Denmark's Case for Antibiotic-Free Animals

NEW YORK, Feb. 10, 2010

Denmark's Case for Antibiotic-Free Animals

Katie Couric Reports on Denmark's Ban on Antibiotics in Livestock

CBS) They call it the "Danish Experiment" - a source of pride for the country's 17,000 farmers. CBS Evening News Anchor Katie Couric reports how unlike industrial farms in the U.S., which use antibiotics to promote growth and prevent disease, farmers in Denmark use antibiotics sparingly, only when animals are sick.

The experiment to stop widespread use of antibiotics was launched 12 years ago, when European studies showed a link between animals who were consuming antibiotic feed everyday and people developing antibiotic resistant infections from handling or eating that meat.

"We don't want to use more medicine than needed, and a lot of the medicine that is given is not needed," said Soren Helmer. Helmer is a second-generation pig farmer whose sows produce more than 30,000 pigs a year. When the ban started, he and his father thought the industry would suffer.

"We thought we could not produce pigs as efficient as we did before," Helmer said. "But that was proven wrong."

Since the ban, the Danish pork industry has grown by 43 percent - making it one of the top exporters of pork in the world. All of Europe followed suit in 2006. But the American Pork Industry doesn't want to.

"What we've seen in Denmark and other countries is that they actually have had some increases in cost of what it takes to produce a pig," said Liz Wagstrom, a veterinarian with the National Pork Board.

"So it's not that unqualified a success. If we did the same thing in the United States, we would likely see small producers pushed out of business, we'd have more sick and dying pigs, and none of that would result in a benefit to the U.S. consumer."

Without growth-promoting antibiotics, it only costs $5 more for every 100 pounds of pork brought to market in this country.

Animal Antibiotics a Threat?

That's a small price for public health, says Dr. Ellen Silbergeld, who has been studying the antibiotic resistance link between livestock and people for the past decade.

"I think the Danish and European experience indicate that there will be real and measurable public health benefits," she said. "There'll be improvements in food safety and actually in the prevalence of drug resistant infections in people."

Pew Campaign on Human Health and Industrial Farming

According to one study, when different countries introduced certain antibiotics on farms, a surge occurred in people contracting antibiotic resistant intestinal infections one to two years later. One infection, Campylobacter, increased 20 percent in Denmark and 70 percent in Spain.

After the ban, a Danish study confirmed that removing antibiotics from farms drastically reduced antibiotic-resistant bacteria in animals and food.

Danish scientists believe if the U.S. doesn't stop pumping its farm animals with antibiotics, drug-resistant diseases in people will only spread.

"It's not going to be a time bomb that goes off like this," said Dr. Frank Aarestrup, of the Danish Food Institute at the University of Denmark. "It's something that's slowly getting more and more complicated, more difficult for us to actually treat infections.

Rep. Slaughter's "Preservation of Antibiotics for Medical Treatment Act"

Some American food producers agree.

"It's just gone too far," said Stephen McDonnell, CEO Applegate Farms.

"What most bothers you about the way industrial farmers in this country currently operate," Couric asked.

"We use too many antibiotics, we use too many growth promotants," McDonnell replied. "The singular focus is to create cheap meat. That's not always the best thing for the health of the Americans who buy it."

"We think with some subtle changes - giving them more space, feeding them a good diet, and not stressing them out by growing them too quickly - you don't even need to use antibiotics," McDonnell added.

McDonnell helps farmers like Duane Koch kick the habit.

"How long have you been raising turkeys, Duane, without using antibiotics," Couric asked.

"We started running without antibiotics roughly 14 years ago," Koch replied.

"Does it make you feel better doing it this way," Couric asked.

"Yeah," Koch said. "Because really, from using the antibiotics so long, a lot of them didn't work well any way anymore."

Today his 18 poultry farms scattered throughout Pennsylvania are more profitable than when he used antibiotics.

Koch says it costs very little to convert a farm to antibiotic-free. And it doesn't cost consumers much more either. People buying antibiotic free turkey thigh meat will spend around $1.40 versus $1.20 for conventionally raised birds.

Koch says higher-quality feed and improving living conditions, his birds are naturally healthier.

Couric asked, "What's the importance of giving them more space?"

"That's just our natural growth promotants," he said. "By giving them more space, we can get weights that are really close to what they're getting, you know, with the growth promotants."

Because farmers are raising livestock successfully without growth-promoting antibiotics - from Lebanon, Pennsylvania to outside Copenhagen - public health officials in this country say this is an idea whose time has come.

"We have identified here that we're talking about a public health issue, that the overuse of antibiotics on farms does pose a risk to human health," said Joshua Sharfstein of the FDA.

The FDA has for the first time come out against using certain antibiotics to promote growth in livestock.

And pending legislation in Congress would ban some types of antibiotics used to treat humans from being administered to healthy farm animals.


http://www.cbsnews.com/stories/2010/02/10/eveningnews/main6195054.shtml



Hello Ms. Couric Ma'am !

Thank you very much on that show of yours about antibiotics in meat, the over-use-of, and resistance there from, to humans and animals. Nice Job! The public is just oblivious to what is going on with the meat they eat. I thought the Danish study was remarkable, and proves what can be done, if an industry wants to do something. sadly, here in the USA, all the industry cares about is their bottom dollar. I have been most concerned about hormones, antibiotics, TSE aka mad cow disease, and other pathogens in meat for some time. I lost my mother to the Heidenhain Variant of Creutzfeldt Jakob Disease, considering North America is home to c-BSE, h-BSE, and the l-BSE in cattle, who is it to say that it should look exactly like the UK c-BSE ??? THEN, my last neck surgery, I believe my neurosurgeon did use a special bone grinder and a few extra precaustion, due to my Mother having died from hvCJD, and they damn near kill me with MRSA. Looking into to that, I was amazed at the amount of antibiotics and hormones that go into cattle due to the fact they are to sick to slaughter. 8 weeks vancomycin straight to the heart via long pic line made a believer in me. now I know some how I was infected probably via the operating arena, there were 7 other's the same week from the same surgcial unit, I was told later (this was in 2002), but we have become immune to these medicines due to over use, not only in humans but animals for human consumption as well. at any given tuesday you can find something like this ;


October 9,2009

WARNING LETTER

CERTIFIED MAIL RETURN RECEIPT REQUESTED

Keith L. Schaeffer Owner Evergreen Acres Dairy, LLC 26162 240th Street Paynesville, Minnesota 56362

Dear Mr. Schaeffer:

Refer to MIN 10 - 01

On April 23 and May 4,2009, the Minnesota Department of Agriculture conducted an investigation of your dairy operation located at 26162 240th Street, Paynesville, Minnesota. This letter notifies you of the violations of the Federal Food, Drug, and Cosmetic Act (the Act) that were found during the investigation of your operation. You can find the Act and its associated regulations on the Internet through links on FDA's web page at www.fda.gov.

The investigation found that you offered for sale an animal for slaughter as food that was adulterated. Under section 402(a)(2)(C)(ii) of the Act, 21 U.S.C. § 342(a)(2)(C)(ii), a food is deemed to be adulterated if it bears or contains a new animal drug that is unsafe under section 512 of the Act, 21 U.S.C. § 360b. Further, under section 402(a)(4) of the Act, 21 U.S.C. § 342(a)(4), a food is deemed to be adulterated if it has been held under insanitary conditions whereby it may have been rendered injurious to health.

Specifically, the investigation revealed that on or about September 16, 2008, you sold a dairy cow identified with your farm ear tag #(b)(4)for slaughter as food. On or about September 17, 2008, (b)(4) slaughtered this animal. United States Department of Agriculture, Food Safety and Inspection Service (USDA/FSIS) analysis of tissue samples collected from this animal identified the presence of neomycin at 31.05 parts per million (ppm) in kidney tissue. FDA has established a tolerance of 7.2 ppm neomycin residue in kidney tissue as codified in Title 21, Code of Federal Regulations, Section 556.430(b)(1), 21 C.F.R. 556.430(b)(1). The presence of this drug in kidney tissue from this animal in this amount causes the food to be adulterated within the meaning of section 402(a)(2)(C)(ii) of the Act, 21 U.S.C. § 342(a)(2)(C)(ii).

The investigation also found that you hold animals under conditions that are so inadequate that medicated animals bearing potentially harmful drug residues are likely to enter the food supply. For example, you failed to maintain complete treatment records. Food from animals held under such conditions is adulterated within the meaning of section 402(a)(4) of the Act, 21 U.S.C. § 342(a)(4).

The investigation also found that you adulterated the new animal drugs neomycin sulfate, sulfadimethoxine oral solution, oxytetracycline injection, oxytetracycline hydrochloride injection, ceftiofur hydrochloride, ceftiofur crystalline free acid, ceftiofur sodium, penicillin G procaine aqueous suspension, florfenicol, tetracycline hydrochloride soluble powder, and tylosin. Specifically, the investigation revealed that you did not use these drugs as directed by their approved labeling. Use of these drugs contrary to their approved labeling is an extralabel use. See 21 C.F.R. 530.3(a).

The extralabel use of approved animal or human drugs in animals is allowed under the Act only if the extralabel use complies with sections 512(a)(4) and (5) of the Act, 21 U.S.C. §§ 360b(a)(4) and (5), and 21 C.F.R. 530, including that the use must be by or on the lawful order of a licensed veterinarian within the context of a valid veterinarian/ client/patient relationship.

The investigation found that you administered neomycin sulfate to lactating dairy cows contrary to the approved indication of use. Neomycin sulfate is not approved for the treatment and control of Salmonella infections. Your extralabel use of neomycin sulfate was not in compliance with 21 C.F.R. 530, and your extralabel use of neomycin sulfate resulted in an illegal drug residue, in violation of 21 C.F.R. 530.11(d).

The investigation also found that you administered the following new animal drugs contrary to the conditions of use set forth in their approved labeling, and you did so without the supervision of a licensed veterinarian, in violation of 21 C.F.R. 530.11(a):

1. Neomycin sulfate (b)(4) - You administered neomycin sulfate to a lactating dairy cow without following the approved indication of use. Neomycin Sulfate (Neomycin Liquid) is not approved for the treatment and control of Salmonella infections.

2. Sulfadhnethoxine oral solution (b)(4) - You administered sulfadimethoxine oral solution to lactating dairy cows without following the approved route of administration, indications for use, and animal class. Sulfadimethoxine oral solution is not approved for intravenous injection, not approved to treat peritonitis, and not approved for use in lactating dairy cows. Furthermore, sulfonamide drugs, which include sulfadimethoxine, are prohibited for extralabel use in lactating dairy cows by 21 C.F.R. 530.41(a)(9).

