Do antibacterial soaps and wipes have any effect on antibiotic resistance? Should we use them in the home?

Over the Christmas holiday, our kitchen has fed more people than normal and cleaning has therefore increased.  I have been giving a lot of thought to the possible benefits and risks of using antimicrobial cleaners and soaps.  When you get into this subject, you find it is actually quite complex.

I have written about something similar before, but there is now a lot of published work that suggests that in most cases, there is no benefit to using antibacterial soaps in the home - there is no statistically significant reduction in infectious disease if antibacterial preparations are used in preference to soap and water*.  Nevertheless, in the US alone, nearly $1 billion per year is spent on antibacterial soaps**.

Of course, many infectious diseases are caused by viruses; they are probably not affected by antibacterial compounds, which have a definite target in the bacterial cell.  Thus, an antibacterial soap or wipe will be no better at preventing transmission of cold viruses than a thorough cleaning with soap or detergent and water.

I have recently been asked to review a couple of scientific papers in which evidence is presented that suggests cleaning agents commonly used in the food industry may induce antibiotic resistance in bacteria.  Antibiotic resistance results when bacteria develop enzymes capable of breaking down the active component of the antibiotic.  One of the first instances of antibiotic resistance occurred very soon after the introduction of penicillin.  Bacteria developed the ability to break the beta-lactam ring of penicillin with an enzyme called beta-lactamase.  (Antibiotic resistance genes can often be transferred from one bacterium to another, so in time, many bacterial strains become resistant.)

We already know that many of our antibiotics are no longer effective because of resistance.  Overuse of antibiotics is blamed.  It is ironic that our cleaning agents may also be causing resistance.

But there is another potential driver for antibiotic resistance: sub-lethal exposure of bacteria to certain herbicides have been shown to change antibiotic susceptibility of Escherichia coli and Salmonella enterica serovar Typhimurium***.  This is not a straightforward relationship, but it is clear that there is the potential to select for antibiotic resistance in these bacteria, which, if transferred to humans by contact with animals and food, can potentially reduce the effectiveness of antibiotic therapy.

Well, that's fairly heavy for the first post of 2016, but it should cause us to think when purchasing home cleaning agents and soaps, or chemicals for use in agriculture and domestic gardens.




* Effect of Antibacterial Home Cleaning and Handwashing Products on Infectious Disease Symptoms.  Larson, Elaine L;Lin, Susan X;Gomez-Pichardo, Cabilia;Della-Latta, Phyllis.  Annals of Internal Medicine; Mar 2, 2004; 140, 5

** https://www.nrdc.org/health/files/antimicrobials.pdf

*** Kurenbach B, Marjoshi D, Amábile-Cuevas CF, Ferguson GC, Godsoe W, Gibson P, Heinemann JA. 2015. Sublethal exposure to commercial formulations of the herbicides dicamba, 2,4-dichlorophenoxyacetic acid, and glyphosate cause changes in antibiotic susceptibility in Escherichia coli and Salmonella enterica serovar Typhimurium.  
mBio 6(2):e00009-15. doi:10.1128/mBio.00009-15.

Unsafe Hospital Food? There is a greater concern

A couple of days ago, I came across a reference to a report that claimed 85% of raw chicken delivered to the University Hospital in Geneva tested positive for strains of Escherichia coli resistant to extended-spectrum beta lactam antibiotics. These antibiotics belong to the penicillin family. The original study was published in  Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.  (Unfortunately, when I tried it, the link was broken).
Apparently, there were workers in the hospital kitchen who tested positive to carriage of the ESBL E. coli, however, the frequency was no greater than in the general population.

The finding of the high rate of contamination with ESBL resistant bacteria in the raw chickens is a concern, not because patients were at risk, but because it indicates that the poultry flocks had probably been exposed to antibiotics that are still used in therapy.  Proper procedures in the kitchens should ensure that the contaminating bacteria are destroyed and that cross contamination from raw meat to cooked or fresh foods is controlled.

The use of antibiotics in animal husbandry is leading to increased incidence of antibiotic resistant bacteria.  See my previous posts on antibiotics:  http://foodsafetywithjaybee.blogspot.co.nz/2011/11/time-to-ban-antibiotic-use-in-animal.html    
et seq.

