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Antibiotic-Resistant Bacteria in Meat on the Rise

Antibiotic-Resistant Bacteria in Meat on the Rise

Yikes, maybe it's time to become vegetarians

Well, this is just lovely: A new report from the Environmental Work Group sheds light on the scariness of antibiotic use in the meat market, finding that antibiotic-resistant forms of bacteria (or, superbugs), are on the rise.

The data, collected over years and ending in 2011 by the National Antimicrobial Resistance Monitoring System, found that supermarket meat samples ended up having high amounts of superbug versions of salmonella and Campylobacter, The New York Times reports.

These bacteria cause 3.6 million cases of food poisoning a year, the study found. Even worse? Fifty-three percent of raw chicken samples contained superbug versions of E. coli, which can sometimes cause diarrhea, urinary tract infections, and pneumonia.

Federal tests found that 9 percent of raw chicken samples and 10 percent of raw ground turkey samples contained superbug salmonella. Even scarier: general salmonella microbes were found in 74 percent of the chicken samples in 2011. Compare that number to 50 percent in 2002. We're definitely going to start overcooking our chicken now.


Scientists are weaponizing viruses to solve a huge problem

As the world fights the SARS-CoV-2 virus causing the COVID-19 pandemic, another group of dangerous pathogens looms in the background. The threat of antibiotic-resistant bacteria has been growing for years and appears to be getting worse. If COVID-19 taught us one thing, it’s that governments should be prepared for more global public health crises, and that includes finding new ways to combat rogue bacteria that are becoming resistant to commonly used drugs.

In contrast to the current pandemic, viruses may be the heroes of the next epidemic rather than the villains. Scientists have shown that viruses could be great weapons against bacteria that are resistant to antibiotics.

I am a biotechnology and policy expert focused on understanding how personal genetic and biological information can improve human health. Every person interacts intimately with a unique assortment of viruses and bacteria, and by deciphering these complex relationships we can better treat infectious diseases caused by antibiotic-resistant bacteria.

Replacing antibiotics with phage

Since the discovery of penicillin in 1928, antibiotics have changed modern medicine. These small molecules fight off bacterial infections by killing or inhibiting the growth of bacteria. The mid-20th century was called the Golden Age for antibiotics, a time when scientists were discovering dozens of new molecules for many diseases.

This high was soon followed by a devastating low. Researchers saw that many bacteria were evolving resistance to antibiotics. Bacteria in our bodies were learning to evade medicine by evolving and mutating to the point that antibiotics no longer worked.

As an alternative to antibiotics, some researchers are turning to a natural enemy of bacteria: bacteriophages. Bacteriophages are viruses that infect bacteria. They outnumber bacteria 10 to 1 and are considered the most abundant organisms on the planet.

Bacteriophages, also known as phages, survive by infecting bacteria, replicating, and bursting out from their host, which destroys the bacterium.

Harnessing the power of phages to fight bacteria isn’t a new idea. In fact, the first recorded use of so-called phage therapy was over a century ago. In 1919, French microbiologist Félix d'Hérelle used a cocktail of phages to treat children suffering from severe dysentery.

D'Hérelle’s actions weren’t an accident. In fact, he is credited with co-discovering phages, and he pioneered the idea of using bacteria’s natural enemies in medicine. He would go on to stop cholera outbreaks in India and plague in Egypt.

Phage therapy is not a standard treatment you can find in your local hospital today. But excitement about phages has grown over the past few years. In particular, scientists are using new knowledge about the complex relationship between phages and bacteria to improve phage therapy. By engineering phages to better target and destroy bacteria, scientists hope to overcome antibiotic resistance.

Engineering phages

Even if you are not a biologist, you may have heard of one type of bacterial immune system: CRISPR, which stands for Clustered Regularly Interspaced Short Palindromic Repeats. This immune system helps bacteria store genetic information from viral infections. The bacteria then use that information to fight off future invaders, much as our own immune system can recognize a particular pathogen to fight off infection.

CRISPR proteins in bacteria locate and cut specific sequences of DNA or RNA found in viruses. Such precise cutting also makes CRISPR proteins efficient tools for editing the genomes of various organisms. This is why the development of CRISPR genome-editing technology won the Chemistry Nobel prize in 2020.

Now scientists are hoping to use the knowledge about CRISPR systems to engineering phages to destroy dangerous bacteria.

When the engineered phage locates specific bacteria, the phage injects CRISPR proteins inside the bacteria, cutting and destroying the microbes’ DNA. Scientists have found a way to turn defense into offense. The proteins normally involved in protecting against viruses are repurposed to target and destroy the bacteria’s own DNA. The scientists can specifically target the DNA that makes the bacteria resistant to antibiotics, making this type of phage therapy extremely effective.

The bacteria Clostridioides difficile is an antibiotic-resistant strain of bacteria that kills 29,000 people in the U.S. every year. In one demonstration of this CRISPR-based technique, researchers engineered phages to inject a molecule that directs the bacteria’s own CRISPR proteins to chew up the bacteria’s DNA like a paper shredder.

CRISPR isn’t the only bacterial immune system. Scientists are discovering more using creative microbiology experiments and advanced computational tools. They have already found tens of thousands of new microbes and dozens of new immune systems. Scientists hope to find more tools that could help them engineer phages to target a wider range of bacteria.

Beyond the science

Science is only half of the solution when it comes to fighting these microbes. Commercialization and regulation are important to ensure that this technology is in society’s toolkit for fending off a worldwide spread of antibiotic-resistant bacteria.

Multiple companies are engineering phages or identifying naturally occurring phages to destroy specific harmful bacteria. Companies like Felix Biotechnology and Cytophage are producing specialized bacteria-killing phages to replace antibiotics in human health and agriculture. BiomX aims to treat infections common in chronic diseases like cystic fibrosis and inflammatory bowel disease using both natural and engineered phage cocktails. Thinking globally, the company PhagePro is using phages to treat cholera. These deadly bacteria affect people primarily in Africa and Asia.

Alongside the commercialization of phage therapy, policies that facilitate safe testing and regulation of the technology are vital. To avoid replicating America’s poor COVID-19 response, I believe the world must invest in, engineer, and then test phage therapies. Proactive planning will help us combat whatever antibiotic-resistant bacteria might spread.


Public Health Warning: This Meat May Contain Life-threatening Antibiotic Resistant Bacteria

Maybe it's time we demanded a health warning on intensively produced meat products. Because when it comes to the link between modern so-called science-based industrial livestock farming and the rise of life-threatening antibiotic resistant bacteria, the evidence just keeps on coming.

