농축유통신문 2012.05.25  09:53:36
http://www.amnews.co.kr/news/articleView.html?idxno=4524

가축용 항생제 사용량이 관련통계를 작성한 이후 가장 낮았던 것으로 나타났다.

정부는 배합사료내 항생제 혼입을 금지하면서 나타난 결과로 풀이하고 있지만 실제론 구제역과 AI 발병에 따른 사육두수감소가 항생제 사용감소에 결정적 영향을 끼친 것으로 분석된다.

배합사료 내 항생제 혼입금지는 2011년 7월부터로 2010년 11월 이후 구제역 발병으로 상당수의 돼지가 살처분되면서 돼지의 항생제 사용량이 크게 준 것 등을 볼 때 착시현상일 가능성이 높다.

지난해 구제역 AI 등의 여파로 살처분된 가축수를 감안할 때 가축사육규모당 항생제 사용량은 오히려 늘었다고 볼 수도 있는 대목이다.

특히, 문제가 되고 있는 자가치료 및 예방용 항생제의 경우 2009년 이후 오히려 매년 증가하고 있는 것 등이 가축두당 항생제 사용량이 증가하고 있다는 분석에 힘을 실어주고 있다.

이러한 상황 등을 종합하지 않고 업체별 항생제 생산량과 판매량만을 갖고 항생제 사용량이 줄었다고 홍보하는 것은 국민을 기만하는 행위라고 밖에 볼 수 없다.

정부는 내년 수의사처방제가 도입되면 항생제 사용량이 획기적으로 줄 것으로 이야기하고 있지만 과도한 밀식 등 사육환경을 개선하지 않는다면 사료용항생제 사용금지에 따른 풍선효과로 고가의 치료용 항생제의 사용이 급증할 수 밖에 없고 고스란히 농가피해 그리고 소비자 피해로 이어질 수밖에 없는 상황이다.

방역 및 위생 당국은 단순히 사료에 항생제 혼입을 줄이고 수의사 처방제가 도입되면 항생제 사용량이 줄어들 것으로 이야기하고 있지만 이러한 규제 위주의 대책으로는 오히려 음성적 항생제의 사용을 부추길 것이라는 반론이 지배적이다.

항생제의 사용량을 줄이기 위해서는 실제로 항생제를 적게 사용하면서도 생산성을 유지하는 사양기술 등의 개발과 보급이 필요하고 관심이 집중되는 항생제 대체 물질의 경우 항생제 수준의 사용법이 확립되고 효능이 검증되도록 이부분 R&D에 더욱 집중할 필요가 있다.

==============

☐ 농림수산검역검사본부(이하 검역검사본부)는 축산 항생제 안전 관리 사업의 일환으로 한국동물약품협회와 공동으로 수행한 “축산용 항생제 사용량 조사” 사업 결과에서 ‘11년 축산용 항생제 사용량이 조사 이래 가장 낮은것으로 나타났다고 밝혔다.

○ ‘11년 축산용 항생제 전체 사용량은 956톤으로 ’01년부터 사용량을 조사한 이래 가장 낮은 수치로 ‘01년(약 1,595톤)에 비해서는 약 40%가 감소하였다.

- 이는 ‘05년부터 농림수산식품부에서 추진해온 배합사료제조용 항생제를 지속적으로 감축한 것이 크게 영향을 미친 것으로 분석된다.

* 전체 축산용 항생제 사용량 중 배합사료제조용은 ‘11년 101톤으로 ’10년(224톤)에 비해 약 55%, ‘01년(766톤)에 비해서는 약 87% 감소함.

○ 모든 축종에서 항생제 사용량이 지속적으로 감소하였으며, 특히 돼지에서 ‘11년에 459톤이 사용되어 ‘01년(918톤)의 절반 수준 (약 50%)으로 감소하였으며, 닭은 약 44%, 소는 약 37%가 감소하였다.

○ 항생제 종류별로는 테트라싸이클린계 항생제가 ’01년 약 752톤에서 ‘11년 약 308톤으로 약 59% 감소하였으며, 설파계 항균제는 ’01년 237톤에서 ‘11년 100톤으로 약 58% 감소하였다.