3. Oxytetracycline injection (b)(4) - You administered oxytetracycline injection to lactating dairy cows without following the approved dose per injection site. Oxytetracycline injection is not approved for use at more than 10 mL per injection site.

4. Oxytetracycline hydrochloride injection (b)(4) - You administered oxytetracycline hydrochloride injection to lactating dairy cows without following the approved animal class and indications for use. Oxytetracycline hydrochloride injection is not approved for use in lactating dairy cattle, or to treat peritonitis.

5. Ceftiofur hydrochloride (b)(4) - You administered ceftiofur hydrochloride to lactating dairy cows without following the approved indications for use. Ceftiofur hydrochloride is not indicated for treating watery mastitis in cattle, or for post-surgical use.

6. Ceftiofur crystalline free acid (b)(4) - You administered ceftiofur crystalline free acid to lactating dairy cows without following the approved indications of use. Ceftiofur crystalline free acid is not indicated for treating watery mastitis, foot rot, or metritis in cattle, nor is it approved for postsurgical use.

7. Ceftiofur sodium (b)(4) - You administered ceftiofur sodium to lactating dairy cows without following the approved indications for use. Ceftiofur sodium is not indicated for treating watery mastitis or metritis in cattle, nor is it approved for post-surgical use.

8. Penicillin G procaine (b)(4) - You administered penicillin G procaine aqueous suspension to lactating dairy cows without following the approved indications for use, dosage amount, or dosage amount per injection site. Penicillin G procaine aqueous suspension is not indicated for treating mastitis in cattle, not approved at a dose more than 1 mLI100 pounds of body weight, and not approved for use at the rate of more than 10 mL per injection site.

9. Florfenicol (b)(4) - You administered florfenicol to lactating dairy cows without following the approved animal class. Florfenicol is not approved for use in female dairy cattle 20 months of age or older.

10.Tetracycline hydrochloride soluble powder (b)(4) - You administered tetracycline hydrochloride soluble powder to lactating dairy cows without following the approved animal class and indications for use. Tetracycline hydrochloride soluble powder is not approved for treating dairy cows or for treatment of uterine infections.

11. Tylosin (b)(4) - You administered tylosin to dairy calves without following the approved route of administration and indications for use.Tylosin is not approved for oral administration, nor is the drug approved for preventing scours (bacterial enteritis) in dairy calves. Furthermore, the extralabel use of approved new animal or human drugs in or on an animal feed (milk) is prohibited by 21 C.F.R. 530.11(b).

Because your use of these drugs was not in conformance with their approved labeling and did not comply with 21 C.F.R. 530, you caused the drugs to be unsafe under section 512(a) of the Act, 21 U.S.C. § 360b(a), and adulterated within the meaning of section 50 1(a)(5) of the Act, 21 U.S.C. § 351(a)(5).

In addition, you adulterated animal feed (milk) within the meaning of section 501 (a)(6) of the Act, 21 U.S.C. § 351 (a)(6). You administered tylosin to dairy calves to prevent Escherichia coli (E. colI) scours by mixing the drug in milk. This caused the animal feed (milk) to which the drug was added to be unsafe within the meaning of section 512(a)(2) of the Act, 21 U.S.C. § 360b(a)(2), and adulterated under section 501(a)(6) of the Act, 21 U.S.C. § 351(a)(6).

The above is not intended to be an all-inclusive list of violations. As a producer of animals offered for use as food, you are responsible for ensuring that your overall operation and the food you distribute are in compliance with the law.

You should take prompt action to correct the violations described in this letter and to establish procedures to ensure that these violations do not recur. Failure to do so may result in regulatory action without further notice such as seizure and/or injunction.

You should notify this office in writing of the steps you have taken to bring your firm into compliance with the law within 15 working days of receiving this letter. Your response should include each step that has been taken or will be taken to correct the violations and to prevent their recurrence. If corrective action cannot be completed within 15 working days of receiving this letter, state the reason for the delay and the time frame within which the corrections will be completed. Please include copies of any available documentation demonstrating that corrections have been made.

Your written response should be sent to Dr. Brian D. Garthwaite, Compliance Officer, U.S. Food and Drug Administration, at the address located on the letterhead. If you have any questions about this letter, please contact Dr. Garthwaite at (612) 758-7132.

Sincerely,

/s/

W. Charles Becoat Director Minneapolis District

BDG/ccl

(b)(4)

Doug Leuders Minnesota Department of Agriculture 625 North Robert Street St. Paul, Minnesota 55155

District Manager, USDA-FSIS Butler Square West, Suite 989-C 100 North Sixth Street Minneapolis, Minnesota 55403


http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm186791.htm



“October 2009

It should be noted that humans can become more susceptible to infection with antimicrobial-resistant zoonotic bacteria to which they are exposed. This can happen, when there has been prior use of antimicrobials, resulting in decrease in colonization resistance (dysregulation of intestinal microbiota) and an increased vulnerability to gastrointestinal illness with antimicrobial-resistant food-borne pathogens. This applies to all infections with all micro-organisms listed in this document.

snip...



http://www.efsa.europa.eu/cs/BlobServer/Scientific_Opinion/1372.pdf?ssbinary=true



http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm189754.htm



Our investigation also found that you hold animals under conditions that are so inadequate that medicated animals bearing potentially harmful drug residues are likely to enter the food supply.


http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm189720.htm



Our investigation also found that you hold animals under conditions that are so inadequate that medicated animals bearing potentially harmful drug residues are likely to enter the food supply.


http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm189789.htm



Our investigation also found that you hold animals under conditions that are so inadequate that medicated animals bearing potentially harmful drug residues are likely to enter the food supply.

Recently Posted Warning Letters Posted on November 17, 2009


http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/default.htm



see also my blog on MRSA here ;


http://staphmrsa.blogspot.com/




IN regards to the Industry hype about that mean old Katie Couric and CBS on the Danish Study on antibiotics and the overuse there of, or not, I wish to submit the following ;




Methicillin-Resistant Staphylococcus aureus (MRSA) Strain ST398 Is Present in Midwestern U.S. Swine and Swine Workers

Recent research has demonstrated that many swine and swine farmers in the Netherlands and Canada are colonized with MRSA. However, no studies to date have investigated carriage of MRSA among swine and swine farmers in the United States (U.S.).

We sampled the nares of 299 swine and 20 workers from two different production systems in Iowa and Illinois, comprising approximately 87,000 live animals. MRSA isolates were typed by pulsed field gel electrophoresis (PFGE) using SmaI and EagI restriction enzymes, and by multi locus sequence typing (MLST). PCR was used to determine SCCmec type and presence of the pvl gene.

In this pilot study, overall MRSA prevalence in swine was 49% (147/299) and 45% (9/20) in workers. The prevalence of MRSA carriage among production system A's swine varied by age, ranging from 36% (11/30) in adult swine to 100% (60/60) of animals aged 9 and 12 weeks. The prevalence among production system A's workers was 64% (9/14). MRSA was not isolated from production system B's swine or workers. Isolates examined were not typeable by PFGE when SmaI was used, but digestion with EagI revealed that the isolates were clonal and were not related to common human types in Iowa (USA100, USA300, and USA400). MLST documented that the isolates were ST398.

These results show that colonization of swine by MRSA was very common on one swine production system in the midwestern U.S., suggesting that agricultural animals could become an important reservoir for this bacterium. MRSA strain ST398 was the only strain documented on this farm. Further studies are examining carriage rates on additional farms.

snip...

Discussion

This study is the first to document MRSA in U.S. swine and swine workers, and to our knowledge, the first to report the presence of ST398 (also reported as non-typeable MRSA, NT-MRSA) [15] in the U.S. Like previous studies in Canada, Denmark, and the Netherlands [11], [12], [24], ST398 was found in both animals and humans, suggesting transmission between the two. The prevalence of MRSA colonization among swine and swine workers was high at one farm system that we examined in the Midwestern U.S., suggesting that agricultural animals could become an important reservoir for this bacterium. Strain ST398 was the only MRSA identified among the swine and swine workers. This strain has been the predominant strain among swine in the Netherlands and Canada. However, Khanna et al. in Canada recently found both ST398 and ST5/USA100 colonizing the nares of swine and swine workers [12]. This difference may indicate that the epidemiology of MRSA on Canadian swine farms is different than on the affected farm system in Iowa and Illinois. On the other hand, the difference may have resulted from differing sampling methodologies. Khanna et al. sampled a small number of humans and swine on 20 farms whereas we took a larger number of samples from a smaller number of farms in two corporate systems. Furthermore, because we did not type all isolates in this pilot study, additional strain types may be present that we did not detect.

snip...

In summary, we report the first isolation of MRSA from swine and swine workers in the U.S. Although the extent of this problem in the U.S. is currently unknown, our findings may have important implications for the epidemiology of MRSA disease. For example, Van Loo et al. identified MRSA in meat products in the Netherlands [32], suggesting that persons who handle raw pork products might be at risk for acquiring MRSA. Future studies should assess the risk of MRSA disease among swine workers and their contacts, survey retail meat products for MRSA contamination, study larger populations of swine and humans to define the epidemiology of MRSA within swine operations, and assess MRSA carriage rates in other livestock.

full text ;




http://www.plosone.org/article/fetchObjectAttachment.action?uri=info%3Adoi%2F10.1371%2Fjournal.pone.0004258&representation=PDF




From Emerging Infectious Diseases

Staphylococcus aureus ST398, New York City and Dominican Republic

Meera Bhat; Caroline Dumortier; Barbara S. Taylor; Maureen Miller; Glenny Vasquez; Jose Yunen; Karen Brudney; Jacqueline Sánchez E.; Carlos Rodriguez-Taveras; Rita Rojas; Patricia Leon; Franklin D. Lowy

Authors and Disclosures

Posted: 05/11/2009; Emerging Infectious Diseases © 2008 Centers for Disease Control and Prevention (CDC)

Abstract Closely related Staphylococcus aureus strains of ST398, an animal-associated strain, were identified in samples collected from humans in northern Manhattan, New York, NY, USA, and in the Dominican Republic. A large population in northern Manhattan has close ties to the Dominican Republic, suggesting international transmission.




We identified a clone of S. aureus previously associated with outbreaks of infections in animals and in humans who work with animals in 2 unique collections of S. aureus isolates. The first was from a population-based study of S. aureus colonization among residents of northern Manhattan in New York, NY, USA;


Consequently, the clone is identified by multilocus sequence typing as sequence type 398 (ST398).