When I gave my inaugural lecture as Professor of Food Microbiology, I reviewed the developments in microbiology that led to the discovery and development of penicillin.  Before the advent of this antibiotic, a simple scratch with a rose thorn could be a death sentence if the scratch became infected.  It would be a catastrophe if we returned to those days because we had squandered our slim advantage over the pathogenic bacteria for short term financial gains by the animal rearing industries.

Antibiotic Resistance in the Environment

Recently I wrote a post about excessive use of antibiotics in animal rearing and the potential for spread of antibiotic resistant bacteria.

One of my research students is studying the presence of antibiotic resistance genes in bacteria in stream and river muds, comparing pristine waters with polluted along a stretch of a river in the Waikato region of New Zealand.

She sampled mud from the river and isolated bacteria.  Her next step was to test the bacteria for resistance to a set of antibiotics drawn from two classes of antibiotics used in animal rearing and human therapy.

The results are surprising:  of 40 isolates, only one was sensitive to any of the antibiotics tested.  At this stage, there is no smoking gun, but it is certainly of concern to see such antibiotic resistance in so many different bacteria in the environment.

***. This article was published on 05/12/2012.  I recently read another article by Jack Heinemann and Sophie Joy van Hamelsveld in Stuff:  https://www.stuff.co.nz/pou-tiaki/300930926/antibioticresistant-bacteria-in-wild-cockles-and-watercress-putting-people-at-risk-of-serious-illness.  

This raises yet another concern about antibiotic resistance.  The testing of water for recreational use does not guarantee that mahinga kai, wild-harvested foods, such as shellfish, are safe to eat.  Shellfish can concentrate bacteria from the water to high levels, even when the tested water appears to be safe. ***

More on antibiotic use in animal rearing

I wrote last month, suggesting that it is high time we banned the sub-therapeutic use of antibiotics currently used in human therapy for animal rearing. 

When I wrote the article, I was not aware that the Food and Drug Administration had, around 9th November 2011, rejected two petitions to ban antibiotics from being used in food animal production. The petitions were filed by a coalition that included  the American Public Health Association and the Union of Concerned Scientists.

It is troubling that in its denial letter, the FDA acknowledged that its “experience with contested, formal withdrawal proceedings is that the process can consume extensive periods of time and agency resources.”  I interpret that to mean that FDA may well think that antibiotic use should be banned, but it can't afford to force the issue.

Meanwhile, researchers at McGill University have shown that bacteria resistant to tetracycline and tylosin can be isolated from pigs raised in a swine complex 2.5 years after administration of these antibiotics ceased.  See Microbial Ecology  DOI 10.1007/s00248-011-9954-0  published on-line 14th October 2011.  Antibiotic resistance genes were found in the bacteria, though the workers were not able to explain their persistence long after antibiotic use ceased.  The results are of significance for both animal and public health because these antibiotic resistant bacteria can be transferred between animals, humans and the environment.

Time to ban antibiotic use in animal husbandry?

As a microbiologist, I sometimes worry that we are killing the golden goose in terms of our ability to combat human disease.  As I wrote earlier, the cost of developing and bringing to market new drugs is astronomical and many companies are shunning new drug development in favour of more lucrative endeavours, such as development of molecular-based test kits for human disease diagnosis.

In this light, it is disturbing to read of the amount of antibiotics used in animal production.  In 2001, Kristin Leutwyler wrote in Scientific American that a study by the Union for Concerned
Scientists had shown meat producers in the USA feed around 25 million pounds of antibiotics to chickens, pigs and cows for non-therapeutic purposes each year (the antibiotics suppress microbial populations and lead to increased growth rates of the animals).  Compared with this, only 3 million pounds per year are used for treating human disease.

In 2009, the House Committee on Rules held a hearing: H.R. 1549 - Preservation of Antibiotics for Medical Treatment Act of 2009, which would have amended the Federal Food, Drug, and Cosmetic Act to require the Secretary of Health and Human Services to deny an application for a new animal drug that is a "critical antimicrobial animal drug" (CAAD) unless the applicant demonstrated a reasonable certainty of no harm to human health due to the development of antimicrobial resistance attributable to the non-therapeutic use of the drug.