☐ 검역검사본부는 농식품부와 함께 수의사처방제 추진, 친환경 축산 확대, 지속적인 항생제 사용량 조사와 더불어 동물용 의약품에 대한 안전성·유효성 재평가,축종별 적정 항생제사용 가이드라인 설정·보급 및 축산농가에 대한 교육․홍보 등을 통해 항생제 사용량을 꾸준히 줄여 안전한 축산물을 생산·공급하도록 노력하겠다고 밝혔다.

<참고자료>

1. 축산용 항생제 사용 실태

□ 국내 동물용 항생제 사용 실태

○ 용도별 항생제 판매 실적

○ 축종별 항생제 판매 실적

○ 항생제 계열별 판매 실적

2. 배합사료제조용 동물용의약품 감축 추진

- (‘04) 53종 → (’08) 16종 → (’09) 9종 → (’11.7) 전면금지

3. 수의사처방제 도입 추진

○ 수의사 처방제 도입방안에 관한 연구용역(’07.5월～’07.11월) 결과를 토대로 처방제 도입방안 마련

- ’11년도 수의사 처방제 시행을 목표로 약사회 등 이해관계자와 합의 도출(’10.3)

- ’10.9.6 수의사처방제를 담은 약사법·수의사법 개정안 대표발의

(심재철의원)

- ‘11.12 약사법 및 수의사법 개정안 국회 통과

○ 수의사처방제 도입

- ‘12. 2 약사법 및 수의사법 개정 공포

- ‘13. 8 수의사처방제 시행(예정)

Volume 8, Number 5—May 2002
http://wwwnc.cdc.gov/eid/article/8/5/01-0267_article.htm

Research

Excess Mortality Associated with Antimicrobial Drug-Resistant Salmonella Typhimurium

Morten Helms*, Pernille Vastrup*, Peter Gerner-Smidt*, and Kåre Mølbak* 

Author affiliations: *Statens Serum Institut, Copenhagen, Denmark;

Abstract

In a matched cohort study, we determined the death rates associated with drug resistance in Salmonella Typhimurium. We linked data from the Danish Surveillance Registry for Enteric Pathogens with the Civil Registration System and the Danish National Discharge Registry. By survival analysis, the 2-year death rates were compared with a matched sample of the general Danish population, after the data were adjusted for differences in comorbidity. In 2,047 patients with S. Typhimurium, 59 deaths were identified. Patients with pansusceptible strains of S. Typhimurium were 2.3 times more likely to die 2 years after infection than persons in the general Danish population. Patients infected with strains resistant to ampicillin, chloramphenicol, streptomycin, sulfonamide, and tetracycline were 4.8 times (95% CI 2.2 to 10.2) more likely to die, whereas quinolone resistance was associated with a mortality rate 10.3 times higher than the general population.

Foodborne Salmonella infections have become a major problem in most industrialized countries. Of particular concern is the increasing number of infections with antimicrobial drug-resistant Salmonella, including the recent emergence of drug-resistant Salmonella enterica serotype Typhimurium (S. Typhimurium) definitive phage type 104 (DT104). This strain is usually resistant to at least five drugs: ampicillin, chloramphenicol, streptomycin, sulfonamides, and tetracycline (R-type ACSSuT) and has become a predominant Salmonella type in many countries, including the United States, United Kingdom, Germany, and France (1–4). In spite of its rapid international dissemination (5) and the fact that antimicrobial drug-resistant Salmonella was associated with human infections before the recent spread of DT104, the available data are inconclusive regarding a possible increased virulence of DT104. Whether antimicrobial drug resistance in DT104 contributes to enhanced illness or death is unclear (5–7). Few studies have addressed the health impact of drug resistance in types of zoonotic Salmonella other than DT104 (8–10), and these studies suggest that drug resistance may be associated with increased illness and death rates.

Excess mortality associated with drug resistance in zoonotic Salmonella is difficult to quantify. Death is a relatively rare event and may not occur until months after the initial diagnosis. Furthermore, a number of factors, including chronic and malignant diseases, may contribute to death from salmonellosis. The objective of this study was to determine death associated with antimicrobial drug resistance in S. Typhimurium. The study was based on a large, unbiased sample of Danish patients registered in a national database. We linked these data with those in the Danish civil registry, which has complete information about survival status. Furthermore, by completing the data with information from hospital discharge registries, we were able to adjust for comorbidity.

