of antimicrobial agents, including antibiotics, food antimicrobial agents, and sanitizers that are used at various stages of the food system, and the mechanisms that microorganisms, particularly foodborne pathogens, have for surviving the stress of exposure to these substances in their environments. Trends in antimicrobial resistance, and the resultant human health, economic, and clinically relevant environmental impacts are also addressed.

Table 1–Reports of antimicrobial use, resistance, and human health impact

DateCountry or InternationalReport sourceReport titleURL address (if applicable)
1969 United Kingdom English Parliament The Report to Parliament by the Joint Committee on Antibiotic Uses in Animal Husbandry and Veterinary Medicine ("Swann Report")
1980 United States National Research Council (NRC) The Effects on Human Health of Subtherapeutic Use of Antimicrobials in Animal Feed http://fermat.nap.edu/
catalog/21.html
1981 United States Council for Agricultural Science & Technology Antibiotics in Animal Feeds, Report 88
1981 United States Institute of Medicine (IOM) Human Health Risks with the Subtherapeutic Use of Penicillin or Tetracyclines in Animal Feed
1989 United States IOM Committee on Human Health Risk Assessment of Using Subtherapeutic Antibiotics in Animals Human Health Risks with the Subtherapeutic Use of Penicillin or Tetracyclines in Animal Feeds
1997 International World Health Organization (WHO) The Medical Impact of the Use of Antimicrobials in Food Animals http://whqlibdoc.who.int/
hq/1997/WHO_EMC_
ZOO_97.4.pdf
1998 United Kingdom UK Ministry of Agriculture, Fisheries, and Food A Review of Antimicrobial Resistance in the Food Chain
1998 United States United States Food and Drug Administration (FDA) Center for Veterinary Medicine (CVM) A proposed framework for evaluating and assuring the human safety of the microbial effects of antimicrobial new drugs intended for use in food-producing animals http://www.fda.gov/cvm/
VMAC/antimi18.html
1998 International WHO Use of Quinolones in Food Animals and Potential Impact on Human Health: Report and Proceedings of a WHO Meeting http://www.who.int/bookorders/
anglais/detart1.jsp?
sesslan=1&codlan=1&
codcol=93&codcch=157
1999 European Union The European Agency for the Evaluation of Medicinal products Antibiotic Resistance in the European Union Associated with Therapeutic Use of Veterinary Medicines
1999 European Union EU Scientific Steering Committee Opinion of the Scientific Steering Committee on Antimicrobial Resistance

http://www.europa.eu.int/comm/
dg24/health/sc/ssc/out50_en.html

1999 United States FDA Risk Assessment on the Human Health Impact of Fluoroquinolone-resistant Campylobacter Associated with Consumption of Chicken http://www.fda.gov/
cvm/Risk_asses.htm

(revised as of January 5, 2001)
1999 United States NRC National Academy of Sciences Committee on Drug Use in Food Animals and the Panel on Animal Health, Food Safety, and Public Health The Use of Drugs in Food Animals: Benefits and Risks http://fermat.nap.edu/
catalog/5137.html
1999 United States U.S. General Accounting Office (GAO) Food Safety: The Agricultural Use of Antibiotics and Its Implications for Human Health http://www.gao.gov/archive/
1999/rc99074.pdf
1999 United Kingdom Advisory Committee on the Microbiological Safety of Food Report on Microbial Antibiotic Resistance in Relation to Food Safety http://www.poultry-health.com/
library/antimicrobials/
acmsf996.htm
(a synopsis)
1999 Australia Joint Expert Advisory Committee on Antibiotic Resistance The Use of Antibiotics in Food-Producing Animals: Antibiotic Resistant Bacteria in Animals and Humans http://www.health.gov.au/
internet/wcms/publishing.nsf/
content/2A8435C71192935
2CA256F180057901E
/$File/jetacar.pdf
1999 European Union European Commission Opinion of the Scientific Steering Committee on Antimicrobial Resistance, May 28, 1999
1999 International WHO The Medical Impact of the Use of Antimicrobials in Food Animals
2000 United States Centers for Disease Control and Prevention Interagency Task Force on Antimicrobial Resistance A Public Action Health Plan to Combat Antimicrobial Resistance http://www.cdc.gov/
drugresistance/actionplan/
2000 International WHO WHO Global Principles for the Containment of Antimicrobial Resistance in Animals Intended for Food http://www.who.int/
salmsurv/links/en/
GSSGlobalPrinciples2000.pdf
2000 International Food and Agriculture Organization of the United Nations (FAO)/WHO Codex Committee on Residues of Veterinary Drugs in Foods Antimicrobial Resistance and the Use of Antimicrobials in Animal Production ftp://ftp.fao.org/codex/
ccrvdf12/rv00_04e.pdf
2001 International Office International Des Epizooties (OIE) Antimicrobial Resistance: Reports prepared by the OIE Ad Hoc Group of Experts on Antimicrobial Resistance http://www.oie.int/eng/publicat/
ouvrages/a_106.htm
2001 International WHO WHO Global Strategy for Containment of Antimicrobial Resistance http://www.who.int/drugresistance/
WHO_Global_Strategy_English.pdf
2001 International WHO Monitoring Antimicrobial Usage in Food Animals for the Protection of Human Health http://www.who.int/
salmsurv/links/en/
GSSMontitoring AMRuseOslo.pdf
2002 United States Alliance for the Prudent Use of Antibiotics The Need to Improve Antimicrobial Use in Agriculture: Ecological and Human Health Consequences ("FAAIR Report") http://www.journals.uchicago.edu/
CID/journal/contents/v34nS3.html
2002 Canada Veterinary Drugs Directorate, Health Canada Report of the Advisory Committee on Animal Uses of Antimicrobials and Impact on Resistance and Human Health Uses of Antimicrobials in Food Animals in Canada: Impact on Resistance and Human Health http://www.hc-sc.gc.ca/dhp-mps/
alt_formats/hpfb-dgpsa/pdf/pubs/
amr-ram_final_report-rapport
_06-27_e.pdf
2003 International WHO Department of Communicable Diseases, Prevention and Eradication and Collaborating Centre for Antimicrobial Resistance in Foodborne Pathogens Impacts of Antimicrobial Growth Promoter Termination in Denmark http://www.who.int/salmsurv/en/
Expertsreportgrowth
promoterdenmark.pdf
2004 International FAO, OIE, and WHO Joint FAO/OIE/WHO Workshop on Non-Human Antimicrobial Usage and Antimicrobial Resistance: Scientific Assessment http://www.who.int/foodsafety/
publications/micro/en/amr.pdf
2004 International FAO, OIE, and WHO Second Joint FAO/OIE/WHO Expert Workshop on Non-Human Antimicrobial Usage and Antimicrobial Resistance: Management Options http://www.who.int/foodsafety/
publications/micro/en/
oslo_report.pdf
2004 United States GAO Federal Agencies Need to Better Focus Efforts to Address Risk to Humans from Antibiotic Use in Animals http://www.gao.gov/highlights/
d04490high.pdf