Abstract
Background: Antimicrobial resistance (AMR) in bacteria is an increasing health concern. The spread of AMR bacteria (AMRB) between animals and humans via the food chain and the exchange of AMR genes requires holistic approaches for risk mitigation. The AMRB exposure of humans via food is currently only poorly understood leaving an important gap for intervention design.Method: This study aimed to assess AMRB prevalence in retail food and subsequent exposure of Swiss consumers in a systematic literature review of data published between 1996 and 2016 covering the Swiss agriculture sector and relevant imported food.Results: Data from 313 out of 9,473 collected studies were extracted yielding 122,438 food samples and 38,362 bacteria isolates of which 30,092 samples and 8,799 isolates were AMR positive. A median AMRB prevalence of >50% was observed for meat and seafood harboring Campylobacter, Enterococcus, Salmonella, Escherichia coli, Listeria, and Vibrio spp. and to a lesser prevalence for milk products harboring starter culture bacteria. Gram-negative AMRB featured predominantly AMR against aminoglycosides, cephalosporins, fluoroquinolones, penicillins, sulfonamides, and tetracyclines observed at AMR exposures scores of levels 1 (medium) and 2 (high) for Campylobacter, Salmonella, E. coli in meat as well as Vibrio and E. coli in seafood. Gram-positive AMRB featured AMR against glycoproteins, lincosamides, macrolides and nitrofurans for Staphylococcus and Enterococcus in meat sources, Staphylococcus in seafood as well as Enterococcus and technologically important bacteria (incl. starters) in fermented or processed dairy products. Knowledge gaps were identified for AMR prevalence in dairy, plant, fermented meat and novel food products and for the role of specific indicator bacteria (Staphylococcus, Enterococcus), starter culture bacteria and their mobile genetic elements in AMR gene transfer.Conclusion: Raw meat, milk, seafood, and certain fermented dairy products featured a medium to high potential of AMR exposure for Gram-negative and Gram-positive foodborne pathogens and indicator bacteria. Food at retail, additional food categories including fermented and novel foods as well as technologically important bacteria and AMR genetics are recommended to be better integrated into systematic One Health AMR surveillance and mitigation strategies to close observed knowledge gaps and enable a comprehensive AMR risk assessment for consumers.
Highlights
RationaleAntimicrobial resistance (AMR) in commensal bacteria as well as opportunistic or obligate pathogens is an increasing public health concern due to the possibility of AMR gene transfer from commensals to pathogens or among pathogens (Friedman, 2015; ICF, 2017)
Transmission of AMR bacteria (AMRB) to humans and to the human gastro intestinal tract is of concern due to either direct infections or the possibility of horizontal gene exchange with other, potentially pathogenic members of the gut microbiota favored by the high cell densities found in the gut (Aarestrup et al, 2008; Haug et al, 2011; Collignon et al, 2016)
Surveillance data from individual European countries are further compiled under the umbrella of the European Centre for Disease Control (ECDC) and European Food Safety Authority (EFSA) to prepare comprehensive annual reports on AMR prevalence dynamics in key bacteria groups in animals, food and human medicine (EFSA and ECDC, 2016)
Summary
RationaleAntimicrobial resistance (AMR) in commensal bacteria as well as opportunistic or obligate pathogens is an increasing public health concern due to the possibility of AMR gene transfer from commensals to pathogens or among pathogens (Friedman, 2015; ICF, 2017). Surveillance data from individual European countries are further compiled under the umbrella of the European Centre for Disease Control (ECDC) and European Food Safety Authority (EFSA) to prepare comprehensive annual reports on AMR prevalence dynamics in key bacteria groups in animals, food (mainly raw meat) and human medicine (EFSA and ECDC, 2016). Specific surveillance programs of food at retail level to determine the exposure of the consumer to AMR bacteria (AMRB) via food are rarely systematically implemented and mainly limited to raw meat samples in combination with human and veterinary medicine data (Federal Office of Public Health Foph Division Communicable Diseases, 2015; EFSA and ECDC, 2016). The integration of food at retail level would contribute to the identification of potential transmission pathways of AMRB between animals and humans and enable the further optimization of AMR mitigation strategies in surveillance and response systems under the One Health concept. The AMRB exposure of humans via food is currently only poorly understood leaving an important gap for intervention design
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