Materials and Methods

Surveillance

In Denmark the diagnosis of human Salmonella infections is made at Statens Serum Institut (SSI) or at 10 clinical microbiology laboratories. The SSI receives notifications of positive findings as well as isolates from the microbiology laboratories. If a specific Salmonella serotype is found more than once from the same person during a period of up to 6 months, only the first positive sample is registered. As a part of this laboratory-based surveillance system, monitoring for antimicrobial resistance in S. Typhimurium was initiated in 1995. In 1995 and 1996, a sample of strains was tested, but from 1997 on, all S. Typhimurium strains received at SSI were tested for antimicrobial susceptibility. This study included all isolates of S. Typhimurium examined from January 1, 1995, through October 31, 1999.

Isolates were tested by tablet diffusion on Danish Blood Agar (SSI Diagnostica, Hillerød, Denmark) with the use of Rosco Neosensitabs (Rosco, Roskilde, Denmark). The panel included 13 drugs from the Danish Integrated Antimicrobial Resistance Monitoring and Research Programme (11). Because reduced susceptibility to ciprofloxacin is difficult to detect by the tablet diffusion test, the E-test (Biodisk, Solna, Sweden) was used as well whenever the tablet diffusion test identified nalidixic acid resistance. In this paper, quinolone resistance refers to strains resistant to the first-generation quinolone nalidixic acid (12).

Registry Linkage Study

All live-born children and citizens of Denmark are assigned a personal identification number, uniquely identifying every person the Danish Civil Registration System (13). Demographic data, including vital status, marriage status, emigration/immigration, and address of residence, are kept in this Civil Registration System.

The matched cohort study used the data from the Civil Registration System to compare the death rates of patients with culture-confirmed S. Typhimurium infections to the death rates of persons in the general Danish population. For each patient, we randomly selected 10 people matched by age, sex, and county of residence. People who were born during the same month and year as the patient and were alive on the date of sample receipt were eligible for the reference group. From the Danish Civil Registration System, we obtained information on vital status, date of change of vital status, (i.e., date of death or emigration) and area of residence (county level) for the patients and the persons included in the reference group.

Data on admissions to hospital and discharge diagnosis were obtained by using the data from the Danish National Patient Registry (14) and the Cancer Registry for all persons included in this study, thereby allowing us to control for preexisting illness (comorbidity). Danish National Patient Registry contains data on all patients discharged from non-psychiatric departments since January 1, 1977. Diagnoses and procedures are coded according to the International Classification of Diseases 8 or International Classification of Diseases 10 (from 1993). Diagnoses obtained during 10 years before infection were used to calculate the comorbidity index.

Statistical Methods

The comorbidity index used the principles described by Charlson et al. (15). This index is a sum of severity scores (weights) corresponding to the number and severity of comorbidity conditions. In the first step, we analyzed the data from the background population to calculate the relative rate associated with each of the diagnostic groups summarized in Table 1. These relative rates served as the weights in the further survival analyses. The index was calculated by adding log-transformed weights, thus taking into account multiple hospital discharges. Diagnostic groups associated with a relative mortality rate <1.2 were not included in the models. By comparing this index with the survival analyses, any difference between the death rates of Salmonella patients and the general population quantifies excess mortality beyond what is attributable to underlying illness.

To compare mortality rates of S. Typhimurium patients with those of the general population, the data were stratified so that each stratum contained 1 patient and 10 persons from the reference group. To control for age, sex, and county of residence, we used conditional proportional hazard regression. Death up to 2 years after infection was determined, after adjusting the data for comorbidity as described. To assess death rates associated with antimicrobial drug resistance, interaction by drug resistance on Salmonella deaths was determined. We used the Wald test to test for homogeneity of the rate ratios. The analyses were conducted by the use of the PHREG procedure of the SAS system (Version 6.12, SAS Inst. Inc., Cary, NC). Death rate ratios (RR) are expressed as the relative death rates of patients compared with the matched sample of the general Danish population, and the term “referents” refers to this unexposed matched sample.

