In the past few days, there have been two interesting reports on antibiotic resistance. One was released by Consumer Reports entitled, “How Safe Is Your Ground Beef?” The other, much less publicized, was put together by scientists and physicians who work in public health and do know something about antibiotic resistance.
This second report was published in the Morbidity and Mortality Weekly Report (MMWR) and is part of the Grand Rounds by the U.S. Centers for Disease Control and Prevention (CDC). From this second report, I like both the title, “Getting Smart about Antibiotics,” and the fact that the authors present an appalling number of figures pointing out the impact of inappropriate antibiotic use in human medicine.
There is no doubt that the “increasing prevalence of antibiotic-resistant bacteria is one of the most serious threats to public health in the 21st century.” But there is also no doubt that this is a complex issue, and pitting one food system against others will not solve the problem. Blaming the use of antibiotics in medicine versus veterinary medicine will not solve the problem either. But for some reason, the discourse about antibiotics resistance has taken the form of blaming somebody or something.
The study of antibiotic resistance is extremely complex because of the variability in the methods of testing for antibiotic resistance and the temporal and spatial inconsistencies in the results. An example of this variability can be seen in Figure 1 (see graph below) created with the interactive feature from the website of the National Antimicrobial Resistance Monitoring System (NARMS).
As expected, the article from Consumer Reports was sensationalistic and did exactly that. Yet we should not forget the other reports — those much less publicized but done with scientific rigor — to make us think for a moment about the scope of the problem. I am referring to reports like the one by Jo Handelsman at Yale University and her colleagues highlighting that the use of manure fertilization, or amendment, can lead to a surge of antibiotic-resistant bacteria in the soil that is not related, or independent, of the antibiotic exposure of the animals from which the manure is obtained.
There is no argument against the fact that human activities of all kinds have resulted in the increase of antibiotic use in the past 50 years, with the consequence of selecting for those bacteria that are resistant. These resistant bacteria may have the genetic components to become resistant or have the physiological properties to quickly adapt and become resistant in the presence of antibiotics in the environment. This consequence is not surprising either, as many scientists have been telling us about the issue of antibiotic resistance, and for a long time.
Most recently, bacteria isolates from ancient Arctic soil and from the microbes that are present in the intestinal tract of an isolated, uncontacted indigenous population of Yanomami Amerindians in South America have revealed the presence of antibiotic resistance. So bacteria have been evolving different resistance mechanisms against antibiotics because these bacteria have been competing with each other for resources in the same environment, mainly in the soil, for thousands of years.
These articles that do not get too much attention but provide us with thoughtful insights should be discussed more. That’s why I like the article published in MMWR. The authors offer a sort of “mea culpa,” if you will, but move on to show us figures that are, again, appalling. The fact that we have “142,000 adult emergency visits annually” because of adverse reactions to antibiotics is telling us that maybe the current antibiotics groups may not be the best approach to combat pathogenic bacteria in the long run. Yet, the search for new classes of antibiotics has not been accelerated over the years, and it may have been slowed down in reality. An extensive study by The Pew Charitable Trusts is unambiguous about this trend: There are too few drugs in development to meet current and anticipated patient needs.
The public should be exposed to these types of reports, too — those reports that show us that everybody should share the burden of antibiotic resistance, and we should not just keep finding scapegoats for a problem that will stay here longer if we do not change the way we understand it.
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