Hot on the heels of a damning report by the Environmental Working Group, which revealed high levels of potentially life-threatening antibiotic-resistant bacteria on raw supermarket meat, the respected Consumer Reports has found potential disease-causing organisms in 90 percent of ground turkey samples purchased from stores nationwide. What's more, many of the bacteria they identified were resistant to more than three antibiotic drug classes.

In their first-ever lab analysis of ground turkey products, Consumer Reports' researchers carried out tests on 257 samples purchased at retail stores nationwide for the presence of five key food poisoning bacteria: enterococcus, E. coli, staphylococcus aureus, salmonella, and campylobacter. The results are of grave concern to us all.

Consumer Reports found at least one of these five food poisoning bacteria in 90 percent of the samples tested. Strains of enterococcus and E. coli bacteria -- both commonly associated with fecal waste contamination -- were identified on 69 percent and 60 percent respectively of the ground turkey samples tested. In addition, more than half of the enterococcus and the E. coli bacteria were resistant to three or more groups of closely related antibiotics. Three samples of ground turkey were contaminated with the life-threatening methicillin-resistant staphylococcus aureus (MRSA), while 12 of the samples harbored Salmonella bacteria, one of the most common causes of foodborne illness in the U.S. Again, it is worrying to note that two-thirds of the Salmonella bacteria were resistant to three or more important antibiotics.

"Our findings strongly suggest that there is a direct relationship between the routine use of antibiotics in animal production and increased antibiotic resistance in bacteria on ground turkey," says Dr. Urvashi Rangan, Director of the Consumer Safety and Sustainability Group at Consumer Reports, according to a press release. "It's very concerning that antibiotics fed to turkeys are creating resistance to antibiotics used in human medicine."

The problem is that most consumers are still not aware that virtually all intensively farmed animals in the U.S. now routinely receive low, sub-therapeutic levels of antibiotics in their feed and water. In fact, we use more antibiotics per pound of meat produced than any other nation in the world and a staggering 80 percent of all the antibiotics produced in the U.S. are used on food-producing animals. The reason? Feeding regular doses of sub-therapeutic antibiotics helps to maximize production of meat, milk or eggs by improving feed efficiency or by suppressing diseases that would inevitably spread in the confined, dirty, and stressful conditions of intensive livestock operations. But while the likes of Cargill, Purdue and Tyson will claim that the routine use of sub-therapeutic antibiotics is necessary for (sic) maintaining animal health and welfare, and enables them to maximize the production of cheap meat, milk and eggs (and to maximize their profits), we now know that there are some very serious costs.

Scientists from around the world now emphatically suggest that the misuse of antibiotics in intensive livestock farming is one of the key causes for the dramatic rise in life-threatening antibiotic-resistant bacteria over recent years. By allowing intensive livestock farms to routinely expose bacteria to sub-therapeutic levels of antibiotics, we are providing the perfect conditions for some very dangerous bacteria to mutate and become resistant to their effects.

As Consumer Reports point out, we are all only human and common slip-ups while handling or cooking meat can sometimes put us all at risk of food poisoning. I suspect that most readers have had food poisoning at some point in their lives. In most cases, the illness is relatively mild (if rather unpleasant) and passes in a few days. But some of the nastier food poisoning bugs such as Salmonella can cause more serious disease and potential complications, particularly for the sick, the elderly or the young. As a result, antibiotics continue to have a vital role to play in treating these more serious cases of food poisoning and other resistant infections.

Yet the rise of antibiotic-resistant bacteria is changing everything. Today, the danger is that if you do happen to contract a multi-resistant bug you may well find the normal antibiotics simply do not work. In some cases, we are running out of options altogether. This is precisely why the UK Government's Chief Medical Officer recently said that the rise of antibiotic resistant bacteria risks a global health catastrophe that ranks alongside the threat of climate change or terrorism.

So is it right that consumers are unwittingly putting themselves and their loved ones at increasing risk of contracting what were previously treatable food poisoning and other bacterial infections simply for the sake of cheaper meat, milk and eggs? Is it acceptable that an accidental spillage in the kitchen refrigerator or the incorrect handling or cooking of meat at a restaurant can now result in a life-threatening -- yet entirely preventable -- antibiotic-resistant disease? Well, Big Ag seems to think so.

I've warned before that the intensive meat industry is actively trying to wash its hands of any responsibility for the emergence of dangerous antibiotic-resistant food poisoning bacteria. Following the infamous 2011 outbreak of antibiotic-resistant salmonella food poisoning, which left one person dead and sickened at least 136 people across 31 states after consuming Cargill's tainted ground turkey, the company's hollow public apology contained a chilling caveat. "We go to great lengths to ensure the food we produce is safe and we fully understand that people expect to be able to consume safe food, each serving, every time," Cargill wrote. But the company then attempted to deflect any responsibility for the outbreak by implicitly blaming the sickened customers involved. "We all need to remember bacteria is everywhere, and we must properly handle and prepare fresh foods wherever they are served." In other words, if people handled meat properly and cooked it thoroughly, says the industry, it doesn't matter if there a few antibiotic-resistant pathogens in it.

Since when did safe handling instructions for food become an excuse for the intensive meat industry to not only continue (mis)using precious antibiotics in a way which actively encourages antibiotic-resistance, but also to absolve themselves of any responsibility for subsequent illnesses or deaths that result? If that's the way Big Ag wants to play it, maybe it's time to demand that packs of intensively-raised meat are labeled with a public health warning of "This Meat May Contain Life-Threatening Antibiotic Resistant Bacteria." At least this would allow consumers to decide whether or not eating tainted meat is actually worth the risk?

I want to stress that good food hygiene practices are essential whenever we handle and cook raw meat. But it doesn't matter how good our hygiene practices are: accidents will inevitably happen. So we all need to do our best to ensure that these inevitable mishaps don't result in a life-threatening disease. If Big Ag isn't going to act responsibly and do all it can to minimize the emergence of antibiotic-resistant bacteria in the first place, then we all need to take matters into our own hands.

The good news is that Consumer Reports found that ground turkey samples from production systems where antibiotics are strictly controlled contained fewer antibiotic-resistant bacteria than intensively-raised ground turkey products. To minimize the risk, Consumer Reports advises consumers to not only adopt good food hygiene practices, but to choose meat which is produced according to meaningful standards, such as Animal Welfare Approved (see Consumer Reports' online guide to what food labels really mean at www.eco-labels.org).