Results

Of 4,075 cases of S. Typhimurium infections reported in Denmark from January 1995 to October 1999, the antimicrobial-drug susceptibility was determined in isolates from 2,059 cases, and a successful link to the Civil Registry System was obtained for 2,047 (99.4%). In the period up to 2 years after entry in the study, 59 deaths were identified in S. Typhimurium patients and 221 deaths among 20,456 referents. The median age of the 59 persons were 74.1 years (range 18.1 to 90.1). In the first 30 days after entry in the study, the cumulative mortality proportion (Kaplan-Meier estimate) was 0.73% for S. Typhimurium patients and 0.04% for the referents (RR 15.4, 95% confidence interval [CI] 6.1 to 39.2). In the period 30 to 720 days after entry, cumulative mortality was 2.75% in S. Typhimurium patients and 1.51% in referents (RR 1.8, 95% CI 1.3 to 2.6). On this basis, we used the period 0 to 720 days in the remaining analyses.

Overall, patients with S. Typhimurium were 3.0 times (95% CI 2.2 to 4.0) more likely to die than referents in the 2 years following infection. After the data were adjusted for comorbidity, the relative rate was 2.3 (95% CI 1.7 to 3.2). This relative death rate was independent of age (p=0.84).

A total of 631 (30.8%) patients were hospitalized in connection with the S. Typhimurium infection. In the reference group, 577 (2.8%) were hospitalized within 60 days of entry. Five of those had gastroenteritis as their primary diagnosis.

Two hundred seventeen (10.6%) of S. Typhimurium patients and 954 (4.7%) persons from the referent group had at least one of the diagnoses listed in Table 1, which summarizes the various diagnostic groups and their weights in relation to the comorbidity index. A total of five HIV infections were found, three among patients and two in the reference group. All five were still living at the end of the study.

In the 2,047 strains, 953 (46.6%) were pansusceptible, 1,094 (53.4%) resistant to at least one drug in the panel, and 639 (30.8%) were resistant to at least two drugs. Resistance to sulfonamides was found in 47.3% of the patient isolates, tetracycline in 25.1%, streptomycin in 22.4%, ampicillin in 19.2%, chloramphenicol in 17.0%, kanamycin in 9.6%, quinolone in 4.1%, trimethoprim in 3.0%, gentamicin in 2.2%, and ceftriaxon in 1.4%. No ciprofloxacin-resistant strains were found. The MIC of ciprofloxacin in the quinolone-resistant isolates ranged from 0.06 to 0.38 mg/L (median 0.09 mg/L).

R-type ACSSuT was found in 283 (13.8%) isolates, and patients infected with this type were 6.9 times more likely to die than the general population, compared with a RR of 2.6 in patients with strains of other R-types (p =0.02). Also, chloramphenicol (7.4 vs. 2.4, p=0.003), quinolones (9.9 versus 2.8, p=0.05), and ampicillin (5.1 versus 2.7, p=0.09) were associated with higher death rates in resistant than sensitive strains.

Table 2 shows the relative death rate associated with antimicrobial resistance after the data was adjusted for coexisting diseases. Infections with pansusceptible strains were 2.3 times (95% CI 1.5 to 3.5) more likely to die than the general population, whereas infection with R-type ACSSuT was associated with 4.8 times (95% CI 2.2 to 10.5) higher mortality. Patients infected with quinolone-resistant strains (R-type Nx) were 10.3 times (95% CI 2.8 to 37.8) more likely to die, and R-type ACSSuTNx was associated with 13.1 times (95% CI 3.3 to 51.9) higher mortality. Three other antimicrobial drugs (trimethoprim, gentamicin, and ceftriaxone) were examined, but because of a low number of resistant strains, valid statistical inference could not be carried out. All the strains resistant to these drugs exhibited R-type ACSSuT. Most (82%) of the chloramphenicol-resistant strains and 72% of the ampicillin-resistant strains were also R-type ACSSuT.