Page 2 of 7

Dominican Republic within 6 months of their interview, none of the colonized participants reported recent travel to the Dominican Republic. No contact among the different households was reported.




http://www.cdc.gov/eid/content/15/2/pdfs/08-0609.pdf







First human isolates of methicillin-resistant Staphylococcus aureus sequence type 398 in Spain


C. Potel & M. Álvarez-Fernández & L. Constenla & P. Álvarez & S. Perez


Received: 31 July 2009 / Accepted: 13 December 2009 # Springer-Verlag 2010


To the Editor,


An emerging sequence type (ST) 398 methicillin-resistant Staphylococcus aureus (MRSA) clone producing infections in humans has been detected across Europe [1]. Recent studies indicate that it is widely distributed in farm animals, particularly in pigs, suggesting transmission between animals and humans [2].


The frequency of MRSA ST398 in the Spanish population is unknown. In this study, we present the first three human cases of MRSA ST398 infections admitted to two hospitals in the north-west of Spain.


Forty-four MRSA strains were isolated in 2006 in both hospitals. They were studied by the analysis of restriction fragment length polymorphism (RFLP) of the coagulase gene patterns and pulsed-field gel electrophoresis (PFGE) [3, 4]. Three non-Sma I typeable MRSA strains were identified; the three strains were EagI PFGE typeable. Next, they were analyzed by multilocus sequence typing (MLST) and spa typing [5, 6]. The staphylococcal chromosome cassette (SCC) mec, the accessory gene regulator (agr) types, and the Panton–Valentine leukocidin (PVL)-encoding genes were polymerase chain reaction (PCR)-identified [7–9].


The three strains were resistant to tetracycline. Besides, one isolate was resistant to levofloxacin, tobramycin, and erythromycin, and another isolate was resistant to levofloxacin and clindamycin, and susceptible to erythromycin; this rare phenotype has already been described [2]. The three MRSA isolates were identical by RFLP. By EagI PFGE, they were closely related following Tenover’s criteria (Fig. 1) [10]. All isolates were ST398, SCCmec-V, agr-1, and PVL genes-negative. They belonged to three spa types; t108, t011, and t1255.


The age of the three patients was 59, 82, and 83 years, respectively. Two patients owned pigs and the other a calf. Two patients were diabetic and were hospitalized because they developed skin and soft-tissue infections by MRSA ST398. The third patient had bronchitis and the strain was isolated from a respiratory secretion submitted to the laboratory from an outpatient clinic. The three patients had had multiple hospital admissions in the last 12 months.


As it has been described previously, the ST398 isolates were resistant to tetracycline [2]. Only another strain from the 44 MRSA strains studied was also resistant to tetracycline. This one belonged to the ST239 clone that was epidemic in north-west Spain until 2002, and since then, it has scarcely been isolated [3]. The ST239 clone is easily identified because of the homogeneity in the resistance profile (it is also resistant to levofloxacin, gentamicin, tobramycin, erythromycin, clindamycin, trimethoprim-sulfamethoxazole, and chloramphenicol) [3]. Therefore, it can be stated that the resistance to tetracycline could be a local marker for a presumptive identification of the ST398 clone.



http://www.springerlink.com/content/p8866u775tvm51w5/fulltext.pdf?page=1



Volume 16, Number 1–January 2010


Letter Skin Lesion Caused by ST398 and ST1 MRSA, Spain1


Carmen Aspiroz, Carmen Lozano, Ana Vindel, Juan J. Lasarte, Myriam Zarazaga, and Carmen Torres Author affiliations: Hospital Royo Villanova, Zaragoza, Spain (C. Aspiroz); Universidad de La Rioja, Logroño, Spain (C. Lozano, M. Zarazaga, C. Torres); Centro Nacional Microbiología, Madrid, Spain (A. Vindel); and Centro Salud San Mateo de Gállego, Zaragoza (J.J. Lasarte) Suggested citation for this article


To the Editor:


Human infections caused by methicillin-resistant Staphylococcus aureus (MRSA) sequence type 398 (ST398) have been emerging in recent years in Europe (1,2). Pigs represent a common reservoir of MRSA ST398, and working with these animals may constitute a risk factor for MRSA carriage and possible infection (2–4). We report a case of human infection caused by MRSA ST398 in Spain.


SEE FULL TEXT ;



http://www.cdc.gov/eid/content/16/1/157.htm



Eurosurveillance, Volume 13, Issue 9, 28 February 2008

Rapid communications


First outbreak of methicillin-resistant Staphylococcus aureus ST398 in a Dutch hospital, June 2007


M WH Wulf (mireille.wulf@gmail.com)1, A Markestein2, F T van der Linden3, A Voss4, C Klaassen4, C M Verduin1,2


1. Laboratory for Pathology and Medical Microbiology, Veldhoven, the Netherlands 2. Department of Hospital Infection Control, St Anna Hospital, Geldrop, the Netherlands 3. Department of Surgery, St Anna Hospital, Geldrop, the Netherlands 4. Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands


We describe the first outbreak of non-typable methicillin-resistant Staphylococcus aureus on a surgical ward in the Netherlands in June 2007. Nine cases of infection and/or colonisation were found among patients and healthcare workers.


Background


In the Netherlands, the proportion of methicillin-resistant S. aureus (MRSA) among clinical isolates of S. aureus is still low [1], but community-acquired MRSA occurs more frequently [2]. This increase is mainly caused by so called ‘non-typable’ MRSA (NTMRSA, i.e. not typable by pulsed-field gel electrophoresis (PFGE) with Sma1 restriction digest [3]) belonging to multilocus sequence typing (MLST) type ST398 [4].


These strains are widely disseminated among pigs, veal calves and people in contact with pigs [5-8]. An association between the use of antibiotics in pig farming and the dissemination of these strains has been suggested [6,8], since the majority of ST398 MRSA are tetracycline-resistant and oxytetracyclins are the most frequently used antibiotics in pig farming.


Transmission within families, as well as single cases of colonised healthcare workers, have been described [5]. One report indicates possible healthcare-acquired infections with a Panton-Valentine leukocidin (PVL)- positive ST398 strain in China [9], but no nosocomial transmission to multiple patients or healthcare workers has occurred in the Netherlands to date.


Outbreak description


In June 2007, MRSA was cultured from a diabetic foot ulcer of a patient on a surgical ward. Subsequent screening of contacts among patients and healthcare workers revealed four additional patients with MRSA infection and/or colonisation and five healthcare workers who carried MRSA.


Two of the five affected patients (one with prostate carcinoma and one with a diabetic foot) were successfully decolonised with mupirocin nasal ointment, chlorhexidine wash, and treatment with trimetoprim/rifampicin.


A further colonised patient with a gastro-intestinal malignancy and two patients with infected diabetic foot ulcers remained colonised, despite several decolonisation regimens.


Of 238 healthcare workers who were screened, five were colonised in the nose and/or throat and had no skin conditions. All five have been treated with mupirocin nasal ointment and chlorhexidine wash and successfully decolonised.


All strains were resistant to tetracycline and non-typable by PFGE. Spa-typing showed that all strains were spa-type t567. This spa-type corresponds to MLST type 398, a type previously found in pigs.


None of the patients had had contact with pigs or veal calves. One healthcare worker lived on the grounds of a pig farm but neither she nor her partner came into contact with pigs themselves. While we presume that this health care worker was the source of the infection, this could not be proven. Permission to sample the pigs on this farm was not granted.


Conclusions


The NT-MRSA strain responsible for this outbreak was spa-type t567, which corresponds to MLST type ST398, the clonal complex to which most of NT-MRSA strains belong. This outbreak shows that transmission on a larger scale than a one-on-one transmission between caretaker and patient can occur with NT-MRSA in a hospital setting.


References


http://www.eurosurveillance.org/images/dynamic/EE/V13N09/art8051.pdf


EDITORIAL


MRSA in livestock animals—an epidemic waiting to happen?


M. Wulf 1 and A. Voss 2,3 1 PAMM Laboratory for Medical Microbiology, Veldhoven , 2 Department of Medical Microbiology, Nijmegen University Centre for Infectious Diseases, Radboud University Nijmegen Medical Centre and 3 Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands Corresponding author and reprint requests: A. Voss, Department of Medical Microbiology, Nijmegen University Centre for Infectious Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands E-mail: vossandreas@gmail.com Copyright © 2008 European Society of Clinical Microbiology and Infectious Diseases


KEYWORDS Community-acquired MRSA • epidemiology • livestock • methicillin-resistant Staphylococcus aureus • pig farming • ST398


ABSTRACT


Screening of pig farmers and pigs in The Netherlands has revealed that >20% of pig farmers and 39% of slaughterhouse pigs are positive for an unusual strain of methicillin-resistant Staphylococcus aureus (MRSA) belonging to sequence type (ST) 398. It is now clear that the emergence of ST398 is not just a Dutch problem, with human infections being described in several European countries, Canada and Singapore. Furthermore, some human isolates have now acquired the genes encoding Panton–Valentine leukocidin. Livestock may become an important source of community-acquired MRSA. A concerted effort on the part of clinicians, infection control practitioners and veterinarians will be required to prevent further spread of this novel strain of MRSA.