At Animal Welfare Approved, we believe that sick animals may sometimes need a course of antibiotics to treat disease and to alleviate pain or suffering. Our standards permit the targeted use of antibiotics on individual animals when alternative treatments are not suitable or not effective, or if a veterinarian has specifically recommended antibiotic treatment. We know that if antibiotics are used appropriately and judiciously in this way to treat only individual sick animals -- and not as a routine sub-therapeutic dose to prevent disease -- then the risk of the development of antibiotic-resistant bacteria is absolutely minimal. The result? Pain and suffering in farm animals is minimized, the risk of disease is minimized, and the efficacy of antibiotics -- for both humans and livestock -- is protected.


Antibiotic-Resistant Bacteria: Big Ag Washes Its Hands of Any Responsibility

We can be pretty certain that in the coming days we will hear this message over and over again "So what if most of the meat on our supermarket shelves is contaminated with antibiotic-resistant bacteria? If you handle and cook your meat properly then a few bacteria shouldn't be a problem and if you get sick with an untreatable disease then it's your own fault.'

The is the kind of contemptible retort we can expect from the intensive meat industry lobby and its many trolls in response to new research by the Environmental Working Group (EWG), which reveals high levels of life-threatening antibiotic-resistant bacteria on raw supermarket meat. Yet the "cook it properly and everything will be ok" spin is just Big Ag's latest attempt to absolve itself of any responsibility for squandering one of the most important medical innovations of our time- and putting American lives at risk.

The EWG analyzed data from the government's National Antimicrobial Resistance Monitoring System (NARMS), which was established to routinely test raw supermarket meat for antibiotic-resistant bacteria as a way of informing public health regulatory policy on the use of drugs in food-producing animals. Using the latest NARMS data, the EWG researchers detected antibiotic-resistant bacteria in a staggering 81 percent of ground turkey 69 percent of pork chops 55 percent of ground beef and 39 percent of chicken breast, wings or thighs samples tested. The EWG's researchers also found "significant amounts" of antibiotic-resistant strains of Salmonella and Campylobacter, which together cause over 3.6 million cases of food poisoning a year. In addition, the researchers found that 53 percent of the raw chicken samples were contaminated with antibiotic-resistant strains of E. coli, some of which can cause severe diarrhea, urinary tract infections and pneumonia -- and even death.

I've written before that scientists from around the world now emphatically link the misuse of antibiotics in intensive livestock farming as one of the key causes for the dramatic rise in life-threatening antibiotic-resistant bacteria over recent years. Today, a staggering 80 percent of all the antibiotics produced in the U.S. are used on food-producing animals. In fact, we use more antibiotics per pound of meat produced than any other nation in the world. Virtually all intensively farmed animals in the U.S. receive regular sub-therapeutic levels of antibiotics in their feed and water to maximize production of meat, milk or eggs by improving feed efficiency or by suppressing diseases that would otherwise spread like wildfire in the confined, dirty, and stressful conditions of intensive livestock operations. The problem for humans is that by allowing intensive livestock farms to routinely expose bacteria to sub-therapeutic levels of antibiotics, we are actually providing the perfect conditions for some very dangerous bacteria to mutate and become resistant to their effects. This means that when we get infected with these antibiotic-resistant diseases, there are fewer and fewer options for treatment. For some particularly nasty disease, we are fast running out of options altogether.

But if people handled meat properly and cooked it thoroughly, says the industry, it doesn't matter if there a few pathogens in it. So what if they're antibiotic-resistant? It goes without saying that food poisoning is nothing new: Anyone who has had even mild food poisoning will know that it's not exactly a pleasant experience. I am the first to acknowledge that good food hygiene is important when handling raw meat -- at home and in the hospitality industry. But accidents inevitably happen. The difference is that, in the not too distant past, if you did accidentally get seriously sick with a nasty food poisoning bug such as Salmonella, you could generally rely on a quick course of antibiotics to make you better. Today, however, it's becoming increasingly likely that a bout of severe food poisoning may lead to serious illness, complications or even death as a result of a bacterial infection that's become resistant to not just one but often multiple antibiotics.

Of course, Big Ag knows only too well that handling and eating contaminated food isn't the only way that we can get sick from antibiotic-resistant bacteria. It's widely accepted that these antibiotic-resistant bacteria spread easily from animal to animal in the closely confined conditions of our factory farms, and then from farm to farm. And new research from Denmark has now confirmed beyond reasonable doubt that some strains of the dangerous antibiotic-resistant bacteria MRSA (Methicillin-Resistant Staphylococcus aureus) can be transmitted from farm animals to people, such as farm workers and meat processing operatives, and eventually into the wider community.

But it doesn't end there. Bacteria are ubiquitous: they are everywhere in our living environment. Scientists have known for some time that bacteria can easily share genetic information --it's one of the reasons that they can mutate so rapidly. So even if bacteria have not been directly exposed to certain antibiotics themselves, they can pick up genetic information from other bacteria in the wider environment that are resistant. So when factory farms spread the millions of gallons of putrid toxic feces held in their open-air lagoons on to the land around their operations, and it leaches into the soils and water networks, the antibiotic-resistant bacteria in the feces can pass on their resistance to other bacteria species in the wider environment.

This is why the "cook it properly and everything will be ok" advice from Big Ag just doesn't cut it. Even if we were all to adopt the most stringent hygiene practices found in today's hospitals- a completely unrealistic, unpalatable and wholly unacceptable scenario - the threat of antibiotic-resistant bacteria to the human population will still exist. But Big Ag is already fully aware of this fact: Remember when the tobacco lobby fought tooth and nail to protect its market, despite overwhelming evidence that they were in fact killing their customers?

In 2011, food giant Cargill voluntarily recalled 36 million pounds of fresh and frozen ground turkey. This was one of the largest Class I recalls of tainted meat in U.S. history, following an outbreak of antibiotic-resistant salmonella food poisoning. The outbreak left one person dead and sickened at least 136 people across 31 states. "It is regrettable that people may have become ill from eating one of our ground turkey products and, for anyone who did, we are truly sorry," Cargill said in a chillingly-worded public statement. "We go to great lengths to ensure the food we produce is safe and we fully understand that people expect to be able to consume safe food, each serving, every time." Yet Cargill then appeared to abdicate any responsibility whatsoever and placed the blame of the outbreak well and truly on the shoulders of the public: "We all need to remember bacteria is everywhere, and we must properly handle and prepare fresh foods wherever they are served." The message? It's now our fault when the antibiotics don't work. We say don't blame us when your system breeds mutant bacteria and you cannot control them!

