Public knowledge of antimicrobial resistance has risen in the United Kingdom in the past few years but is still low, according to a survey.

A consumer survey was carried out in 2016 and 2019 and repeated in July this year. A sample of 2,555 UK residents aged 16 to 75 took part in the work commissioned by the Food Standards Agency (FSA), which was more than in 2016 and 2019.

About a quarter of respondents had heard of the term antimicrobial resistance, which is up from 16 percent in 2016, however awareness of the acronym “AMR” remained unchanged at 11 percent. More people were familiar with the words “superbugs” or “antibiotic resistance” at around 70 percent.

Younger respondents are more likely to have heard of “antimicrobial resistance” and “AMR” than older people.

Of the 2,134 respondents who had heard of either “antimicrobial resistance” or “antibiotic resistance”, more than half could not answer when asked about the difference between the two terms. From those that could respond, many struggled with the differences or provided a definition of one of the terms only. Antibiotic resistance is a type of antimicrobial resistance.

Points of concern
Levels of concern about “antimicrobial resistance within the food chain” was at 59 percent, moderately increasing from 55 percent in 2019 but down from 62 percent in 2016.

After being given a description of AMR, more than half felt the “overuse of antimicrobials/antibiotics by doctors and patients” contributed to an increase in human infections with antimicrobial/antibiotic resistant bacteria. Just less than half cited overuse in veterinary medicine.

When given information about antibiotic resistance, 70 percent said they were concerned about “antimicrobial/antibiotic resistance from people taking too many antibiotics.”

People were slightly less concerned about the risk of antimicrobial resistance from food imported from the EU or produced in the UK, than they were about food from non-EU countries. However, this difference is also seen in questions on food poisoning, suggesting general concerns on the safety of food from other countries, rather than specific AMR worries.

Respondents were most likely to choose “cooking food thoroughly” and “washing hands before starting to prepare or cook,” as things that could protect against the spread of AMR.

From a list, people mainly picked poultry or red meat as sources of AMR, followed by eggs, dairy products and seafood.

Heat treatment and AMR genes
Another project looked at the impact of cooking on AMR genes and discovered a lack of evidence to determine if there was a risk to human health.

It found AMR bacteria are not more heat-resistant than non-AMR bacteria. So, cooking at 70 degrees C (158 degrees F) for two minutes or equivalent should be sufficient to kill AMR bacteria that may be in food.

Identified studies provided some evidence that AMR genes persist in cooked foods following heat treatments but they may not be functional. The limited evidence suggests that heat treatment effective at eliminating bacteria may not be sufficient to destroy AMR genes.

Of 53 publications identified between 1990 and May 2021, only four studied the impact of heat treatments on AMR genes.

None of them demonstrated whether genes from heat-treated AMR bacteria could be taken up by other live bacteria in the human gut after ingestion.

There is also little evidence and a gap in knowledge on the impact of sub-lethal heat treatments on AMR bacteria and genes and of different domestic or foodservice cooking methods.

Scientists from the TEC Partnership (Grimsby Institute) and the universities of Lincoln and Liverpool recommended further research to provide evidence for an assessment of risk in relation to transfer of AMR genes from heat-treated foods to bacteria in other matrices.

Finally, the FSA has commissioned a survey of AMR bacteria in lamb and turkey meat at retail to see if they pose a risk to public health and to allow monitoring of trends over time.

Work involves collecting 200 lamb and 200 turkey samples on retail sale in the UK from October to January 2021. Results are expected in early 2022. It is an extension of an EU-harmonized survey on AMR E. coli in retail meats.

Analysis will require isolation and enrichment of E. coli from all meat samples, prior to testing for AMR, Extended Spectrum Beta Lactamases (ESBLs), AmpC and Carbapenemase-producing E. coli. Analysis for colistin resistance and the colistin resistant mcr genes will be included, as well as testing for AMR Campylobacter in turkey.

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