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DIGITAL OBJECT IDENTIFIER (DOI) 10.1111/j.1469-0691.2008.01970.x About DOI


http://www3.interscience.wiley.com/journal/119414762/abstract?CRETRY=1&SRETRY=0




Emerg Infect Dis. 2009 May; 15(5): 845–847. doi: 10.3201/eid1505.081417. PMCID: PMC2687035


Copyright notice

Community-acquired Methicillin-Resistant Staphylococcus aureus ST398 Infection, Italy

Angelo Pan, Antonio Battisti, Alessia Zoncada, Francesco Bernieri, Massimo Boldini, Alessia Franco, Maurilio Giorgi, Manuela Iurescia, Silvia Lorenzotti, Mario Martinotti, Monica Monaci, and Annalisa Pantosti Istituti Ospitalieri di Cremona, Cremona, Italy (A. Pan, A. Zoncada, F. Bernieri, S. Lorenzotti, M. Martinotti) Istituto Zooprofilattico Sperimentale delle Regioni Lazio e Toscana, Rome, Italy (A. Battisti, A. Franco, M. Iurescia) Istituto Zooprofilattico Sperimentale delle Regioni Lombardia ed Emilia-Romagna, Cremona (M. Boldini) Azienda Sanitaria Locale di Cremona, Cremona (M. Giorgi) Istituto Superiore di Sanità, Rome (M. Monaci, A. Pantosti)

Corresponding author. Address for correspondence: Angelo Pan, Divisione di Malattie Infettive, Istituti Ospitalieri di Cremona, Largo Priori 1, 26100 Cremona, Italy; email: a.pan@ospedale.cremona.it

Keywords: Antimicrobial resistance, staphylococci, Staphylococcus aureus, community acquired, MRSA, ST398, pig strain, bloodstream infection, letter

To the Editor: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has been identified in livestock animals (particularly pigs), veterinarians, and animal farm workers (1,2). CA-MRSA strains from pigs have been classified most frequently within the multilocus sequence type (ST) 398 (1) and have been rarely identified as a cause of invasive infection in humans (1,3,4). We report a case of invasive infection in a pig-farm worker in Cremona, Italy, an intensive animal farming area; the infection was caused by MRSA of swine origin, ST398.

full text ;


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2687035/




EID Journal Home > Volume 16, Number 2–February 2010

Volume 16, Number 2–February 2010 Letter Methicillin-Resistant Staphylococcus aureus ST398, Italy Laura Soavi, Roberto Stellini, Liana Signorini, Benvenuto Antonini, Palmino Pedroni, Livio Zanetti, Bruno Milanesi, Annalisa Pantosti, Alberto Matteelli, Angelo Pan, and Giampiero Carosi Author affiliations: University of Brescia, Brescia, Italy (L. Soavi, R. Stellini, L. Signorini, A. Matteelli, G. Carosi); Presidio Ospedaliero di Manerbio, Manerbio, Italy (B. Antonini, P. Pedroni, L. Zanetti, B. Milanesi); Istituto Superiore di Sanità, Rome, Italy (A. Pantosti); and Istituti Ospitalieri di Cremona, Cremona, Italy (A. Pan)

Suggested citation for this article

To the Editor: It has recently become apparent that livestock can constitute a new methicillin-resistant Staphylococcus aureus (MRSA) reservoir and be a source of a novel and rapidly emerging type of MRSA. These livestock-associated MRSA clones are nontypeable by use of pulsed-field gel electrophoresis with SmaI and belong to sequence type (ST) 398 (1). MRSA ST398 clones account for 20% of all MRSA in the Netherlands (2), but the emergence of such clones has been described worldwide (3). Although ST398 transmission has been reported primarily between animals, persons with occupational exposure to livestock are at higher risk for MRSA carriage than the general population. Even though MRSA ST398 usually causes colonization, several cases of infections of variable clinical relevance, varying from skin and soft tissue infections (4) to endocarditis (5) and pneumonia (6), have been described over the past few years. Most instances of ST398 human carriers have been identified among persons who work at pig farms (7). Data regarding MRSA colonization of dairy farmers are less exhaustive and, to our knowledge, only 1 instance of direct transmission between cattle and humans has been proven. MRSA isolates from cows with subclinical mastitis in 2007 in Hungary were indistinguishable from MRSA isolates from the tonsil swab of a farmer who worked with these animals (. We report a case of MRSA ST398 invasive disease in a cattle farmer, as well as a case of MRSA ST398 necrotizing fasciitis


http://www.cdc.gov/eid/content/16/2/346.htm




Volume 15, Number 7–July 2009


Dispatch Methicillin-Resistant Staphylococcus aureus ST398 in Swine Farm Personnel, Belgium


Olivier Denis, Carl Suetens,1 Marie Hallin, Boudewijn Catry, Ilse Ramboer, Marc Dispas, Glenda Willems, Bart Gordts, Patrick Butaye, and Marc J. Struelens Author affiliations: Université Libre de Bruxelles Hôpital Erasme, Brussels, Belgium (O. Denis, M. Hallin, M.J. Struelens); Scientific Institute of Public Health, Brussels (C. Suetens, B. Catry, I. Ramboer); Veterinary and Agrochemical Research Centre, Brussels (M. Dispas, G. Willems, P. Butaye); and AZ Sint-Jan, Brugge, Belgium (B. Gordts)

Abstract We assessed methicillin-resistant Staphylococcus aureus (MRSA) in persons on 49 swine farms in Belgium. Surveys showed that 48 (37.8%) persons carried MRSA ST398 and 1 (0.8%) had concurrent skin infection. Risk factors for carriage were MRSA carriage by pigs, regular contact with pigs and companion animals, and use of protective clothing.

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Conclusions Human carriage of MRSA was associated with swine colonization with MRSA. Prevalence rate (38%) was higher than that for hospitalized patients or nursing home residents in Belgium (www.nsih.be/surv_mrsa/download_fr.asp). MRSA isolates from farmers belonged to closely related spa types corresponding to ST398, which are unrelated to hospital- and community-acquired strains but identical to strains from humans in contact with pigs in other European countries (1,2,10).

Despite the high prevalence of nasal MRSA, active MRSA skin infection was detected infrequently (<1%),


http://www.cdc.gov/EID/content/15/7/1098.htm%22%3Ehttp://www.cdc.gov/EID/content/15/7/1098.htm




doi:10.1016/j.vetmic.2009.12.044 How to Cite or Link Using DOI Copyright © 2010 Elsevier B.V. All rights reserved. Permissions & Reprints


Methicillin-resistant Staphylococcus aureus (MRSA) ST398 associated with clinical and subclinical mastitis in Belgian cows


Wannes Vanderhaeghena, b, , , , Tineke Cerpentierc, Connie Adriaensena, Jo Viccac, Katleen Hermansb and Patrick Butayea, b


a Veterinary and Agrochemical Research Center, CODA-CERVA-VAR, Groeselenberg 99, B-1180 Ukkel, Belgium


b Ghent University, Faculty of Veterinary Medicine, Department of Pathology, Bacteriology and Poultry Diseases, Salisburylaan 133, 9820 Merelbeke, Belgium


c University College KaHo Sint-Lieven, Association Catholic University Leuven, Department of Agro- and Biotechnology, Hospitaalstraat 23, 9100 Sint-Niklaas, Belgium


Received 28 October 2009; revised 24 December 2009; accepted 28 December 2009. Available online 11 January 2010.

Abstract


Methicillin-resistant Staphylococcus aureus (MRSA) is infrequently reported in mastitis. Yet, as in many other countries, the prevalence of methicillin resistance among S. aureus from mastitis is currently unknown in Belgium.


To elucidate this, the presence of mecA was investigated in 118 S. aureus strains originating from diagnostic mastitis milk samples from 118 different farms experiencing S. aureus mastitis. MRSA strains were characterized by disk diffusion susceptibility testing, spa-typing, MLST and SCCmec-typing. In an additional study, four MRSA-positive farms were selected to assess the in-herd prevalence of MRSA, by sampling all cows in lactation. Isolated MRSA strains were similarly characterized.


The mecA gene was detected in 11 (9.3%) of the 118 S. aureus isolates, indicating that nearly 10% of the Belgian farms suffering from S. aureus mastitis have an MRSA problem. The in-herd prevalence varied between 0% and 7.4%. Characterization of the MRSA strains showed that they were all resistant to tetracycline. Additional resistances to macrolides, lincosamides and aminoglycosides were frequently detected. The strains were ST398, spa-types t011 or t567 and had SCCmec-type IVa or V, proving that they belong to the emerging livestock-associated MRSA (LA-MRSA) strains of CC398.


Our study shows that after detection in Belgian pigs, horses and poultry, LA-MRSA has also attained Belgian cattle. It is the first report on frequent isolation of LA-MRSA from bovine infections. As the in-herd isolation rate resembles that of regular S. aureus in farms experiencing S. aureus mastitis, the multi-resistance of LA-MRSA strains may cause future treatment problems.


Keywords: Methicillin-resistant Staphylococcus aureus; MRSA; Mastitis; Belgium; ST398; Multidrug resistance


http://www.sciencedirect.com/


High occurrence of methicillin-resistant Staphylococcus aureus ST398 in equine nasal samples


A. Van den Eedea, , , A. Martensa, U. Lipinskab, M. Struelensc, A. Deplanoc, O. Denisc, F. Haesebrouckb, F. Gasthuysa and K. Hermansb

aDepartment of Surgery and Anaesthesiology of Domestic Animals, Ghent University, Faculty of Veterinary Medicine, Salisburylaan 133, B-9820 Merelbeke, Belgium


bDepartment of Pathology, Bacteriology and Poultry Diseases, Ghent University, Faculty of Veterinary Medicine, Salisburylaan 133, B-9820 Merelbeke, Belgium


cLaboratoire de Référence MRSA-Staphylocoques, Department of Microbiology, Université Libre de Bruxelles, Hôpital Erasme, Route de Lennik 808, B-1070 Brussels, Belgium


Received 30 March 2008; revised 23 June 2008; accepted 26 June 2008. Available online 5 July 2008.


Abstract


Methicillin-resistant Staphylococcus aureus (MRSA) infections do occur in equine patients. Little is known, however, about their origin and the general equine MRSA colonization status. In West European horses in particular, neither the colonization rate nor the present strains or their antimicrobial susceptibility patterns are known.


In the present study, a sample of 110 (Belgian, French, Dutch and Luxemburg) horses presented at a Belgian equine clinic was screened for nasal MRSA carriage. An indirect culturing protocol using a 0.001% colistin and nalidixic acid containing broth was compared to a direct agar method. Phenotypic identification following growth on a chromogenic MRSA screening agar (ChromID™ MRSA) was combined with genotypic analysis (PCR, PFGE, SCCmec, spa, and MLST typing). Antimicrobial susceptibility was tested through disk diffusion.


Twelve (10.9%) horses carried MRSA, with the enrichment protocol resulting in a significantly higher isolation rate. None of the isolated strains were typeable through SmaI PFGE. They all harboured SCCmec type IVa or V and belonged to spa type t011 or t1451 of the ST398 lineage. All isolates were tetracycline resistant and sulfonamide and enrofloxacin susceptible. Macrolide, lincosamide, trimethoprim and aminoglycoside susceptibility varied and in total five different antimicrobial resistance patterns were distinguished.


These results show that ST398 is certainly present in West European horses. Due to its known interspecies transmission and the structure of the equine industry, the presence of this clone in horses poses a substantial health hazard for both animals and humans.