Safe handling instructions for food should exist to protect consumers from the risk of catching treatable food poisoning bugs. It should not be seen as an excuse for the intensive meat industry to continue to misuse these vital medicines in a way which is actively encouraging antibiotic-resistance, nor as a means of absolving itself of all responsibility for any illnesses or deaths that result. It's exactly the same kind of asinine mentality that thinks it's ok for industrial farms to continue to pollute our waterways with fecal waste, pharmaceuticals and agrochemicals: "Our drinking water is treated to ensure it's safe for consumption, so where's the problem?"

No one wants food poisoning and every individual should take care over how they handle and cook meat. But we all know that accidents will inevitably happen. The big question is: does anyone really think it's acceptable that an accidental spill in the refrigerator or a mistake in the restaurant kitchen could now result in a potentially untreatable -- but entirely preventable -- life-threatening antibiotic-resistant disease? Is cheap meat really worth it?


Superbugs Invade America’s Supermarket Meat

Washington D.C. -- The latest round of tests by federal scientists, quietly published in February , has documented startlingly high percentages of supermarket meat containing antibiotic-resistant bacteria, according to a new Environmental Working Group analysis .

EWG’s analysis of data buried in the federal government’s National Antimicrobial Resistance Monitoring System has found that store-bought meat tested in 2011 contained antibiotic-resistant bacteria in 81 percent of raw ground turkey, 69 percent of raw pork chops, 55 percent of raw ground beef and 39 percent of raw chicken parts.

“Consumers should be very concerned that antibiotic-resistant bacteria are now common in the meat aisles of most American supermarkets,” said EWG nutritionist Dawn Undurraga, the report’s principal author . “These organisms can cause foodborne illnesses and other infections. Worse, they spread antibiotic-resistance, which threatens to bring on a post-antibiotic era where important medicines critical to treating people could become ineffective.”

EWG researchers found that 53 percent of raw chicken samples were tainted with an antibiotic-resistant form of Escherichia coli, also known as E. coli, a microbe that normally inhabits feces and can cause diarrhea, urinary tract infections and pneumonia. The extent of antibiotic-resistant E. coli on chicken is alarming because bacteria readily share antibiotic-resistance genes.

As well, EWG found that antibiotic resistance in salmonella is growing fast: of all salmonella microbes found on raw chicken sampled in 2011, 74 percent were antibiotic-resistant, compared to less than 50 percent in 2002.

A significant contributor to the looming superbug crisis is the unnecessary antibiotic usage by factory farms that produce most of the 8.9 billion animals raised for food in the U.S. every year. Industrial livestock producers routinely give healthy animals antibiotics to get them to slaughter faster or prevent infection in crowded, stressful and often unsanitary living conditions.

Pharmaceutical makers have powerful financial incentives to encourage abuse of antibiotics in livestock operations. In 2011, they sold nearly 30 million pounds of antibiotics for use on domestic food-producing animals, up 22 percent over 2005 sales by weight, according to reports complied by the FDA and the Animal Health Institute, an industry group. Today, pharmaceuticals sold for use on food-producing animals amount to nearly 80 percent of the American antibiotics market.

“ Slowing the spread of antibiotic resistance will require concerted efforts, not only by the FDA and lawmakers, but by pharmaceutical companies, doctors, veterinarians, livestock producers and big agribusinesses ,” said Renee Sharp, EWG’s director of research. “ It’s time for big agribusiness to exercise the same restraint shown by good doctors and patients: use antibiotics only by prescription for treatment or control of disease.”

The federal Food and Drug Administration’s efforts to address antibiotic abuse in livestock operations consist of only voluntary guidance documents – not regulations that carry the force of law. EWG takes the position that the FDA must take more aggressive steps to keep antibiotic-resistant bacteria from proliferating in the nation’s meat supply. Livestock producers must not squander the effectiveness of vital medicines.

Rep. Louise Slaughter (D-N.Y.) has introduced the Preservation of Antibiotics for Medical Treatment Act (PAMTA) , aimed at curbing overuse of antibiotics on farms.

“Consumers need protections on the food they eat now,” said Craig Cox, EWG’s vice president of natural resources and agriculture. “ And they need a new farm bill that will help producers reduce their use of antibiotics and level the playing field for farmers and ranchers committed to more sustainable ways to raise livestock."

Consumers can reduce their exposure to superbugs by eating less factory-farm meat, buying meat raised without antibiotics, and following EWG’s downloadable Tips to Avoiding Superbugs in Meat . They can also order a wallet card for a small donation and view a detailed label decoder .

This project was partially funded by an educational grant from Applegate .


Safe Pork Guidelines

What can people who eat pork do?

Continued

  • Use separate cutting boards for meat and produce. "Throw the cutting board or knife in the sink after you use it,” Halloran says.
  • Choose antibiotic-free pork products, including those labeled “certified organic.” Also look for animal welfare labels such as Animal Welfare Approved or Certified Humane, which prohibit the use of ractopamine and allow antibiotics only for disease treatment, not prevention.
  • Disinfect all objects that come into contact with pork. "A little bleach in water is the cheapest and most effective killer of these germs,” Tierno says. “Combine a whiskey glass of bleach and half a quart of water to disinfect utensils and countertops."
  • Wash hands thoroughly after preparing raw meat.
  • Cook pork thoroughly. Use a meat thermometer when cooking pork to ensure it reaches at least 145 F for whole pork and 160 F for ground pork, Halloran says.

Donald W. Schaffner, PhD, says everyone can eat pork products safely as long as they take the proper precautions. He is a professor of food sciences at Rutgers University in New Brunswick, N.J. “If you like it, you should keep eating it, just cook it thoroughly,” he says. “Not everyone can afford organic meats.”


Organic meat less likely to be contaminated with multidrug-resistant bacteria

Meat that is certified organic by the U.S. Department of Agriculture is less likely to be contaminated with bacteria that can sicken people, including dangerous, multidrug-resistant organisms, compared to conventionally produced meat, according to a study from researchers at the Johns Hopkins Bloomberg School of Public Health.

The findings highlight the risk for consumers to contract foodborne illness -- contaminated animal products and produce sicken tens of millions of people in the U.S. each year -- and the prevalence of multidrug-resistant organisms that, when they lead to illness, can complicate treatment.