The CAAD is a drug intended for use in food-producing animals that contains specified antibiotics, or other drugs used in humans to treat or prevent disease or infection caused by microorganisms. The Rule would also require the Secretary to withdraw approval of a non-therapeutic use of such drugs in food-producing animals two years after the date of enactment of the Act unless certain safety requirements are met.

That rule died in Committee.  It has been reintroduced in the 2011-2012 Congress, and went to Committee on 9th March, 2011. 

It has been argued that there are no good studies linking antibiotic use in animal rearing to the development of antibiotic-resistant diseases.

While this may be so, and I'm not sure that it is, it is hard to imagine how else multiple antibiotic resistant strains of bacteria could be found in animals and ultimately in humans.  A classic experiment shown to most undergraduate students of microbiology over the last 50 years is the selection of antibiotic-resistant bacteria.  All that is required is the production of a concentration gradient of antibiotic across a Petri dish.  The agar is seeded with the target bacteria and those that grow at the most concentrated side are picked off and recultured on another gradient.  Very quickly, a resistant strain can be isolated.

This laboratory procedure is effectively repeated in animals fed sub-therapeutic levels of antibiotics in their diet or drinking water - the survivors of the first dose are constantly exposed and eventually dominate the population.  As microorganisms transfer genetic information among themselves, the number of different strains resistant to the antibiotics also increases.

I would be less concerned if the antibiotics used for treating animals were no longer in use for human therapy.  Then the benefits could perhaps be justified, though even then, the class of antibiotic is important, as bacteria becoming resistant to one member of the class might also develop resistance to others.  If humans become infected by strains resistant to antibiotics used in human therapy, there may be no cure available for the infection.  These infections could easily be transferred by handling raw meats from treated animals, though there is again a lack of sound scientific evidence.

The view is clouded by the indiscriminate use of antibiotics by humans.  It's not just a case of doctors prescribing antibiotics when they are not justified, though I have seen antibiotics prescribed for viral diseases, which generally can't be treated with these chemicals.  Look up "availability of antibiotics over the counter" and you will get pages telling you that there is none.  However, it is well known that antibiotics can be bought freely over the counter in some countries.  Even the antibiotics of last resort - the only ones that can treat certain diseases - can be bought in pharmacies in some Asian countries and there are papers in the scientific literature showing the levels of resistance in bacterial populations.

I truly hope that President Obama eventually signs this legislation and that leaders of other countries do likewise.  I would hate for us to descend to the state before the introduction of penicillin, when even a scratch from a rose thorn could result in painful death.

Walls have ears and bacteria have antibiotic resistance

Recently, I was having my lunch at a conference and couldn't help overhearing a conversation between two people sitting alonside me.  I suppose I should have tried not to listen, but their discussion was in my own field.

It appeared that one of them had read a survey conducted on the bacteria isolated from poultry in USA.  Even "organically grown" chicken contained bacteria that displayed multiple-antibiotic resistance.  This implies that the chicken farms may be using antibiotics in the flock rearing operation, though it doesn't necessarily prove the point.

Without getting into the rights and wrongs of using antibiotics in rearing of "organically grown" poultry, this does point to a wider concern: that farmers may be using sub-therapeutic levels of antibiotics widely to improve growth rates and yields of all meat animals.  Any bacteria that survive and grow in the presence of antibiotic are likely to be resistant to the chemicals and if these bacteria should go on to infect humans, those antibiotics will be useless for treatment.

I'm not sure if these people were talking about a survey*** conducted by the Translational Genomics Research Institute (TGen) in Arizona.  These scientists tested 136 samples of 80 brands of beef, chicken, pork and turkey collected from 26 retail stores in five US cities.  They found that nearly half of the samples contained Staphylococcus aureus and that just over half of these isolates were resistant to at least three classes of antibiotics.  Further analysis suggested that the bacteria were from the animals and not from the processing factories, again indicating that antibiotics had probably been used in rearing the animals.

It might make meat more expensive, but I believe that governments must force the reduction in the amount of antibiotics used in animal rearing if we are to avoid catastrophic consequences for the human population in the near future.  Remember: it has been estimated that the cost of getting a new drug onto the market is now between 2 and 3 billion dollars.  We aren't going to get many new drugs at that rate.



*** The full report is available at:

http://dx.doi.org/10.1093/cid/cir181

(The report is a technical report, intended to be read by other scientists, but anyone should be able to follow the discussion).