A total of 270 of the isolates with R-type ACSSuT were phage-typed, and 217 (80.4%) were DT104, 18 (6.7%) DT12, 11 (4.1%) DT120, and the rest were other or unknown phage types. Strains with other R-types were distributed over a number of different phage types. A total of 1,667 were examined, and the three most common were DT12 (46.8%), DT66 (6.0%), and U288 (4.9%). Thirty-nine (2.3%) were DT104. In the patients with R-type ACSSuT, no difference in the death rate between persons infected with DT104 (relative death rate 4.4, 95% CI 1.7 to 11.6) and other phage types (relative death rate 6.4, 95% CI 1.3 to 32.4) was found; both estimates were adjusted for comorbidity.

No difference in age and sex distribution between patients infected with R-type ACSSuT and other antibiograms were found. The median age in both groups was 33 years (range 1 to 87 and 0 to 95, respectively, p=0.89).

Figure

Figure. Survival comparison of patients infected with Salmonella Typhimurium (by resistance level) to referents. The patients and referents were matched by age, gender, and county of residence.

Finally, we analyzed a model with three levels of resistance: non-ACSSuT, R-type ACSSuT (Nx-sensitive), and R-type ACSSuTNx. The figure shows the survival curve of the referents and patients according to these three groups. In the group of 40 cases with R-type ACSSuTNx, we identified five deaths within the 2-year period after infection, one of those within the first month of infection, three within 6 months, and one within 18 months. The relative risk associated with an infection with R-type ACSSuTNx was 12.4 without adjusting the data for comorbidity. After adjustment, the RR associated with this resistance pattern was 13.1. The median age in this group was 43 years (range 1 to 89), 10 years higher than the R-type ACSSuT quinolone-sensitive group.

Discussion

Since the 1990s, the frequency of antimicrobial drug resistance in zoonotic Salmonella and the number of drugs to which the strains are resistant has increased, primarily as a consequence of antimicrobial use in food production (1,9,16–18). The recent development of fluoroquinolone resistance is of particular concern (16–21). At present, a fluoroquinolone is the drug of first choice for extraintestinal and serious intestinal Salmonella infections in adults, and resistance to this drug may potentially reduce the efficacy of early empirical treatment. The health impact of antimicrobial drug resistance in zoonotic Salmonella needs to be determined (21,22). We used data from registries created for other purposes to avoid bias and were able to explore long-term death rates and adjust the data for comorbidity.

The comorbidity index was based on discharge diagnoses from patients admitted to hospitals in Denmark and to a lesser degree on data from outpatient clinics but did not include data from general practitioners. Any patient with a coexisting disease severe enough to alter the outcome of a Salmonella infection is likely to have had contact with a hospital or an outpatient clinic within the 10-year period before infection. The backbone for the construction of the comorbidity index was the National Discharge Registry. A validation of this registry showed that there was agreement between the registry and hospital records of 75% to 90%, using 3-digit level International Classification of Diseases diagnoses (14).

In general, patients with S. Typhimurium infections were 2.3 times more likely to die than the matched sample of the Danish population during a 2-year follow-up. This figure is likely to reflect both long-term consequences of S. Typhimurium as well as underlying diseases and conditions not fully described by our comorbidity score based on hospital discharge diagnosis. The excess mortality was independent of age, a finding which warrants further studies. The cumulative mortality in the first 30 days, 0.7%, is comparable with the case-fatality rate of 0.8% for all nontyphoidal Salmonella serotypes found in data from FoodNet 1996-97 (23).

We found that S. Typhimurium with R-type ACSSuT was associated with higher death rates than other strains. Similar tendencies were found for chloramphenicol and ampicillin, both being markers for R-type ACSSuT. Patients infected with R-type ACSSuT were seven times more likely to die than the general population, but when the data were adjusted for underlying illness, this figure was reduced to fivefold higher mortality. This reduction was expected; a part of the excess mortality associated with R-type ACSSuT was attributable to underlying illness. However, the excess mortality still tended to be elevated after adjustment. Patients with quinolone-resistant strains had a marked and substantial excess mortality, which could not be explained by imbalances in comorbidity. All the quinolone-resistant strains in this study were designated as fluoroquinolone-susceptible by NCCLS cut-offs for ciprofloxacin. Several patients in the study were part of an outbreak of S. Typhimurium DT104 R-type ACSSuTNx traced back to swine herds in the Danish island of Zealand (17).