The researchers found that, compared to conventionally processed meats, organic-certified meats were 56 percent less likely to be contaminated with multidrug-resistant bacteria. The study was based on nationwide testing of meats from 2012 to 2017 as part of the U.S. National Antimicrobial Resistance Monitoring System (NARMS).

In order for meat to be certified organic by the USDA, animals can never have been administered antibiotics or hormones, and animal feed and forage such as grass and hay must be 100 percent organic. A longstanding concern about antibiotic use in livestock and livestock feed is the increased prevalence of antibiotic-resistant pathogens. To monitor this trend, in 1996 the federal government developed NARMS to track antibiotic resistance in bacteria isolated from retail meats, farmed animals, and patients with foodborne illness in the U.S.

For their study, the Bloomberg School research team analyzed U.S. Food and Drug Administration-NARMS data from randomly sampled chicken breast, ground beef, ground turkey, and pork for any contamination and for contamination by multidrug-resistant organisms. The analysis covers four types of bacteria: Salmonella, Campylobacter, Enterococcus, and Escherichia coli.

The study covered a total of 39,348 meat samples, of which 1,422 were found to be contaminated with at least one multidrug-resistant organism. The rate of contamination was 4 percent in the conventionally produced meat samples and just under 1 percent in those that were produced organically.

The study was published May 12 in Environmental Health Perspectives.

"The presence of pathogenic bacteria is worrisome in and of itself, considering the possible increased risk of contracting foodborne illness," says senior author Meghan Davis, DVM, PhD, associate professor in the Department of Environmental Health and Engineering at the Bloomberg School. "If infections turn out to be multidrug resistant, they can be more deadly and more costly to treat."

The analysis also suggested that the type of processing facility may influence the likelihood of meat contamination. Meat processors fall into three categories: exclusively organic, exclusively conventional, or those that handle both organic and conventional meats -- so-called "split" processors. The study found that among conventional meats, those processed at facilities that exclusively handled conventional meats were contaminated with bacteria one-third of the time, while those handled at facilities that processed both conventional and organic meats were contaminated one-quarter of the time. The prevalence of multidrug-resistant bacteria was roughly the same in these two meat processor categories.

"The required disinfection of equipment between processing batches of organic and conventional meats may explain our findings of reduced bacterial contamination on products from facilities that process both types of meats," says Davis.

The authors believe their findings have relevance for regulatory agencies and consumers. "How we raise animals matters," says Davis. "As a veterinarian, I recognize that we sometimes need to use antibiotics to treat sick animals, but taking advantage of opportunities to reduce antibiotics use could benefit everyone. Consumer choice and regulatory oversight are two strategies to do this."


Antibiotics in Your Food: What's Causing the Rise in Antibiotic-Resistant Bacteria in Our Food Supply and Why You Should Buy Antibiotic-Free Food

As the use of antibiotics in farming and raising livestock has increased, new antibiotic resistant bacteria, or "superbugs" are emerging. Here's what you need to know about antibiotics in your food and eating antibiotic-free food.

As the use of antibiotics in farming and raising livestock has increased, new antibiotic resistant bacteria, or "superbugs" are emerging. Here&aposs what you need to know about antibiotics in your food and eating antibiotic-free food. Watch: Visit a VT Chicken Farm

Last fall I flew halfway across the country to go grocery shopping with Everly Macario. We set out from her second-story apartment in Hyde Park near the University of Chicago and walked to the supermarket to buy a couple of rib steaks that Macario planned to serve to her husband and two children, ages 7 and 13. Macario, who is 46, holds a doctorate in public health from Harvard University and has spent decades as a consultant, working to prevent deaths from chronic conditions such as cancer and cardiac disease.

Yet she believes that what she buys-or more accurately, refuses to buy-in the supermarket is the most important action she takes, not only for her family&aposs health but for the health of every person in this country. "I am determined that no product from an animal that has been fed antibiotics will ever enter my home," she said as we walked along the meat counter peering at beef, poultry and pork. "I look for labels that read �rtified organic,&apos ‘no antibiotics&apos or ‘raised without antibiotics.&apos"

It&aposs not the antibiotics themselves that are troubling: animals pass the drugs through their systems long before they are slaughtered and animal products are tested for traces of antibiotics. What really worries Macario is the increasing wave of antibiotic-resistant bacteria that might be traveling on her food.

This article was produced in collaboration with the Food & Environment Reporting Network, an independent, non-profit news organization producing investigative reporting on food, agriculture and environmental health.

Macario has reason to be vigilant. Her 18-month-old son, Simon, died in 2004 from an infection known as methicillin-resistant Staphylococcus aureus (or MRSA, pronounced "mersa"). Simon was a husky, happy toddler. On his first birthday, Macario marveled to her husband that the baby had never been sick. Then one morning the boy awoke with, in Macario&aposs words, a "blood-curdling shriek." Rushed to the hospital, Simon was put on a heart-lung machine. "The doctors administered every available antibiotic," she said. "It didn&apost work. The bacteria were resistant to all of the medication." In less than 24 hours he was dead. "The bacteria released toxins that destroyed his vital organs," Macario said.

No one knows how Simon contracted the bacteria. He had never been to a hospital, once thought to be the primary incubators of MRSA. He had a robust immune system. He wasn&apost in child care. He had no cuts through which the bacteria could infect him. The germs that killed him were "community-acquired" MRSA-CA, meaning that he came in contact with them through everyday living, as opposed to "hospital-acquired" MRSA, a strain that is associated with medical centers and nursing homes.

While it remains unclear how MRSA infected Simon, what is known is that these antibiotic-resistant bacteria are on the rise. According to the Centers for Disease Control and Prevention, the incidence of MRSA in the United States more than doubled between 1999 and 2005, from 127,000 to 280,000, and MRSA-related deaths rose from 11,200 to 17,200. Perhaps it&aposs no coincidence that while the quantity of antibiotics given to humans has remained stable, the amount fed to livestock has soared. According to Food and Drug Administration records, antibiotic use on farms grew from about 18 million pounds in 1999 to nearly 30 million pounds in 2011.

Today 80 percent of the antibiotics used in the United States are fed to livestock. Theirs is a diet laced with low "subtherapeutic" doses of antibiotics, not to cure illness but to make the animals grow faster and survive cramped living conditions. The low doses kill many bacteria, but some develop mutations that make them immune to the same drugs that once destroyed them.

"It is very hard to prove that a specific antibiotic given to an animal for food production led to the development of a resistant bacterium in a specific patient," said Stuart Levy, M.D., president of the Alliance for the Prudent Use of Antibiotics and a professor at Tufts University School of Medicine. "But it is a truism that antibiotic use leads to resistance, and the more antibiotics you use, the more resistance you get."