Keywords: Staphylococcus aureus; MRSA; Horse; Nasal colonization, ST398


http://www.sciencedirect.com/


Veterinary Microbiology Volume 141, Issues 1-2, 24 February 2010, Pages 96-102


Methicillin-resistant Staphylococcus aureus in horses and horse personnel: An investigation of several outbreaks


E. van Duijkerena, , , M. Molemanb, M.M. Sloet van Oldruitenborgh-Oosterbaanb, J. Multema, A. Troelstrac, A.C. Fluitc, W.J.B. van Wameld, D.J. Houwersa, A.J. de Neelinge and J.A. Wagenaara, f


a Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, PO Box 80165, 3508 TD Utrecht, Utrecht University, The Netherlands


b Department of Equine Medicine, Faculty of Veterinary Medicine, Utrecht University, The Netherlands


c Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, The Netherlands


d Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands


e National Institute of Public Health and the Environment, Laboratory for Infectious Diseases and Screening, Bilthoven, The Netherlands


f Central Veterinary Institute of Wageningen UR, Lelystad, The Netherlands


Received 29 May 2009; revised 9 July 2009; accepted 3 August 2009. Available online 8 August 2009.


Abstract


At the Veterinary Microbiological Diagnostic Center, the Netherlands, the percentage of methicillin-resistant Staphylococcus aureus (MRSA) isolates found in equine clinical samples increased from 0% in 2002 to 37% in 2008. MRSA of spa-type t064, belonging to MLST ST8 and spa-types t011 and t2123, both belonging to the livestock-associated MLST ST398, predominated.


During an outbreak of post-surgical MRSA infections in horses at a veterinary teaching hospital in 2006/2007, MRSA isolates of spa-type t2123 were cultured from 7 horses and 4/61 personnel which indicated zoonotic transmission. After intervention the outbreak stopped. However, another outbreak occurred in 2008, where 17 equine MRSA isolates of spa-type t011 (n = 12), t2123 (n = 4), and t064 (n = 1) were found. This time, 16/170 personnel were positive for MRSA with spa-type t011 (n = 11) and t2123 (n = 5). Personnel in close contact with horses were more often MRSA-positive (15/106) than those without (1/64).


Screening of horses upon admission showed that 9.3% were MRSA-positive predominantly with spa-type t011. Weekly cross-sectional sampling of all hospitalized horses for 5 weeks showed that 42% of the horses were MRSA-positive at least once, again predominantly with spa-type t011, which suggests that nosocomial transmission took place. Fifty-three percent of the environmental samples were MRSA-positive, including samples from students’ and staff members’ rooms, and all were spa-type t011. This indicates that humans contribute to spreading the organism. Culturing of samples employing high-salt pre-enrichment performed better than a comparable method without pre-enrichment.


Our results show that nosocomial transmission occurs in equine clinics and suggests that personnel play a role in the transmission.


Keywords: Horse; MRSA; Staphylococcus aureus; Transmission; Environment


http://www.sciencedirect.com/


Preventive Veterinary Medicine Volume 91, Issues 2-4, 1 October 2009, Pages 270-273


Short communication


Occurrence of methicillin-resistant Staphylococcus aureus in rats living on pig farms


A.W. van de Giessen, a, , M.G. van Santen-Verheuvela, P.D. Hengevelda, T. Boscha, E.M. Broensa and C.B.E.M. Reuskena


aCentre for Infectious Disease Control Nertherlands, National Institute for Public Health and the Environment, Bilthoven, The Netherlands


Received 20 March 2009; revised 8 May 2009; accepted 8 May 2009. Available online 11 June 2009.


Abstract


In The Netherlands, MRSA ST398 has emerged in hospitals and human carriers have been associated with exposure to pigs and cattle. High prevalences of MRSA ST398 in pigs and pig farmers have been determined and the transmission routes of MRSA on pig farms need to be elucidated. In the south of the Netherlands, in recent years, the black rat (Rattus rattus) has emerged as a prominent rodent on livestock farms. From March till May 2008, a survey on MRSA in rats living on livestock farms in the south of The Netherlands and the north of Belgium was conducted. In total, 40 black rats (R. rattus) and 3 brown rats (Rattus norvegicus) were collected on 12 farms including five pig farms, five poultry farms, one mixed pig and veal farm and one goat farm. MRSA ST398 was detected in black rats captured at two of the five pig farms as well as in a black rat living on the mixed pig and veal farm. From one black rat captured at another pig farm MRSA ST 97 was isolated. Considering the behaviour of rats on livestock farms, it is concluded that rats might play a role in the spread and persistence of MRSA on pig farms.


Keywords: Staphylococcus aureus; Methicillin resistance; Swine; Transmission; Rats; Rodents


Article Outline


http://www.sciencedirect.com/


JAC Advance Access originally published online on October 21, 2009 Journal of Antimicrobial Chemotherapy 2009 64(6):1325-1326; doi:10.1093/jac/dkp378 © The Author 2009. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


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Research letters


Detection of methicillin-resistant Staphylococcus aureus ST398 in food samples of animal origin in Spain



Carmen Lozano, María López, Elena Gómez-Sanz, Fernanda Ruiz-Larrea, Carmen Torres and Myriam Zarazaga* Departamento de Agricultura y Alimentación, Universidad de La Rioja, Madre de Dios 51, 26006 Logroño, Spain



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* Corresponding author. Tel: +34-941-299751; Fax: +34-941-299721; E-mail: myriam.zarazaga@unirioja.es


Keywords: MRSA , food microbiology , ST398 , ST125 , ST217



Sir, Methicillin-resistant Staphylococcus aureus (MRSA) strains belonging to clonal lineage sequence type (ST) 398 are being reported at an increasing frequency in Europe.1 This new MRSA type has been isolated from colonized and infected animals and humans, and also from meat in some countries,1,2 representing a risk to human health; nevertheless, so far, no data about detection of MRSA ST398 in food in Spain have been published.



http://jac.oxfordjournals.org/cgi/content/extract/64/6/1325



doi:10.1016/j.ijfoodmicro.2008.12.007 How to Cite or Link Using DOI Copyright © 2008 Elsevier B.V. All rights reserved.



Prevalence of methicillin-resistant Staphylococcus aureus in meat



E. de Boera, , , J.T.M. Zwartkruis-Nahuisa, B. Wita, X.W. Huijsdensc, A.J. de Neelingc, T. Boschc, R.A.A. van Oosteromb, A. Vilaa and A.E. Heuvelinka


aFood and Consumer Product Safety Authority (VWA), PO Box 202, 7200 AE Zutphen, The Netherlands


bFood and Consumer Product Safety Authority (VWA), PO Box 19506, 2500 CM Den Haag, The Netherlands


cNational Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands


Received 13 August 2008; revised 18 November 2008; accepted 7 December 2008. Available online 13 December 2008.


Abstract


Recently the isolation of methicillin-resistant Staphylococcus aureus (MRSA) strains from several food-producing animals has been reported. During slaughtering of MRSA-positive animals, contamination of carcasses with MRSA may occur and consequently the meat of these animals may get contaminated. The aim of this study was to estimate the prevalence of MRSA in raw meat samples from the retail trade.


Samples of raw beef, pork, veal, lamb/mutton, chicken, turkey, fowl and game were collected from the retail trade. A detection method including a two-step enrichment in Mueller–Hinton broth + 6.5% NaCl and phenol red mannitol broth containing ceftizoxime and aztreonam, followed by isolation on MRSA ID agar (bioMérieux) was evaluated and subsequently applied for the detection of MRSA in samples of raw meats.


MRSA strains were isolated from 264 (11.9%) of 2217 samples analyzed. Isolation percentages for the meat species were: beef (10.6%), veal (15.2%), lamb and mutton (6.2%), pork (10.7%), chicken (16.0%), turkey (35.3%), fowl (3.4%) and game (2.2%). The majority (85%) of the isolated strains belonged to spa-types of pulsed-field gel electrophoresis (PFGE) non-typeable (NT)-MRSA, corresponding to the multilocus sequence type ST398, a type also recently isolated in the Netherlands from pigs. However, a smaller part of these strains were found to be of other ST's, possibly of human origin.



Further studies are needed to elucidate transmission routes of MRSA in relation to meat and other foods and to provide the tools for preventing the spread of MRSA. At present the high prevalence of MRSA in meat has not been shown to contribute significantly to the dissemination of MRSA to humans and the possible health hazard for consumers of the presence of MRSA in foods should be further elucidated.


Keywords: MRSA; Meat; MLST; spa-Typing


http://www.sciencedirect.com/



Thursday, February 11, 2010



Denmark's Case for Antibiotic-Free Animals NEW YORK, Feb. 10, 2010


snip...



According to one study, when different countries introduced certain antibiotics on farms, a surge occurred in people contracting antibiotic resistant intestinal infections one to two years later. One infection, Campylobacter, increased 20 percent in Denmark and 70 percent in Spain.


After the ban, a Danish study confirmed that removing antibiotics from farms drastically reduced antibiotic-resistant bacteria in animals and food.


Danish scientists believe if the U.S. doesn't stop pumping its farm animals with antibiotics, drug-resistant diseases in people will only spread.


"It's not going to be a time bomb that goes off like this," said Dr. Frank Aarestrup, of the Danish Food Institute at the University of Denmark. "It's something that's slowly getting more and more complicated, more difficult for us to actually treat infections.


