{"id":1385,"date":"2015-04-21T09:03:10","date_gmt":"2015-04-21T13:03:10","guid":{"rendered":"http:\/\/allphasepharma.com\/dir\/?p=1385"},"modified":"2015-04-21T10:06:31","modified_gmt":"2015-04-21T14:06:31","slug":"an-inconvenient-truth-ciprofloxacin-resistant-campylobacter","status":"publish","type":"post","link":"https:\/\/allphasepharma.com\/dir\/2015\/04\/21\/1385\/an-inconvenient-truth-ciprofloxacin-resistant-campylobacter\/","title":{"rendered":"An Inconvenient Truth: Ciprofloxacin-Resistant Campylobacter"},"content":{"rendered":"

When Al Gore became a best-selling author with \u201cAn Inconvenient Truth\u201d he warned about climate change.\u00a0 When it comes to antibiotic resistance and the current situation of \u201cBad Bugs, No Drugs\u201d, there are many voices warning us about a return to the pre-antibiotic era.\"An<\/a><\/p>\n

Why does it take so long to create awareness when receding glacier and arctic ice give us documented facts and figures?\u00a0 Why don\u2019t regulators stop the use of antibiotics in veterinary medicine when antimicrobial resistance trends are overwhelmingly showing the consequence of current practices?\u00a0 What does it take to change a mindset, or health policies?<\/p>\n

Take campylobacter as an example.\u00a0 A common enteric pathogen in humans, its source is livestock.\u00a0 This organism was only recognized in 1972 as a cause of human GI infection but we soon learned that it is a leading cause in most bacterial intestinal infections.<\/p>\n

Enter ciprofloxacin, enrofloxacin and other fluoroquinolones (FQs). Microbiologic data in the early 1980ies showed\u00a0universal activity against campylobacter\u00a0and other enterics. \u00a0A great new drug class for humans, and great for animals too, had entered the scene. \u00a0Unsurprisingly, broiler units in many countries found it to great advantage to use FQs.\u00a0 In fact, most chickens were given FQs for 30+ days during\u00a0their 35 days of broiler life before slaughter.<\/p>\n

As would be expected, with widespread use, resistance to ciprofloxacin rose at an alarming rate:<\/p>\n

\"Table<\/a><\/p>\n

Is there really a\u00a0difference in resistance rates between the US and other parts of the world? \u00a0While the table seems to suggest a lower incidence in the US, this impression may not be accurate.<\/p>\n

\"Campy
US, EU, UK, French Breakpoint Categories for Campylobacter sp.<\/figcaption><\/figure>\n

Comparing resistance rates across regions runs into a\u00a0major confounder: different breakpoint definitions. \u00a0A campylobacter with an MIC of 1 mg\/L designated\u00a0as R (resistant) by EUCAST criteria would still be considered fully susceptible in the US using CLSI criteria.<\/p>\n

Clearly, MIC data clarity would provide more clarity than breakpoint categories which change\u00a0ever so often. If cross-country comparisons are impossible because source MIC data are not available, one\u00a0would hope that longitudinal surveillance data would provide reasonable trend information.<\/p>\n

A PubMed search (2010 till now) with the search terms: campylobacter \/ ciprofloxacin \/ resistance \/ poultry came up with recent publications\u00a0from: France, Poland, Portugal, China, Italy, Turkey, the Philippines, Canada, UK, Chile, Brazil, Germany, Japan, Australia, even Vietnam, Jordan and Ethiopia.\u00a0 Blatantly missing were publications from the USA describing the US situation.<\/p>\n

When concerns about quinolone resistance finally resulted in legislative action preventing their indiscriminate use in veterinary use, it came much later in the US (2004) than in EU countries which had implemented safeguards and initiated surveillance measures earlier. Unfortunately, there is hardly any\u00a0data to show whether the situation in US broiler units has changed since 2004.<\/p>\n