By avoiding foods from animals that have been fed antibiotics, Macario believes she is doing more than just protecting her family from direct exposure to these "superbugs." She is attacking the plague at its source.

That Which Does Not Kill Me…
It&aposs hard to imagine that until World War II, infectious diseases such as pneumonia and tuberculosis were dreaded killers in this country. Beginning with the introduction of penicillin in the 1940s, these scourges could finally be cured with antibiotics. It was nothing short of a miracle. But scientists have always been aware that the miraculous antibiotics could become useless if they were underdosed and failed to knock out an infection completely. Bacteria are reproductive dynamos a single Staph can divide every 30 minutes, meaning that one resistant bacterium is able to erupt into a colony of more than 1 million in less than a day. In the presence of a nonlethal dose of antibiotics, bacteria can mutate to become resistant, breeding a new strain. Which is exactly what began to happen on farms across the U.S.

In the early 1950s, drug companies began marketing antibiotics for livestock after studies showed that low doses of penicillin, tetracycline, bacitracin and other drugs used to cure infections in humans made animals grow more quickly. Unfortunately, within two decades there was persuasive scientific evidence that the low-dose antibiotics were a recipe for disaster. In a seminal 1976 study, Levy administered small amounts of the antibiotic tetracycline to a flock of chickens. Soon, the chickens were carrying E. coli bacteria that were resistant not only to tetracycline, but to other antibiotics as well. Within weeks, the farmers who tended those birds also carried resistant bacteria.

A year later (1977), the Food and Drug Administration, the federal agency mandated to protect Americans&apos health, announced plans to ban feeding livestock low doses of antibiotics, which, according to the FDA, had not been "shown safe for widespread, subtherapeutic use." But bowing to pressure from legislators and agribusiness, the FDA failed to act on its recommendation, even after the American Academy of Pediatrics, the Centers for Disease Control and Prevention, the National Academy of Sciences, the U.S. Department of Agriculture and the World Health Organization identified subtherapeutic use of antibiotics as a human health issue. More than 30 years later, when the Natural Resources Defense Council and other groups sued in 2011, the FDA revoked its recommendation and said that a "voluntary" effort would be more effective.

Hog Heaven, Hog Hell
If there is a ground zero for the abuse of antibiotics in the United States, it&aposs probably Iowa, where hogs outnumber humans seven to one. During the 90-minute drive up I-35 from Des Moines to visit one farm, I was rarely out of sight of rows of long, low barns-each home to at least 2,000 pigs confined shoulder-to-shoulder in pens-known as CAFOs (Concentrated Animal Feeding Operations). In 2009, Tara Smith, Ph.D., a researcher at the University of Iowa, published a study that found that nearly half of the hogs at two large Iowa farms carried MRSA. More worrisome, 45 percent of the workers at those farms harbored the bacteria.

A study published in 2011 by the Translational Genomics Research Institute showed that MRSA was finding its way into our meats. Researchers analyzed 136 samples of beef, poultry and pork from 36 supermarkets in California, Illinois, Florida, Arizona and Washington, D.C. Nearly one-quarter of the samples tested positive for MRSA.

A Plague of New Superbugs
And it&aposs not only MRSA. During studies that lasted from 2005 to 2012, Amee Manges, a researcher at McGill University, found that supermarket chicken in Ontario and Quebec carried E. coli bacteria that bore a close genetic relation to strains that caused stubborn, drug-resistant urinary tract infections in 350 women she examined in Montreal. In 2011, antibiotic-resistant Salmonella in ground turkey sold by Cargill sickened 136 consumers in 35 states, killing one. An examination of pork chops and ground pork published by Consumer Reports in 2012 showed that almost two-thirds of samples tested positive for resistant Yersinia enterocolitica, a bacterium that causes food poisoning. Some meat was also contaminated with drug-resistant Salmonella, Staphylococcus and Listeria. While cooking meat properly will kill bacteria, every year thousands of people are sickened by them, and for some (especially the very young, the very old and those with weak immune systems) the illnesses can be fatal.

"We are calling on retailers and grocery stores… to commit to stopping these practices and stocking only meat that was raised without feeding antibiotics to healthy animals," Jean Halloran, director of food policy initiatives at the Consumers Union, said in a statement accompanying the release of the report.

Companies that sell the drugs used on livestock deny that there is a connection between resistant bacteria found in animals and humans. "There isn&apost sufficient data to draw the conclusions drawn by Consumer Reports that attribute resistant bacteria in pork to the animals receiving antibiotics," said Ron Phillips, vice president for legislative and public affairs at the Animal Health Institute, a trade group representing Bayer, Merck and other pharmaceutical companies. "Resistant bacteria are out there and can come from a lot of different sources. In fact, there have been numerous studies over the past decade that have examined potential pathways for antibiotic-resistant material to transfer from animals to humans."

Phillips contends: "Several of these assessments have been done on different kinds of antibiotics and each and every one of them, including one performed by the FDA itself, have come to the conclusion that there is a vanishingly small level of risk."

But it is virtually impossible to find a microbiologist unaffiliated with industry who agrees with him. "There are decades of evidence linking antibiotic use in food production with the emergence of drug resistance," said Lance B. Price, a professor at George Washington University&aposs School of Public Health and Health Services. "There&aposs very clear, sound science showing that the multi-drug-resistant strains emerged from drug use in food animal production then spread to humans. Anyone saying that there&aposs no data is either deceiving themselves or lying."

Price led a team of 33 researchers from 19 countries who tracked the origins and evolution of Staph associated with pigs and other meat animals. They discovered a nonresistant strain of Staph that originated in humans and was transmitted to livestock. There, it quickly became resistant to antibiotics and was passed back to humans as a virulent form of MRSA, according to a paper they published in 2012.

A Better Solution?
So could keeping antibiotics off the farm keep humans out of the hospital? In 2009, Tara Smith of the University of Iowa sought to answer that question. As part of the study, she took nasal swabs from Sarah Willis, Willis&aposs 11-year-old daughter, mother and father and their farm workers to test for MRSA. Smith was interested in the family because Sarah&aposs father, Paul Willis, founded Niman Ranch&aposs pork collective in the late 1990s. The operation has since grown to include more than 500 family farmers. Niman farmers never administer antibiotics to livestock nor do they confine their animals in CAFOs. On the day I visited Sarah Willis, the pigs on her family&aposs 800-acre property were playing chase with each other or snoozing in the late-autumn sunshine of their paddocks-a rare sight in Iowa.