Rep. Slaughter's "Preservation of Antibiotics for Medical Treatment Act" Some American food producers agree. "It's just gone too far," said Stephen McDonnell, CEO Applegate Farms.


snip...


see full text ;


http://staphmrsa.blogspot.com/2010_02_01_archive.html



Friday, January 29, 2010 14th International Congress on Infectious Diseases H-type and L-type Atypical BSE January 2010 (special pre-congress edition)



http://bse-atypical.blogspot.com/2010/01/14th-international-congress-on.html



*** CJD USA RISING, with UNKNOWN PHENOTYPE ;


5 Includes 41 cases in which the diagnosis is pending, and 17 inconclusive cases; 6 Includes 46 cases with type determination pending in which the diagnosis of vCJD has been excluded.


http://www.cjdsurveillance.com/pdf/case-table.pdf



Saturday, January 2, 2010

Human Prion Diseases in the United States January 1, 2010 ***FINAL***


http://prionunitusaupdate2008.blogspot.com/2010/01/human-prion-diseases-in-united-states.html



my comments to PLosone here ;


http://www.plosone.org/annotation/listThread.action?inReplyTo=info%3Adoi%2F10.1371%2Fannotation%2F04ce2b24-613d-46e6-9802-4131e2bfa6fd&root=info%3Adoi%2F10.1371%2Fannotation%2F04ce2b24-613d-46e6-9802-4131e2bfa6fd



Thursday, February 4, 2010

SPONGIFORM ENCEPHALOPATHY ADVISORY COMMITTEE Draft Minutes of the 103rd Meeting held on 24th November 2009


http://seac992007.blogspot.com/2010/02/spongiform-encephalopathy-advisory.html



Friday, February 05, 2010

New Variant Creutzfelt Jakob Disease case reports United States 2010 A Review


http://vcjd.blogspot.com/2010/02/new-variant-creutzfelt-jakob-disease.html



Wednesday, February 10, 2010

NAIS MAD COW TRACEABILITY DUMPED BY USDA APHIS 2010


http://naiscoolyes.blogspot.com/2010/02/nais-mad-cow-traceability-dumped-by.html





Terry S. Singeltary Sr.
P.O. Box 42
Bacliff, Texas USA 77518

EFSA publishes results of the first survey on MRSA in pigs in the EU

Press Release 24 November 2009 EFSA publishes results of the first survey on MRSA in pigs in the EU

The European Food Safety Authority (EFSA) has published the first EU-wide survey on MRSA (Methicillin-resistant Staphylococcus aureus) in breeding pigs. The results indicate that MRSA, a bacterium resistant to many antibiotics, is commonly detected in holdings with breeding pigs in some EU Member States. The survey provides estimates of its occurrence and makes recommendations for further monitoring and investigation of the causes and implications of MRSA findings in pig holdings in the EU. The survey was carried out in 24 Member States[1], 17 of which found some type of MRSA in their holdings with breeding pigs and 7 none at all. On average, different types of MRSA were found in 1 out of 4 holdings with breeding pigs across the EU, but the survey also says that figures vary greatly between Member States. MRSA ST398 was the most reported type of MRSA among the holdings with breeding pigs in the EU; some Member States also reported other types, but their prevalence was much lower[2].

MRSA is a major concern for public health and its various types are recognised as an important cause of hospital-acquired (or nosocomial) infections in humans. The specific type MRSA ST398 has been identified in some domestic animals and is considered an occupational health risk for farmers, veterinarians and their families, who may become exposed to it through direct or indirect contact with these animals. In an opinion published earlier this year, EFSA’s Biological Hazards (BIOHAZ) Panel assessed the public health significance of MRSA in animals and food[3] and concluded that the MRSA ST398[4] strain is less likely to contribute to the spread of MRSA in hospitals than other types carried by humans. The Panel also said that there is currently no evidence that MRSA ST398 can be transmitted to humans by eating or handling contaminated food.

In the survey published today, EFSA recommends monitoring of pigs and other food producing animals for MRSA. It also says further research should be carried out, so that the reasons for differences in the prevalence of MRSA in the various Member States can be identified and used to propose options on possible control measures.

_________________________________________ Note to editors:

The Staphylococcus aureus is a bacterium that can be persistently or intermittently carried by healthy humans and is a very common cause of minor skin infections that usually do not require treatment. In patients in hospitals, Staphylococcus aureus is a common cause of hospital-acquired infections. Its variant Methicillin-Resistant Staphylococcus aureus (MRSA) emerged in the 1970s and is now often found in hospitals in many European Member States. MRSA is resistant to many commonly used antibiotics. In recent years, clones of MRSA have evolved outside the hospitals, causing infections among people who have no connection with hospitals. Most recently MRSA has also been detected in several farm animal species.

EFSA’s Zoonoses Unit monitors and analyses the situation on zoonoses, zoonotic agents, antimicrobial resistance, microbiological contaminants and food-borne outbreaks across Europe. The Unit is supported by a Task Force on Zoonoses Data Collection consisting of a pan-European network of national representatives of Member States, other reporting countries, as well as World Health Organisation (WHO) and World organisation for animal health (OIE). They gather each year data in their respective countries.

EFSA’s BIOHAZ Panel provides scientific advice on biological hazards in relation to food safety and food-borne diseases. This covers food-borne zoonoses (animal diseases transmissible to humans), Transmissible spongiform Encephalopathies (BSE/TSEs), food microbiology, food hygiene and associated waste management issues. The Panel’s risk assessment work helps to provide a sound foundation for European policies and legislation and supports risk managers in taking effective and timely decisions.

Analysis of the baseline survey on the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in holdings with breeding pigs, in the EU, 2008 [1] - Part A: MRSA prevalence estimates

EFSA’s previous work on MRSA:

EFSA’s BIOHAZ Panel “Assessment of the Public Health significance of Methicillin-resistant Staphylococcus aureus (MRSA) in animals and foods” Joint scientific report of ECDC, EFSA and EMEA on Methicillin-resistant Staphylococcus aureus (MRSA) in livestock, companion animals and food

Joint Opinion of ECDC, EFSA, EMEA and SCENIHR on antimicrobial resistance (AMR) focused on zoonotic infections

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[1] The sampling took place during 2008. Dust samples were taken in the environment of pigs in a total of 5,073 holdings from 24 EU Member States and two non-Member States. The pooled sample of each holding was tested for the presence of the various MRSA strains. [2] Only six Member States and one non-Member State reported MRSA non-ST398 in the holdings with breeding pigs. The prevalence of MRSA non-ST398 in holdings with breeding pigs across the participating Member States was substantially lower than the prevalence of MRSA and MRSA ST398. [3] EFSA’s BIOHAZ Panel opinion on the “Assessment of the Public Health significance of Methicillin-resistant Staphylococcus aureus (MRSA) in animals and foods” of March 2009 [4] In its opinion the BIOHAZ Panel refers to CC398 which corresponds to MRSA ST398.



http://www.efsa.europa.eu/EFSA/efsa_locale-1178620753812_1211903070258.htm



http://staphmrsa.blogspot.com/




TSS

Methicillin-Resistant Staphylococcus aureus (MRSA) Strain ST398 Is Present in Midwestern U.S. Swine and Swine Workers

Methicillin-Resistant Staphylococcus aureus (MRSA) Strain ST398 Is Present in Midwestern U.S. Swine and Swine Workers

Tara C. Smith1,2*, Michael J. Male1,2, Abby L. Harper1,2, Jennifer S. Kroeger3, Gregory P. Tinkler2, Erin D. Moritz1,2, Ana W. Capuano1,2, Loreen A. Herwaldt1,3,4, Daniel J. Diekema3,4,5

1 Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, United States of America, 2 Center for Emerging Infectious Diseases, University of Iowa College of Public Health, Iowa City, Iowa, United States of America, 3 Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States of America, 4 Program of Hospital Epidemiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States of America, 5 Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States of America

Abstract Background Recent research has demonstrated that many swine and swine farmers in the Netherlands and Canada are colonized with MRSA. However, no studies to date have investigated carriage of MRSA among swine and swine farmers in the United States (U.S.).

Methods We sampled the nares of 299 swine and 20 workers from two different production systems in Iowa and Illinois, comprising approximately 87,000 live animals. MRSA isolates were typed by pulsed field gel electrophoresis (PFGE) using SmaI and EagI restriction enzymes, and by multi locus sequence typing (MLST). PCR was used to determine SCCmec type and presence of the pvl gene.

Results In this pilot study, overall MRSA prevalence in swine was 49% (147/299) and 45% (9/20) in workers. The prevalence of MRSA carriage among production system A's swine varied by age, ranging from 36% (11/30) in adult swine to 100% (60/60) of animals aged 9 and 12 weeks. The prevalence among production system A's workers was 64% (9/14). MRSA was not isolated from production system B's swine or workers. Isolates examined were not typeable by PFGE when SmaI was used, but digestion with EagI revealed that the isolates were clonal and were not related to common human types in Iowa (USA100, USA300, and USA400). MLST documented that the isolates were ST398.

Conclusions These results show that colonization of swine by MRSA was very common on one swine production system in the midwestern U.S., suggesting that agricultural animals could become an important reservoir for this bacterium. MRSA strain ST398 was the only strain documented on this farm. Further studies are examining carriage rates on additional farms.

Citation: Smith TC, Male MJ, Harper AL, Kroeger JS, Tinkler GP, et al. (2008) Methicillin-Resistant Staphylococcus aureus (MRSA) Strain ST398 Is Present in Midwestern U.S. Swine and Swine Workers. PLoS ONE 4(1): e4258. doi:10.1371/journal.pone.0004258

Editor: Ulrich Dobrindt, University of Würzburg, Germany

Received: October 9, 2008; Accepted: December 19, 2008; Published: January 23, 2008

Copyright: © 2009 Smith et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: This study was funded with departmental startup funds (TCS). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

* E-mail: tara-smith@uiowa.edu

Introduction ...snip...end

see full text ;


http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0004258


MRSA

http://staphmrsa.blogspot.com/

WARNING LETTER An inspection of your licensed medicated feed mill, Cargill, Inc. 1000% higher than the levels indicated on the product's label. ...

Public Health Service Food and Drug Administration

Seattle District Pacific Region 2201 23rd Drive SE Bothell, WA 98021-4421

Telephone: 425-486-8788 FAX: 425-483-4996

June 25, 2008

CERTIFIED MAIL RETURN RECEIPT REQUESTED

Gregory R. Page, President and CEO Cargill, Inc. 15407 McGinty Road West Wayzata, Minnesota 55391

In reply refer to Warning Letter SEA 08-22

WARNING LETTER

Dear Mr. Page:

An inspection of your licensed medicated feed mill, Cargill, Inc., located at 1406 Industrial Avenue, Billings, Montana, conducted by the U.S. Food and Drug Administration (FDA) on February 25, 26, and 27, 2008, found significant deviations from current Good Manufacturing Practice (cGMP) regulations for Medicated Feeds (Title 21, Code of Federal Regulations, Part 225 (21 C.F.R. 225)). These deviations cause feeds being manufactured at this facility to be adulterated within the meaning of section 501 (a)(2)(B) of the Federal Food, Drug, and Cosmetic Act (the Act) [21 U.S.C. § 351(a)(2)(B)]. In addition, your llama feed, Llama Mineral, was found to contain the new animal drug [redacted] (chlortetracycline), which is not approved for use in llama feed. The use of the new animal drug, Type A, medicated article [redacted] (chlortetracycline), contrary to its approved labeling causes the drug to be deemed unsafe within the meaning of section 512(a)(1) of the Act [21 U.S.C. § 360b(a)(1)] and adulterated with in the meaning of section 501 (a)(5) of the Act [21 U.S.C. § 351(a)(5)]. In addition, the llama feed containing [redacted] (chlortetracycline) is deemed to be unsafe within the meaning of section 512(a)(2) of the Act [21 U.S.C. § 360b(a)(2)] and adulterated within the meaning of section 501 (a)(6) of the Act [21 U.S.C. § 351(a)(6)].

