Abstract
Restricting antibiotic use in food production animals is a target for reducing antimicrobial drug–resistant infections in humans. To estimate the probability of antibiotic-resistant nontyphoidal salmonellosis per meal made with beef during 2002–2010, we used US surveillance data. Applying data for nontyphoidal Salmonella in raised-without-antibiotics cattle, we tested the effect of removing antibiotic use from all beef cattle production. We found an average of 1.2 antibiotic-resistant nontyphoidal salmonellosis cases per 1 million beef meals made with beef initially contaminated with antibiotic-resistant nontyphoidal Salmonella at slaughter or retail and 0.031 cases per 1 million meals irrespective of beef contamination status. Neither outcome showed sustained change except for increases in 2003 and 2009 (>98% confidence) when larger or more outbreaks occurred. Switching all beef production to a raised-without-antibiotics system may not have a significant effect on antibiotic-resistant nontyphoidal salmonellosis (94.3% confidence).
Highlights
Restricting antibiotic use in food production animals is a target for reducing antimicrobial drug–resistant infections in humans
Our model follows the method of previously published antimicrobial resistance (AMR) risk assessments [6,16] but uniquely addresses temporal changes and relies solely on nationwide surveillance data (Appendix Table 1, https:// wwwnc.cdc.gov/EID/article/26/9/19-0922-App1. pdf).We used this model for 3 objectives: 1) estimate the risk for antibiotic-resistant nontyphoidal salmonellosis per meal made with beef, using the yearly cases of illnesses (Illres) and the number of meals made with beef that year (Mealres) (Figure 1); 2) evaluate change over time in all model outcomes; and 3) assess the effect that potential future restrictions on antibiotic use in beef cattle would have on antibioticresistant nontyphoidal salmonellosis disease burden (Appendix)
To ensure that the resistance fraction is specific to nontyphoidal salmonellosis attributed to consumption of beef, we estimated the fraction of beef-attributed nontyphoidal salmonellosis cases with AMR by matching cases in the Centers for Disease Control and Prevention data collected from clinical patient samples as part of National Antimicrobial Resistance Monitoring System (NARMS) [17] with beef-attributable outbreak data from National Outbreak Reporting System (NORS) by using sample metadata, (Appendix Table 1)
Summary
Restricting antibiotic use in food production animals is a target for reducing antimicrobial drug–resistant infections in humans. Switching all beef production to a raised-without-antibiotics system may not have a significant effect on antibiotic-resistant nontyphoidal salmonellosis (94.3% confidence). Increased antimicrobial resistance (AMR), or antibiotic resistance, has resulted in initiatives to reduce the use of antibiotics in food production animals [1,2], but quantification of the public health effects of decreasing antibiotic use in livestock remains limited [3,4]. Surveillance studies of antibiotic use and AMR in humans and livestock can be used to generate estimates of risk based on empirical data and can show the results of long-term conditions or systematic changes over time. We used the estimates to predict change in antibiotic-resistant salmonellosis resulting from hypothetical scenarios of antibiotic restriction in beef cattle
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