Smith also tested nine other farmers who did not use antibiotics. And she tested nine farmers who did administer the drugs to their animals. The results? Even though all the farmers in her tests ran large, commercial pig operations, not one of the producers who avoided antibiotics tested positive for MRSA, while nearly half the farmers who routinely used antibiotics on their pigs carried resistant bacteria. In other words, avoiding the drugs on the farm might be one way of reducing the prevalence of these virulent strains.

The findings resonated with Sarah Willis. One of those pig CAFOs is less than a mile from her house. In 2011, there were seven cases of MRSA in her daughter&aposs school district. It took two rounds of antibiotic treatment to cure the youngsters. "I avoid meat raised on antibiotics due to health concerns," Willis said. "But it&aposs more important to me that I am voting with my dollars. I would rather spend my money on food that is raised responsibly."

The real tragedy of subtherapeutic antibiotic use is that it is unnecessary. Before joining Niman, Paul Willis administered antibiotics to his hogs. "And we had more health problems with our animals then than now," he said, when Sarah and I met him at a cafe. "Going antibiotic-free is not only good for people, but animals as well." Studies in Denmark, a major pork-producing country that banned subtherapeutic antibiotics in 2000 (followed by the rest of the European Union in 2006), confirm Paul Willis&aposs observations. In Denmark, incidences of resistant bacteria fell dramatically, in both people and animals, after the ban. Pork production rose.

A Demand for Drug-Free
For Willis, though, "it was a customer issue. My biggest customers pushed for the animals to be free from antibiotics, so I banned drugs." Companies that now refuse to sell meat produced with antibiotics include Whole Foods Market and Chipotle Mexican Grill, and the list is growing. Hyatt Hotels now offers antibiotic-free options at all its restaurants. At a time when sales of most meat and poultry products are flat, antibiotic-free-meat sales are climbing at a rate of 10 to 15 percent annually and sales from antibiotic-free pork alone now approach $500 million a year, according to Kevin Kimle, a faculty member in the economics department at Iowa State University.

Everly Macario is convinced that conscientious shoppers are the key to boosting those numbers. "If we buy only antibiotic-free meat, then demand for conventional meat will drop and more farmers will stop drugging their animals. It&aposs something every shopper can do." She does not stop at shopping: Macario helped found the MRSA Research Center at the University of Chicago Medical Center. She also became the leader of Supermoms Against Superbugs, which met with food-policy legislators in Washington, D.C., in 2012 to discuss ways to keep antibiotics viable.

But to date, there has been no solid progress. Congresswoman Louise Slaughter, a Democrat from upstate New York and a microbiologist by training, has repeatedly tried to legislate limits on the use of the drugs in animals, without success. In an email, Slaughter said, "With the threat of antibiotic resistance higher than ever, I will once again introduce the Preservation of Antibiotics for Medical Treatment Act at the start of the 113th Congress. As the science continues to make clear, there is no more time for delay."

Macario is frustrated. But while the FDA stonewalls and Congress dithers in the face of intense lobbying from agribusiness and pharmaceutical companies, there is one way to effect change.

"I love meat," Macario said during our visit to the supermarket. "I crave it. I&aposm originally from Argentina. My grandfather raised cattle." At the store, Macario zeroed in on Rain Crow Ranch grass-fed steaks. The package was not labeled "antibiotic-free," but Macario had researched the company and its farms and was confident that they never used antibiotics. The steaks, at $21.99 a pound, were pricier than the same cuts raised with antibiotics (though the Consumer Reports survey found that many antibiotic-free meats cost the same or in some cases less). All the other meats, dairy products and eggs she chose had similar assurances of avoiding antibiotics.

"When I shop for food, I always try to remember what one consumer advocate in Washington told me," Macario said. "Congress and big agricultural interests are scared to death of moms."


Bacteria On The Rise: The Fight Against Antibiotic Resistance

Not too long ago infectious diseases where the plight of humanity. A high fever was almost a death sentence, and any birth or surgical procedure carried an enormous risk of complications through infections.

But In 1928, Alexander Fleming discovered a compound he called penicillin. It was to change the world of medicine forever. In the war against disease, humankind suddenly had the advantage. It took a decade until the world realised the impact of this discovery. World War II saw the first widespread use of this antibiotic to treat wounded soldiers and what a difference it made. It seemed to beat a major human predator that was capable of keeping the population at check.

Since penicillin, about 100 antibiotic compounds have been discovered. In the developed world, there is probably no one who has not had a course of antibiotics in their lifetime. Even though this miracle fell into our hands less than a century ago, its success has gifted us with a sense of security when it comes to bacterial infections. In fact, our trust in antibiotics has grown so big that we do not remember the fight against infection, we do not know what it must have been like to be helpless against bacteria, to rely on our immune system and painkillers alone to ward off deadly inflammations.

Antibiotics are as common as aspirin, routinely prescribed, all too often consumed unnecessarily. This sense of security is false and has been from the very beginning. Our careless treatment of this accidental miracle puts us on the brink of a new dark age of medicine as bacteria are fighting back.

What we have taken for granted was not a human invention – but merely a discovery of compounds that bacteria and other microorganisms have been using for ages to win little advantages in the eternal struggle for space and nutrients. We believed that the war was won, but when it comes to antibiotics we are fighting on the enemies’ turf. Antibiotic resistance is not just the buzzword of the century, it is as old as bacteria themselves, who have evolved to develop, refine and transmit resistance.

Unfortunately, what might be portrayed as a shocking surprise for the healthcare system has, in fact, been a long time coming. Resistance to penicillin was recorded as early as the mid 1940s. In 1960, cases of resistance were rampant. The first multi-resistant bacterium MRSA (methicillin resistant staphylococcus aureus) was discovered in 1961, a strain resistant to all beta-lactam antibodies. This was just the beginning of the dawn of antibiotic resistance.

Another prominent re-emergence of a disease linked to multi-drug resistance is tuberculosis. Almost eradicated at one point from the mind of people in the developed world, now strains of the bacteria resistant to all first and second line antibiotics are on the rise in several countries. In 2013, the Center for Disease Control (CDC) released a list of bacteria of concern, categorising the most troublesome emergences of resistant bacteria into three hazard categories: urgent, serious and concerning. As of 2016, twelve diseases, including tuberculosis, fell into the serious category and pose significant threat of developing into urgent problems without further investment into prevention. Urgent public health threats are those bacteria with even higher resistance to antibiotics that might not yet be widespread, but have the potential to become uncontrollable risks. This category already includes Colstridium, causing a quarter of a million infections per year, carbapenem-resistant Enterobacteriaceae (CRE) and drug resistant gonorrhea. It is likely that the number of diseases categorised as urgent threats will rise.