We reviewed your firm's response, dated March 13, 2008, to the FDA-483. We found that the response lacks sufficient detail, explanation, documentation, or substantive corrective action plans to adequately address the deviations noted during the February 2008 inspection of your licensed medicated feed mill in Billings, Montana.

We acknowledge your firm has made some changes and corrections in response to Agency findings and requests. However, we have found that, while some individual cGMP deficiencies may have been corrected, your firm has failed to institute sufficient corrections for your firm's manufacturing processes to conform to the following cGMP requirements in 21 C.F.R. 225:

1. When results of laboratory assays of drug components indicated that medicated feeds were not within permissible assay limits, your facility did not implement investigations and corrective actions, as required by 21 C.F.R. 225.58(d). For example:

a. An assay of the cattle feed "NB TRANS PL 5LB [redacted]" manufactured on March 29, 2007, and submitted for sulfamethazine analysis on or about April 12, 2007, determined a sulfamethazine level 26% above the claimed potency. No investigation or corrective action was undertaken at that time.

b. An assay of the cattle feed "NB TRANS PL 10LB [redacted] manufactured on May 15, 2007, and submitted for sulfamethazine analysis on or about June 12, 2007, determined a sulfamethazine level 24.4% above the claimed potency. No investigation or corrective action was undertaken at that time.

We acknowledge your firm's response that the importance of performing an immediate investigation into the reason for an out-of-tolerance assay result and implementing corrective action has been reviewed with appropriate personnel to ensure compliance with regard to any future out-of-tolerance assays. We further acknowledge your firm's action of completing investigations into these two assays at the time of the February 2008 inspection. However, the results. of the assays were reported to your Billings, Montana feed mill seven to ten months prior to the February 2008 inspection. FDA does not consider an investigation occurring after a seven to ten month delay to be sufficient. Further, your response states that with respect to the February 2008 investigation, "no manufacturing errors were noted." However, FDA was informed by your firm at the time of inspection that the assay of the feed manufactured on March 29, 2007, failed because [redacted] mixer was not functioning properly. The malfunction of [redacted] mixer constitutes a manufacturing error.

2. When results of laboratory assays indicated that medicated feeds failed to meet the labeled drug potency, your facility did not take corrective actions that included discontinuing distribution of the feeds, as required by 21 C.F.R. 225.58(e). For example:

a. An assay of the cattle feed "NB TRANS PL 5LB [redacted]" manufactured on March 29, 2007, and submitted for sulfamethazine analysis on or about April 12, 2007, determined a sulfamethazine level 26% above the claimed potency. No investigation or corrective action was undertaken at that time, including discontinuing distribution of the affected feed products.

b. An assay of the cattle feed "NB TRANS PL 10LB [redacted]" manufactured on May 15, 2007, and submitted for sulfamethazine analysis on or about June 12, 2007, determined a sulfamethazine level 24.4% above the claimed potency. No corrective action was undertaken at that time, including discontinuing distribution of the affected feed products.

We acknowledge your firm's response that the importance of withholding such feed from distribution has been reviewed with appropriate personnel to ensure compliance with regard to any future out-of-tolerance assays. Your response also notes that there was no product available for recovery. This is understandable as the investigation into the assays that showed the feeds not to be in accord with permissible limits did not occur for seven to ten months after the assay results were reported. However, as discussed above, FDA does not consider corrective action taken seven to ten months after the reported assay results to be sufficient.

3. Laboratory analysis results demonstrate that the cleanout procedures established and used in the production of your facility's medicated feeds are not adequate to prevent unsafe contamination of feed, as required by 21 C.F.R. 225.65(b). For example:

a. Laboratory analysis by the Montana State Department of Agriculture found chlorotetracycline in Nutrena Naturewise Lamb and Sheep Feed, manufactured on February 4, 2008, at 550 grams per ton, which is 10 times higher than the level of 50 grams per ton indicated on the product's label. FDA analysis of a sample collected from a different portion of the same lot of lamb and sheep feed found levels of chlorotetracycline at 160 grams per ton (320 % of formula).

b. FDA analysis of a retain sample collected from a lot of medicated cattle feed manufactured at your facility, identified as "Nutrabeef Cattle Grower Feed," found levels of chlortetracycline at 4.8 parts per million (ppm). This product is formulated to contain no chlortetracycline.

c. FDA analysis of a retain sample collected from a lot of medicated cattle feed manufactured at your facility, identified as "Miller FDLT 45/27," found levels of chlortetracycline at 88.0 ppm. This product is formulated to contain no chlortetracycline.

d. FDA analysis of a retain sample collected from a lot of non-medicated llama feed manufactured at your facility, identified as "Llama Mineral," found levels of chlortetracycline at 96.0 ppm. This product is formulated to contain no chlortetracycline.

We acknowledge your firm's response that the incident described above regarding Nutrena Naturewise Lamb and Sheep Feed represents an isolated incident.

However, this response is inadequate in light of analytical sample results confirming cross contamination in several additional products (i.e., "Nutrabeef Cattle Grower Feed," "Miller FDLT 45/27," and "Llama Mineral"). As these analytical results indicate that this is not an isolated incident, FDA continues to have concerns regarding the adequacy of the cleanout procedures at your Billings, Montana facility.

4. Your facility does hot utilize proper sequential production of medicated feeds on a predetermined basis designed to prevent unsafe contamination of feeds with residual drugs in the manufacture of medicated and non-medicated feeds, as required by 21 C.F.R. 225.65(b)(3). For example:

a. On February 4, 2008, your facility produced a medicated feed, identified as "Nutrena Naturewise Lamb and Sheep Feed," which is formulated to contain relatively low levels (0.55 lbs per ton) of the Type A, medicated article [redacted] (chlortetracycline), following the production of a medicated feed, identified as "Nutrena CTC 10 Gram," which is formulated to contain relatively high levels (222 lbs per ton) of the Type A, medicated article [redacted]. This resulted in levels of chlortetracycline in the lamb and sheep feed up to 1000% higher than the levels indicated on the product's label.

b. On January 8, 2008, your facility produced a lot of non-medicated feed, identified as "Llama Mineral," which is formulated to contain no chlortetracycline, following the production of a medicated feed, identified as "Nutrena CTC 10 Gram," which is formulated to contain relatively high levels (222 lbs per ton) of the Type A, medicated article [redacted] (chlortetracycline). This resulted in cross contamination of the "Llam a Mineral" with levels of chlortetracycline at 96.0 ppm.

c. On November 19, 2007, your facility produced a lot of, medicated feed, identified as "Miller FDLT 45/27," which is formulated to contain no chlortetracycline, following the production of a medicated feed, identified as "Nutrena CTC 10 Gram," which is formulated to contain relatively high levels (222 lbs per ton) of the Type A, medicated article [redacted] (chlortetracycline). This resulted in cross contamination of the "Miller FDLT 45/27" with levels of chlortetracycline at 88.0 ppm.

d. On November 5, 2007, your facility produced a lot of medicated feed, identified as "Nutrabeef Cattle Grower Feed," which is formulated to contain no chlortetracycline, following the production of a medicated feed, identified as "Nutrena CTC 10 Gram," which is formulated to contain relatively high levels (222 lbs per ton) of the Type A, medicated article [redacted] (chlortetracycline). This resulted in cross contamination of the "Nutrabeef Cattle Grower Feed" with levels of chlortetracycline at 4.8 ppm.

We acknowledge your firm's response that: (1) the incident described above regarding Nutrena Naturewise Lamb and Sheep Feed represents an isolated incident; (2) the Billings, Montana facility has reviewed its sequencing and flushing procedures and has determined that the procedures for sequencing feeds are adequate and substantiated with appropriate residue testing analysis; and (3) the importance of proper sequencing and flushing has been reviewed with appropriate personnel. We further acknowledge your firm's decision to no longer manufacture the medicated feed identified as "Nutrena CTC 10 Gram" at the Billings, Montana facility. Though the firm has suspended its production of the Nutrena CTC 10 Gram, this response fails to detail any changes in the firm's sequencing procedures to prevent future cross-contamination of products.

As a manufacturer of medicated feeds you are required to use all Type A, medicated articles and Type B medicated feeds in accordance with their labeled mixing directions. However, you did not use the Type A, medicated article [redacted] in accordance with its labeled mixing directions when you added it directly into feed ration mixes rather than following the product's labeled mixing direction, which indicates to [redacted] and then [redacted] therefore, the use of the new animal drug, Type A, medicated article [redacted] (chlortetracycline), contrary to its approved labeling causes the drug to be deemed unsafe within the meaning of section 512(a)(1) of the Act [21 U.S.C. § 360b(a)(1)] and adulterated within the meaning of section 501(a)(5) of the Act [21 U.S.C. § 351(a)(5)].

We acknowledge your firm's response stating that adding this drug directly from the bag to the mixer "is a long-time standard industry practice" and that "[d]rug reconciliation records, mixer efficiency tests and laboratory assays have all substantiated this practice...." However, this response is inadequate as it fails to indicate what efforts the firm will undertake to bring its manufacturing processes into compliance with the [redacted](chlortetracycline) labeled mixing directions.

The above is not intended to be an all-inclusive list of violations. As a manufacturer of medicated and non-medicated feeds, you are responsible for assuring that your overall operation and the products you manufacture and distribute are in compliance with the law.

You should take prompt action to correct these violations and you should establish procedures whereby such violations do not recur. Failure to promptly correct these violations may result in regulatory and/or administrative sanctions. These sanctions include, but are not limited to, seizure, injunction, and/or notice of opportunity for a hearing on a proposal to withdraw approval of your Medicated Feed Mill License under section 512(m)(4)(B)(ii) of the Act [21 U.S.C. § 360b(m)(4)(B)(ii)] and 21 C.F.R. 515.22(c)(2).

Based on the results of the February 2008 inspection, evaluated together with the evidence before FDA when the Medicated Feed License was approved, the methods used in, or the facilities and controls used for, the manufacture, processing, and packing of medicated feeds are inadequate to assure and preserve the identity, strength, quality, and purity of the new animal drug therein. This letter notifies you of our findings and provides you an opportunity to correct the above deficiencies in your operations.

