A global threat from a food security perspective
In a recent review on the transmission of bacteria to humans through food, we discussed the implication of the food chain in the spread of antibiotic resistance.
This is a central theme for food microbiology and food safety globally, which is why we explore this topic here.
Antibiotic resistance as a threat to public health
Antibiotics (molecules with antibacterial activity that kill or prevent the growth of bacteria) are essential for the treatment and prevention of certain bacterial infections, both in humans and animals. Resistance occurs when bacteria stop responding to antibiotics, rendering them ineffective for therapeutic use.
Without global action, we could witness a "post-antibiotic" era in which many common infections (including foodborne infections like salmonellosis) could cause high mortality rates. The rise in antibiotic resistance globally is one of the greatest threats to human and animal health, but also to the safety of our food and the environment, requiring a multi-sectoral approach known as "One Health" to contain it.
Currently, several international (WHO, FAO, OIE, EC, EFSA, ECDC, CDC) and national (DGS) entities consider antibiotic resistance one of the greatest threats to global public health. A report published in 2014 even projects that by 2050 antibiotic resistance will cause the death of 10 million people per year, more deaths than other diseases such as cancer and diabetes, if a global response to the problem is not implemented.
More recently (November 2018), the ECDC reported that in the EU, 33,000 people die annually from infections due to antibiotic-resistant bacteria, particularly those associated with healthcare facilities, with the impact equivalent to three major infections (HIV, tuberculosis, and influenza).
Additionally, infections transmitted through the food chain (e.g., more severe salmonellosis and campylobacteriosis) are becoming increasingly difficult to treat (longer lasting infections and more treatment failures) as antibiotics become less effective, with the CDC suggesting that 1 in 5 infections caused by resistant bacteria are caused by bacteria from animals and food.
In fact, antibiotic resistance is currently considered a priority in food safety, so all professionals in this area should be aware of its impact, how it spreads through the food chain, and what role they can play in its prevention and control.
Causes of antibiotic resistance
Antibiotic resistance is a naturally occurring phenomenon, but it has become a complex and multifactorial problem exacerbated by the misuse of antibiotics in humans and animals. Among the various causes of increased antibiotic resistance are over-prescription of antibiotics, interruption of treatment, inefficient infection control in healthcare facilities, but also the overuse of antibiotics in animal (terrestrial/aquatic) and agricultural production, and poor hygiene and sanitary conditions.
In fact, most classes of antibiotics critical for the treatment of infections in human medicine are also used in animals, with an estimated 70% of antimicrobials sold for animal production in the EU . The excessive and inappropriate use of antibiotics in intensive animal/agricultural production, as well as poor hygiene practices in the food chain, are directly associated with the emergence of resistance in pathogenic zoonotic bacteria and their spread from animal production to humans through the food chain (food of animal and plant origin), as exemplified by Salmonella in poultry and swine.
The risk is particularly high in countries where factors that favor the spread of antibiotic resistance (e.g., lack of regulation of antibiotic use in animal/agricultural production, inadequate sanitary conditions) are significant, and may contribute to worsening the situation globally through trade in animals and food, as recently detected in a study on food imported into the EU.
What can we do?
To reduce the impact and limit the spread of antibiotic resistance, the entire community, including nutritionists, both as healthcare professionals and as professionals in the food sector, has a role to play. For healthcare professionals, measures to prevent the transmission of infections (professional-patient) are fundamental, such as promoting proper handwashing and maintaining up-to-date vaccinations.
In the food and meal production sector, it is essential to promote and apply good practices (from primary production, processing and distribution of food to the consumer) in order to reduce the transmission of infections through food and thus prevent and control the spread of antibiotic resistance in the food chain.
Five Keys to Safer Food
In this regard, the WHO recommends that the entire community know and follow the “Five Keys to Safer Food” – maintaining cleanliness, separating raw foods from cooked foods, cooking foods thoroughly, keeping foods at safe temperatures, and using safe water and raw materials. Nutritionists should play a relevant role in changing population behaviors, both through educating food handlers and consumers.
Additionally, the WHO recommends choosing foods that have been produced without the use of antibiotics (for promoting animal growth and preventing disease in healthy animals), and it is up to companies, their professionals, and consumers to select and value this type of production. The BSAC's "Antibiotic Footprint" campaign is an example, aiming to recognize initiatives that promote the responsible use of antibiotics in humans, animals, and agriculture. In fact, the responsible use of antibiotics in the food chain (animals and agriculture) promotes sustainability and food safety, as well as potentially saving lives.
Educational campaigns and projects
Additionally, global strategic plans from various entities to contain antibiotic resistance recommend increasing awareness and understanding of the problem through educational campaigns.
Portugal is one of the EU countries with the greatest lack of knowledge about antibiotics (e.g., more than 60% do not know that antibiotics do not kill viruses or that antibiotic growth promoters in livestock have been banned in the EU) (Eurobarometer results on antibiotic resistance), therefore it is up to all organizations to contribute to changing risky behaviors. In this sense, the University also has a responsibility in educating future healthcare professionals and transferring this knowledge to the entire community, and can play a relevant role through the implementation of projects involving the population, such as the MicroMundo@UPorto project.
Adapted from the publication in the provisional journal of AEFCNAUP