As bacteria are starting to gain ground, the discovery rate for new antibiotics has stalled.

Overall, currently used antibiotics can be sorted into four categories based on their point of attack within the bacterium. The mechanisms targeted are cellular pathways unique to bacteria. The effects of the compounds are by design directed at bacterial cells only. Despite that, some antibiotic classes carry severe side effects, leading to heavy overuse of safer antibiotics. The requirement of drugs to only hit targets characteristic to bacterial cells, but not harm human cells, limits the pool of possible new targets for future antibiotics. This is a disadvantage for future discovery that further enhances the problem of antibiotic resistance.

Bacteria have ways to survive attacks. Resistance mechanisms include enzymes that can inactivate the attacking chemical compound directly, protective mutations in the antibiotic target and even pumps that excrete the antibiotics from the bacterial cell before they can take effect. They also have ways to communicate their evasive advantage to other bacteria through transfer of genetic material. Their high growth rate coupled with evolutionary pressures allows them to adapt quickly through mutations that give them an evolutionary advantage, allowing for new forms of resistance to emerge.

The incorrect use of antibiotics by patients and overprescription is not the only source of overuse. Low doses of antibiotics given to farm animals to promote muscle growth has been banned in many European countries since the 1970s when this practise was associated with an increase in bacterial antibiotic resistance. However, this method of enhancing meat production is still in use in most of the world. In 2013 the FDA has released a guidance (#213), which advises fading out of the use of medically important antibiotics until 2017.

Can a post-antibiotic era be prevented?

In recognition of this spiralling global problem, the UN met to discuss the state of antibiotic resistance and possible solutions in September 2016. The resulting paper agrees with a proposed plan of action published by the World Health Organisation in 2014.

A part of the problem is to be tackled by increasing training of the public and healthcare professionals on the use and prescription of the drugs. At the same time, antibiotics that are not yet associated with widespread resistance are to be limited to emergency uses.

The efficiency of some antibiotics can be supported by the additional treatment with inhibitors for the resistance mechanism. Furthermore, development of resistance can potentially be fought with antibiotic cocktails that target several bacterial weak points.

While these measures are necessary to stall the development of further resistance, new approaches and ideas are needed to bring us to a position of continued protection.

The road to securing our continued lead in the fight against bacterial resistance is stony, and added difficulties stem from very worldly problems. The pharmaceutical industry has been facing a crisis for the last decade, which has led to restructuring of research foci. Fighting for their financial survival, antibiotics and antibiotic research- an area where new hits are increasingly unlikely to be generated and with traditionally low-priced finished products - have not been priorities in the industry’s research agenda, as they represent high risk-low gain investments.

As a result, the challenge is left to academic research and industry collaborations to bring fresh ideas into this dire situation. The last few years have seen several advances that raise hope in the approach from academia - where even the most obscure sounding ideas have a chance to blossom and develop into our saving grace.

In essence, the discovery process for modern antibiotics is not different from how Flemming discovered penicillin, since synthetic approaches to antibiotic discovery have not been successful. Trusting the brilliance of evolution, natural habitats of bacteria are screened for antibiotic substances produced by competing microorganisms. Most new antibiotics have been found in cultured microorganisms from soil samples. Given that only 1% of microorganisms are cultivable with current methods, there is a huge number microorganisms out there we have not tapped into yet and they can potentially produce antibiotics. This revelation precisely led to the discovery of one of the truly novel and potent antibiotic compounds: teixobactin. This discovery emerged through an innovative technique that allowed researchers to grow previously uncultivable bacteria and it creates promise of the discovery of more lead compounds in the future.

A further promising novel antibiotic substance, lugdunin, was discovered in 2016. It was thanks to scientists’ curiosity about the lack of Staphylococcus aureus in specific samples of human nasal microbiota and their inspiring out-of-the-box thinking that led to the discovery. Venturing even further into the unknown, some researchers have discovered that fungi growing in the fur of wild sloths contain natural compounds with antibiotic properties. Other approaches are focused on age-old remedies like honey, which has been valued for its wound healing properties in ancient Egypt and earlier, but its active ingredients remain mysterious. In the search for ever-new antibiotics, these creative approaches might just be what the doctor ordered.

Small molecule and peptide antibiotics are currently the best weapons against bacteria but, even though we might be able to find new versions of them and utilise them yet a little longer, we are still like Alice and Queen of Hearts: constantly running only to remain in the same spot. To get a step ahead of the game again, we might want to consider yet other possibilities. Phage therapy, for example, has been of some interest for years. The idea is to use bacteria's own natural predators to hunt them down. Developing resistance to a small molecule is easily achieved by little adjustments to the drug target. Fending off a highly selective and much more complex phage, however, is not so easily done. Even though some cases of success have been recorded for experimental phage therapy, until recently the redesign of phages for medical purposes has been a difficult endeavour. The emergence of the CRISPR/Cas9 system as an easily accessible research tool gives us the ability to edit genes more easily than ever before and might be just the tool that makes recoding phages for conventional therapy attainable.

Finally, the ultimate protection against bacterial infection might simply be our own immune system. Nothing is as capable as our bodies at recognising and eradicating previously encountered pathogens. Widespread immunisations and the development of new vaccines will help relieve the burden on antibiotics one disease at a time.

As we protect the status quo with the necessary policies and strengthen our position with new antibiotic compounds, innovative technologies and vaccines, it is imperative to remain conscious of our limited knowledge about nature. Even though we have come a long way since Alexander Flemming and our understanding of diseases and their possible cures is astounding in comparison, we will likely never fully comprehend the intricate mechanisms that contribute to the emergence of resistance. Knowledge is power and identifying unknown details of the workings of nature will help design strategies for disease and resistance prevention.

The use of antibiotics has saved countless lives. We might not remember what the world was like without these miracle drugs, but we might be on the brink of revisiting a pre-antibiotic time. We need to start valuing this tool more and accept that maintaining the lead we have in this race against evolution will take constant effort and innovation. Policy makers, researchers and pharmaceutical companies are beginning to pick up the challenge. However, this is an issue everyone can contribute to by responsibly handling one of the last century's greatest gifts to human health.

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