You should notify this office in writing, within fifteen (15) working days of receipt of this letter, of the specific steps you have taken to correct the noted violations. Your, response should include an explanation of each step being taken to correct the cGMP violations and prevent their recurrence. If corrective action cannot be completed within fifteen (15) working days, state the reason for the delay and the date by which the corrections will be completed. Include copies of any available documentation demonstrating that corrections have been made.

Please send your written response to the Food and Drug Administration, Attention: Michael J. Donovan, Compliance Officer, 22201 23rd Drive SE, Bothell, Washington 98021. If you have questions regarding any issue in this letter, please contact Mr. Donovan at (425) 483-4906.

Sincerely,

/S/

Charles M. Breen District Director

Enclosure:

Form FDA 483

cc: Terry Wright, Plant Manager Cargill, Inc., 1406 Industrial Avenue, Billings, Montana 59101-3127

Sue Carson, Quality Assurance and Regulatory Manager Cargill Animal Nutrition, P.O. Box 5614, Minneapolis, Minnesota 55440-5614

Bob Church, Agricultural Specialist Montana Department of Agriculture, Feed and Fertilizer Division 303 North Roberts, Helena, Montana 59620-0201


http://www.fda.gov/foi/warning_letters/s6856c.htm


> This resulted in levels of chlortetracycline in the lamb and sheep feed up to 1000% higher than the levels indicated on the product's label. ...


holy smokes! no wonder many of us are becoming resistant to antibiotics. ...


http://staphmrsa.blogspot.com/


Chlortetracycline plus lasalocid sodium

http://www.fda.gov/cvm/FOI/141-250033106.pdf


Chlortetracycline review history and regulatory outcomes


snip...

Final review and outcomes

The APVMA completed the Chlortetracycline Review Final Report* in May 1999 but did not publish a final report because only a small number of registrants were involved. The APVMA found that the registration and approvals of the products containing chlortetracycline could be varied to meet the current requirements for continued registration.

In the final review the APVMA recommended:

cancelling approval for the use of chlortetracycline in sheep, lambs and lactating animals
ancelling approval for the use of chlortetracycline in animals producing milk for human consumption. Product labels must carry the statement, ‘Do not use in lactating cows where milk or milk products may be used for human consumption.’
increasing withholding periods for pigs, poultry, and cattle for some use patterns
withdrawing MRLs for milk, sheep, lambs and lactating animals
establishing new MRLs for pig offal (liver and kidney)
establishing MRLs for cattle, eggs and poultry.

Chlortetracycline as a topical application is currently listed in Table 5 of the MRL Standard; Table 5 applies to ‘Uses of substances where maximum residue limits are not necessary‘.

For more information please contact the Chemical Review Program on (02) 6210 4749 or by email to chemrev@apvma.gov.au

* Contact the APVMA for copies of this document

http://www.apvma.gov.au/chemrev/chlortetracyclineHistory.shtml



TSS

Community-associated methicillin-resistant Staphylococcus aureus ST8 ("USA300") in an HIV-positive patient in Cologne, Germany, February 2008

Euro Surveill 2008;13(13) Published online March 2008

Community-associated methicillin-resistant Staphylococcus aureus ST8 ("USA300") in an HIV-positive patient in Cologne, Germany, February 2008




W Witte (wittew@rki.de), C Braulke, B Strommenger

Robert Koch Institut, Wernigerode, Germany



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The first cases of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) were reported in 1996 in Minnesota, United States (US) and were deep-seated skin and soft tissue infections and a few cases of necrotising pneumonia, mainly in children and among the Native American population [1]. A few years later, a large outbreak of CA-MRSA infections was reported in the men who have sex with men (MSM) community in California, predominantly among human immunodeficiency virus (HIV)-positive patients; data on sexual transmission was not available [2]. A recent report on the spread of CA-MRSA, mainly due to the widely disseminated strain "USA300", in numerous MSM in San Francisco and in one patient in Boston suggested sexual transmission [3], but initiated critical reviews concerning the transmission route and the corresponding public health message [4,5].
CA-MRSA "USA300", the most widely spread CA-MRSA strain in the US [6], has been detected in Germany since 2005 [7]. This clonal lineage is characterised by multilocus sequence type (MLST) ST8, spa-sequence type t008, SCCmec IVa, the presence of an additional arginine decomposition pathway (arginine catabolic mobile element (ACME) on a staphylococcal cassette chromosome (SCC)-element) with arcA as marker gene, and macrolide-resistance coded by the msrA (efflux pump) and mphB (phosphorylation) genes [7,8]. The contribution of ACME to virulence has been shown in a rabbit model [9]. The capacity of CA-MRSA "USA300" to cause invasive infections seems not to be due to production of the Panton-Valentine leukocidin cytotoxin, but rather to the synthesis of a large number of small phenol-soluble peptides, which are able to recruit and lyse neutrophilic granulocytes [10].

Here we report a case of infection with CA-MRSA ST8 ("USA300") in an HIV-positive 35-year-old MSM patient in Cologne, Germany. The isolate originated from an infected cyst in the upper abdominal area, which opened spontaneously. The patient suffered from acquired immunodeficiency syndrome (AIDS). His CD4+ T-cell count was 200/microlitre with a fully suppressed virus load due to HIV treatment. A specimen from the cyst was taken for microbiological diagnostics. Primary topical treatment was performed by instillation of Leukase beads containing trypsin, framycetin sulphate and lidocaine hydrochloride (Merck, Vienna). After obtaining the microbiology results, oral doxycyclin (200 mg per day) was included in the treatment. The infection had healed completely after 14 days. Nasal swabs were negative for MRSA.

The isolate exhibited the typical characteristics of CA-MRSA ST8 ("USA300", see above). It was resistant to oxacillin, erythromycin, ciprofloxacin, moxifloxacin and susceptible to gentamicin, oxytetracycline, clindamycin, rifampicin, cotrimoxazole, fusidic acid, linezolid, fosfomycin, tigecycline and daptomycin.

As shown in the US, CA-MRSA ST8 ("USA300") may spread rapidly in MSM communities [3]. European doctors caring for HIV-positive patients and MSM with skin and soft tissue infections should be aware of the possibility of CA-MRSA in order to provide proper care and prevent further spread.

Targeted measures include proper bacteriological diagnosis of skin and soft tissue infections in patients attending dermatological and surgical practises, as well as in HIV-positive patients. When MRSA is detected, it is likely that the infection is caused by a CA-MRSA strain. Early recognition of CA-MRSA ST8 ("USA300") is possible by PCR detection of the lukS-lukF and arcA genes [11]. Confirmation is obtained by additional typing such as spa-typing, MLST, and SCCmec [7]. Further spread can be prevented by personal, environmental and health care hygienic measures [12,13].




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References

Naimi TS, LeDell KH, Boxrud DJ, Groom AV, Steward CD, Johnson SK, et al. Epidemiology and clonality of community-acquired methicillin-resistant Staphylococcus aureus in Minnesota. Clin Infect Dis. 2001 Oct 1;33(7):990-6.
Centers for Disease Control and Prevention (CDC). Outbreaks of community-associated methicillin-resistant Staphylococcus aureus skin infection - Los Angeles County California, 2002-2003. MMWR Morb Mortal Wkly Rep. 2003;52(5):88. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5205a4.htm
Diep BA, Chambers HF, Graber CJ, Szumowski JD, Miller LG, Han LL, et al. Emergence of multidrug-resistant, community-associated, methicillin-resistant Staphylococcus aureus clone USA300 in men who have sex with men. Ann Intern Med. 2008;148(4):249-57.
Skiest D, Brown K, Cooper TW, Hoffman-Roberts H, Mussa HR, Elliott AC. Prospective comparison of methicillin-susceptible and methicillin-resistant community associated Staphylococcus aureus infections in hospitalized patients. J Infect. 2007;54(5):427-34.
Centers for Disease Control and Prevention (CDC). CDC statement on MRSA in men who have sex with men. 2008 Jan 16. Available from: http://www.cdc.gov/od/oc/media/pressrel/2008/t080116.htm
Van de Laar MJW, Monnet DL, Herida M. Multidrug-resistant methicillin-resistant Staphylococcus aureus (MRSA) strain in a men-who-have-sex-with-men (MSM) community in the United States: comment. Euro Surveill. 2008;13(3). Available from: http://www.eurosurveillance.org/edition/v13n03/080117_1.asp
Witte W, Strommenger B, Cuny C, Heuck D, Nuebel U. Methicillin-resistant Staphylococcus aureus containing the Panton-Valentine leucocidin gene in Germany in 2005 and 2006. J Antimicrob Chemother. 2007;60(6):1258-63.
Tenover F, McDougal L, Goering RV, Killgore G, Projan SJ, Patel JB, et al. Characterization of a strain of community-associated methicillin-resistant Staphylococcus aureus widely disseminated in the United States. J Clin Microbiol. 2006;44(1):108-18.
Chambers HF. Deconstructing virulence of the community MRSA clone USA300. in NARSA 8th Annual Meeting. 2007. Reston, VA, USA, March 5-6. Available from: http://www3.niaid.nih.gov/topics/antimicrobialResistance/PDF/futureMedicineMRSAeditorial.pdf
Wang R, Braughton KR, Kretschmer D, Bach TH, Queck SY, Li M, et al. Identification of novel cytolytic peptides as key virulence determinants. Nature Med. 2007;13(12):1510-4.
Strommenger B, Braulke C, Pasemann B, Schmidt C, Witte W. Multiplex PCR for rapid detection of Staphylococcus aureus isolates suspected to represent community-acquired strains. J Clin Microbiol. 2008;46(2):582-7.
Cohen PR. Community-acquired methicillin-resistant Staphylococcus aureus skin infections: implications for patients and practitioners. Am J Clin Dermatol. 2007;8(5):259-70.
Wiese-Posselt M, Heuck D, Draeger A, Mielke M, Witte W, Ammon A et al. Successful termination of a furunculosis outbreak due to lukS-lukF-positive, methicillin-susceptible Staphylococcus aureus in a German village by stringent decolonization, 2002 - 2005. Clin Infect Dis. 2007;44(11):88-95.





Citation style for this article: . Community-associated methicillin-resistant Staphylococcus aureus ST8 ("USA300") in an HIV-positive patient in Cologne, Germany, February 2008. Euro Surveill 2008;13(13). Available online: http://www.eurosurveillance.org/edition/v13n13/080327_3.asp


http://www.eurosurveillance.org/edition/v13n13/080327_3.asp



tss