Most deaths occurred in relation to infections with S. Typhimurium DT104, and we were not able to demonstrate any statistically significant variation among different phage types. In our initial model we took age into account, expecting a relatively higher mortality among the elderly. But again, we could not demonstrate such an effect. In other words, no additive effect was found between age and drug resistance compared with age and being infected by sensitive strains of S. Typhimurium.

A study from England suggests that the isolation rates of drug-resistant DT104 from blood cultures are not higher than those of other S. Typhimurium phage types and that the frequency is comparable with the incidence of blood culture isolates of Salmonella Enteritidis (7). The study suggests that S. Typhimurium of R-type ACSSuT does not cause invasive disease more often than Salmonella Enteritidis. However, the overall mortality in relation to S. Typhimurium infection is higher. Two studies based on outbreaks of resistant Salmonella in the United States and the United Kingdom have found case fatality rates of 4.2% and 3.0% respectively (6,8). Even though they were based on outbreak investigations, the cumulative death rate is comparable to our results (2.9% after 6 months of infection).

Antimicrobial drug resistance in zoonotic Salmonella may be associated with adverse consequences in several ways, including treatment failures. However, treatment failures have, until now, been infrequently reported (17,21). We had no data on treatment with antimicrobial drugs. Therefore, exploring the extent to which the excess mortality of patients infected with quinolone-resistant strains was caused by reduced efficacy of drugs was impossible. We estimate that approximately 20% of the patients were prescribed empiric treatment in connection with the collection of specimens and that some of the deaths may have been associated with reduced efficacy of flouroquinolones, as described in Mølbak et al. (17).

Resistant bacteria have a selective advantage in ecosystems where antimicrobial drugs are used. Studies have shown that treatment with antimicrobial drugs (for any reason) is a major risk factor for infections with antimicrobial drug-resistant bacteria, and that this association may result in increased incidence and illness severity (9,24,25). Infection with drug-resistant S. Typhimurium in patients treated for other infections may contribute to the excess mortality we found.

Infections with resistant Salmonella may be associated with increased severity for reasons that are poorly understood. An increased virulence of drug-resistant Salmonella has not been well characterized. Two earlier studies found increased rates of hospitalizations (10) and death (8), but these studies had limitations. Lee et al. (10) were only able to control for comorbidity in a limited way, and none of the earlier studies were restricted to a single serotype and able explore the impact of specific resistance patterns as we did.

The use of antimicrobial drugs in food production is one of the major factors in the emergence and dissemination of antimicrobial drug-resistance in foodborne bacterial pathogens. We were able to determine death rates in a large sample of patients with S. Typhimurium and to control for confounding factors in the analyses. We associated resistance in S. Typhimurium with excess mortality, and the demonstration of a hazard to human health underscores the need for restrictions in the use of antimicrobial drugs in the production of food from animals. A particular risk was associated with quinolone resistance, indicating that the use of fluoroquinolones for food production animals should be discontinued.

Dr. Helms is a research fellow at the Department of Epidemiology Research, Statens Serum Institut, studying health outcomes in relation to foodborne bacterial infections, in particular the hazards associated with drug-resistant bacteria in our food supply.

Acknowledgments

We thank Per Krag Andersen for his statistical advice, the Salmonella Laboratory of The Danish Veterinary Laboratory for phage typing, and the 10 microbiology laboratories in Denmark for reporting findings of Salmonella Typhimurium to the SSI. We also thank the two reviewers for helpful suggestions.

The study was funded by The Danish Research Center for Environmental Health.

References

Figure

• Figure. Survival comparison of patients infected with Salmonella Typhimurium (by resistance level) to referents. The patients and referents were matched by age, gender, and county of residence.