So, what do with know about campylobacter resistance in the US? \u00a0Surprisingly little. The CDC report quoted above is based on data before 2010.<\/p>\n

What is available is spotty and uninterpretable for most part. \u00a0Zhao reports that US meat sampled for campylobacter were ciprofloxacin-resistant in 58%[1]<\/a>. \u00a0Lower rates were\u00a0found in pigs (17%)\u00a0[2]<\/a>\u00a0and in cattle (38%)\u00a0[3]<\/a>.\u00a0 As would be expected, resistance rates vary widely and are influenced by campylobacter species, geographic location, livestock tested, broiler unit, antibiotic use…<\/p>\n

Once upon a time, erythromycin and FQs were the treatment of choice for human campylobacter infections.\u00a0 No longer: now treatment with azithromycin (for moderately severe infection) or penems, chloramphenicol and gentamicin (for severe infections) is recommended[4]<\/a>.<\/p>\n

It seems that carbapenems are being used so much nowadays that the end of their effective life-span is forseeable.\u00a0 If \u00a0the fear of CRE pathogens and the advent of KPC strains not enough to convince everyone that our current practice is irresponsible and shortsighted, if not to say foolish, what does it take to stop current practice?<\/p>\n

Al Gore to the rescue?\u00a0 He is already solidly booked out \u2026sorry, no such luck!!<\/p>\n

 <\/p>\n

References:<\/strong><\/p>\n

[1]<\/a> Zhao J Antimicrob Chemother. 2015 May;70(5):1314
\n[2]<\/a> Macarena\u00a0 Appl Environ Microbiol. 2012 Apr; 78(8): 2698
\n[3]<\/a> Sanat\u00a0 PLoS One. 2011; 6(10): e25778
\n[4]<\/a> Mandell\u00a0 Principles and Practice of Infectious Diseases. Chapter 218: Campylobacter jejuni and related species<\/p>\n","protected":false},"excerpt":{"rendered":"

When Al Gore became a best-selling author with \u201cAn Inconvenient Truth\u201d he warned about climate change.\u00a0 When it comes to antibiotic resistance and the current situation of \u201cBad Bugs, No Drugs\u201d, there are many voices warning us about a return to the pre-antibiotic era. Why does it take so long Continue reading An Inconvenient Truth: Ciprofloxacin-Resistant Campylobacter<\/span>→<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":1397,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[18],"tags":[955,403,950,953,948,949,947,915,639,42,575,41,363,945,952,626,5,509,951,351,954,946,528],"class_list":["post-1385","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-the_viewpoint","tag-al-gore","tag-antibiotic-blog","tag-breakpoint-differences","tag-broiler-units","tag-bsac","tag-ca-sfm","tag-campylobacter","tag-carbapenem-resistance","tag-cdc","tag-ciprofloxacin","tag-ciprofloxacin-resistance","tag-clsi","tag-cre","tag-enrofloxacin","tag-epidemiology-of-campylobacter-resistance","tag-eucast","tag-fda","tag-fluoroquinolones","tag-inconvenient-truth","tag-kpc","tag-mic-breakpoint-harmonization","tag-resistance-development","tag-veterinary-use-of-antibiotics"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2015\/04\/An-Inconvenient-Truth1.jpg?fit=640%2C180&ssl=1","jetpack_shortlink":"https:\/\/wp.me\/p4KWFr-ml","jetpack_sharing_enabled":true,"jetpack-related-posts":[{"id":2174,"url":"https:\/\/allphasepharma.com\/dir\/2015\/12\/07\/2174\/food-for-thought-sprinkled-with-small-amounts-of-antibiotic-residues\/","url_meta":{"origin":1385,"position":0},"title":"Food for Thought, Sprinkled With Small Amounts of Antibiotic Residues","author":"Harald","date":"December 7, 2015","format":false,"excerpt":"80% of antibiotics worldwide are used in veterinary medicine. 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