…now what? When I’m not blogging
or fighting crime, one of the things I do is worry (along with some science!) about the spread of antibiotic resistance. The U.S. government has several programs that monitor the spread of antibiotic resistance, both in the clinic and the food supply (e.g., NARMS). Right now, these programs are looking for carbapenem-resistant bacteria (‘CREs’): these organisms are resistant to any drug that begins with cef-, ceph-, or ends with -cillin, and are often resistant to all other drugs, with the exception of colistin which can cause renal failure and often doesn’t seem to be that effective even against bacteria that, in the lab, are sensitive to colistin.
Needless to say, finding a CRE in a foodborne isolate would be an all-hands-on-deck emergency, a Joe Biden-sized Big Deal.
A colleague who has been combating antibiotic resistance since it was initially recognized as a problem, once told me, “When we saw the very first cases of MRSA, if we knew then what we know now, we would have rigorously isolated those patients, screened the workers rigorously, moved screened patients to other facilities, and then burnt those hospitals to the ground.” I think he was joking about the hospitals. Maybe.
So if we find a CRE in food we should take really strong action: recall the product, screen the plant and the workers, shutter the plant until we figure what is happening, and so on, since we often do this for ‘ordinary’ cases of microbial contamination.
Here’s the problem: there are plenty of cases where we couldn’t do this. Put another way, the only way we would be able to do this is by accident: the CRE would have to happen to occur in a ‘zero-tolerance’ food product (e.g., processed foods such as ‘nut butter‘). But if it was seen on a meat product–in English, a piece of meat you buy from the grocery store–unless it happens to be one of a handful of E. coli strains (some Shigatoxin producing strains), there really isn’t much that can be done from a regulatory perspective. If detected at a plant, unless a certain threshold of contamination is breached (i.e., greater than X percent of pieces are contaminated, depending on the type of meat), there’s nothing the government can do other than ask nicely.
To the best of my knowledge, and I’m not speaking out of total ignorance here, there is no plan to deal with this potential problem when it occurs. And, yes, I wrote when, not if.
Unfortunately, hope isn’t a good public health plan.