Tables

• Table 1. The distribution of comorbidity diagnosis of 2,047 patients with S. Typhimurium infection and a sample of the general Danish population of 20,456 persons
  
• Table 2. Two-year relative death rate of patients infected with Salmonella Typhimurium, by antimicrobial susceptibility pattern. Registry linkage study including 2,047 patients and a random matched sample of 20,456 people from the Danish…

Suggested citation: Helms M, Vastrup P, Gerner-Smidt P, and Mølbak K. Excess Mortality Associated with Antimicrobial Drug-Resistant Salmonella Typhimurium. Emerg Infect Dis. [serial on the Internet]. 2002 May [date cited]. Available from http://wwwnc.cdc.gov/eid/article/8/5/01-0267.htm

DOI: 10.3201/eid0805.010267

미국의 동물용 항생제 사용량 증가

2011년 미국에서 사용된 동물용 항생제는 총 2990만 파운드.
2011년 미국에서 사용된 인체용 항생제는 총 730만 파운드.

가축에 사용된 항생제가 인체용 항생제에 비해 3.9배나 더 많아
(미국 내 항생제의 80%를 가축에 사용, 인체용은 20%에 불과)

니실린 및 테트라사이클린
2009년  1150만 파운드 –> 2011년 1440만 파운드

미국 내 페니실린 판매량 중 38%와 테트라사이클린 판매량 중 98%가 동물에서 사용됨
(인체 치료용 항생제 포함한 통계)

Animal Antibiotic Use Continues Upwards, FDA Keeps Blinders on

http://www.huffingtonpost.com/david-wallinga-md/animal-antibiotic-use_b_2654385.html

With legislation in 2008, Congress for the first time asked the Food and Drug Administration (FDA) to collect and report to the public the overall sales of antibiotics used in food animals. February 6 marked the release of a third year’s worth of data.

Penicillins and tetracyclines sold for animal use increased for the second year in a row. From 11.5 million pounds in 2009, sales rose to 14.4 million pounds in 2011. The two classes of antibiotics remain the most commonly used antibiotics in livestock and poultry, despite their obvious import for treating infections in people as well. In 2011, animal sales accounted for 38 percent of total penicillin sales and 98 percent of total tetracycline sales, including in humans.

Use of antibiotics in animals overall also continues to rise, to 29.9 million pounds in 2011. That compares with at least 7.3 million pounds (according to FDA data, comparing to 7.7 million according to Pew) sold for use in humans. The fact that 3.9 times more antibiotics are used in animals than humans, as this new infographic illustrates from the PEW Charitable Trusts, may shock most Americans.

For 34 years, the FDA considered the routine use of penicillins and tetracyclines in animal feed, for purposes like growth promotion, a public health threat. The agency had moved in 1977 to withdraw its approval for these animal feed products on the grounds that such use had not been shown to be safe for people. That official stance remained on the books until 2011.

IATP produced a recent bibliography listing 147 studies comprising a compelling body of evidence that this routine use antibiotics at nontherapeutic levels in animal feed helps drive an epidemic of expensive, hard-to-treat superbug infections in people, including those coming from a meat supply replete with bacteria resistant to multiple antibiotics.

In December 2011, FDA backtracked from its 1977 proposal claiming the move to protect public health by ending addition of penicillins and tetracyclines to animal feed was now outdated. Instead, said FDA, it was changing focus, by asking pharmaceutical companies to voluntarily to reduce the sales of their antibiotic products sold for use in animal feed.

So, if the success of FDA’s approach strikes you as unlikely, you’re not alone. Along with my partners in Keep Antibiotics Working, I have been quite skeptical of this voluntary approach, but apparently there’s been skepticism within the FDA as well.

Last March, a Federal judge ordered the FDA to reverse its decision and withdraw the animal products after all. In effect, the judge said that the stand first taken by the FDA in 1977 had been right. The FDA has appealed the judge’s decision.

“In the face of the antibiotic resistance crisis, we cannot afford to be standing still. We need strong action to combat the overuse of antibiotics in animal agriculture,” said Steven Roach, Public Health Program Director at Food Animal Concerns Trust (FACT) and a member of Keep Antibiotics Working.

Nothing less will suffice for the public’s health. The World Economic Forum recently reported that overuse and misuse of antibiotics has created the real and immediate threat that once easily treatable infections will rage, and be unresponsive to treatment with any existing antibiotics.

As a parent of young children who get bacterial bronchitis, ear infections and skin infections, that keeps me awake at night.

신생아, 병원·조리원서 변종세균 MRSA 무방비 노출