As the world is celebrating the World Food Day, it is well worth considering the impact of antibiotics and antibiotic resistance on safe food. Food safety is also linked to the sustainable development goals, in particular Sustainable Development Goals 2 - Zero Hunger and 3 - Health and Well-being.
Safe, nutritious and sufficient – SDG 2 – Zero Hunger
The first target of Sustainable Development Goal (SDG) 2 is to “end hunger and ensure access by all people, in particular the poor and people in vulnerable situations, including infants, to safe, nutritious and sufficient food all year round.” Safe food means that the food should not make us sick, and not contain things hazardous to our health. These hazards can be classified as physical, chemical or microbiological. WHO has estimated that 600 million people fall ill globally due to foodborne diseases. More than 400,000 of them die, and one third of these fatalities are children under 5 years of age. Microbiological hazards are generally due to contamination with pathogens such as bacteria, but it is also important to recognize the impact of antibiotic resistance in these pathogens.
Commonly, microbiological hazards are related to food contaminated by a variety of bacterial species like Salmonella sp. Campylobacter sp., Listeria sp., Bacillus cereus or Escherichia coli. While some microbiological hazards are clearly visible on the food through spoiling, not all hazardous foods are visibly spoiled. Bacteria and other microbes that spread through foods such as meat, vegetables and other fresh produce are called food-borne pathogens. Infectious foodborne diseases acquired from contaminated raw or cooked food are major causes of mortality and morbidity globally. Most commonly, foodborne pathogens cause diarrheal diseases.
In meat, foodborne pathogens are often a result of suboptimal infection control and biosecurity. Bacteria carried by the animals in for example their gastrointestinal tracts, can contaminate the meat during slaughter or in butcher shops. In the case of vegetables or produce, contaminants come from the soil, manure or irrigation water.
Antibiotics in the food chain
To ensure safe and sufficient food, antibiotics and disinfectants are used in a variety of ways in food production. In some cases, antibiotics are even used as preservatives in for example milk and seafood, and antibacterial substances may also be used in efforts to maintain the safety of crops. Antibiotics are still used to promote growth of animals in many parts of the world, prophylactically to prevent disease and to treat sick animals. This use of antibiotics in animals accounts to a majority of the global antibiotic use (by weight), but also creates a legitimate conflict of interest. On the one hand, there is the interest of farmers to make a living, and the perception that routine antibiotic use is necessary for safe and effective production. And on the other hand, there is the interest to reduce antibiotic use to limit antibiotic resistance. Correctly used, antibiotics can treat sick animals, and enable sustainable production of safe food.
Feces and urine from animals are often used as manure in agriculture. Unless properly treated, the manure may still contain fecal bacteria from the animals. These bacteria, together with bacteria that occur naturally in soil, may then contaminate the crops. Also, if the water source for irrigation is unsafe, pathogens from the water may also contribute to the contamination.
Antibiotic resistance as a food safety matter
When antibiotics are used injudiciously, whether by humans or in food animals, this increases the development and spread of resistance and the risk that the antibiotics used will actually be ineffective. But similarly, antibiotics that are used control diseases in animals may become ineffective due to antibiotic resistance. In some instances, this will lead to increased animal suffering and decreased production, spread of antibiotic resistance in the foodborne pathogens in production herds and, as a consequence, to antibiotic resistance in the foodborne infections.
As noted above, foodborne infections are a major cause of the global burden of disease. While non-invasive diarrhea is mostly not appropriate to treat with antibiotics it remains a major source of antibiotic misuse, and treatment of invasive infections relies on antibiotics. As an example, an outbreak of 3816 cases with an uncommon variant of E. coli (enteroaggregative and producing Shiga toxin) via contaminated sprouts was reported in Germany in 2011. The bacterium caused a severe infection, 20% of the patients developed hemolytic-uremic syndrome and 54 patients died. The strain was resistant to beta-lactam antibiotics, including third-generation cephalosporins and was partially resistant to fluoroquinolones. Treatment options were carbapenems and ciprofloxacin.
What can we do?
Food safety is an important issue, and action needs to be taken on many different levels, for example:
- Use antibiotics judiciously, both in food production and in humans.
- Prevent infections, by for example handwashing, kitchen hygiene and improving hygiene in animal production.
- Ensure that the water sources are safe, and remain safe.
Maintaining access to safe food is vital for everyone and requires constant efforts in quality control, surveillance and hygiene. And when the worst happens, access to healthcare and effective antibiotics is vital to save lives.
More news and opinion from 2019
- ReAct’s 2019 wrap up and 2020 expectations
- Blog post by UNDP and ReAct: Antimicrobial resistance: An emerging crisis
- Water, sanitation and hygiene services critical to curbing antibiotic quick fix
- Diagnostics: Antibiotic susceptibility
- ReAct highlights during World Antibiotic Awareness week 2019
- 2019 AMR photo competition prizes announced
- Launch of UNICEF’s institutional guidance on antimicrobial resistance
- Proposed ban on colistin for animal use announced in Indonesia
- School children led celebration of World Toilet Day and World Antibiotic Awareness Week
- 10 Innovate4AMR-winning teams enjoyed 3-day workshop in Geneva
- After 4 collaborative meeting days: Actions for the future in Latin America
- Four key points from joint comments to One Health Global Leaders Group on AMR
- Why are children more vulnerable to AMR?
- Dr Yoel Lubell, Health Economist, on Thailand, AMR, UCH and cultural factors driving AMR
- UHC and AMR: The Thai Experience
- Why do effective antibiotics matter for quality of care and patient safety?
- New ReAct policy brief: Antimicrobial resistance and universal health coverage – What’s the deal?
- Three key takeaways from the ReAct Africa conference
- Diagnostics: Species identification
- AMR-specific indicator proposed for monitoring Sustainable Development Goals
- Five focus areas at the 2nd Ministerial Conference on AMR hosted by the Netherlands
- Safety concerns of fecal microbiota transplants
- Upcoming ReAct Africa Conference: universal health coverage and antimicrobial resistance in focus
- Mother Earth conference in Argentina – the environment in focus
- Diagnostics: What are we talking about?
- Connecting global to local civil-society-agenda on AMR at CSO convening in Geneva
- ReAct colleagues featured in WHO Bulletin as leading profiles in the work on reacting to antibiotic resistance
- RAN stakeholder at WHO IPC consultation – for standards and guidelines in African Union member states
- WHA conversation on Antibiotic Resistance as a Global Development Problem co-organized by ReAct
- Insights from ReAct Asia Pacific project on antibiotic stewardship in secondary level hospitals in India
- Open letter to UN Member States from former IACG members Anthony So and Otto Cars
- ReAct UHC Intervention at UNGA Multi-stakeholder Hearing for High-level Meeting on UHC
- ReAct Latin America honors Earth Day
- Medicines Patent Pool’s view on the role of licenses for antibiotics – World Intellectual Property Day
- Second time for Innovate4AMR competition!
- World Health Day 2019: Universal Health Coverage
- Diagnostics: Constraints for successful implementation
- Antibiotic Shortages: magnitude, causes and possible solutions: A new WHO meeting report
- Erry Setyawan, FAO, on Indonesian NAP: We need to work together to make it possible to manage AMR
- ReAct’s new 5-year strategic plan receives funding from Sida
- How infections spread and how to stop them
- Generating data for policy and practice