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Contents: SUPERBUGS

Chicken Out of Urinary Tract Infections

Campylobacter Joins the Resistance

The Hard-Boiled Truth: Salmonella and Eggs

Don’t Wash Your Meat

Bacteria or Cancer? It's Your Choice 

SUPERBUGS: Chicken Out of Urinary Tract Infections 

Urinary Tract Infections are the most common infectious disease in women, affecting millions every year in the United States. And they are getting harder and harder to treat as antibiotic resistance among the chief pathogen, E. coli, becomes more and more common. 

When people think of E. coli infection, they typically think of the Jack-in-the-Box E. coli 0157:H7 infection, which starts as hemorrhagic colitis (profuse bloody diarrhea) and can then progress to kidney failure, seizures, coma and death. While E. coli 0157:H7 remains the leading cause of acute kidney failure of our children in this country,[31] only about 50,000 people get infected every year and only about 50 die. But literally millions of people get what's called "extraintestinal" E. coli infections--urinary tract infections (UTIs) which can invade the bloodstream and cause an estimated 36,000 deaths annually in the United States. That's over 500 times as many deaths as E. coli 0157:H7. We know where E. coli 0157:H7 comes from--fecal contamination from the meat, dairy and egg industries[1]--but where do these other E. coli come from? 

Medical researchers at the University of Minnesota published a clue to the mystery this April in the Journal of Infectious Disease. Taking over a thousand food samples from multiple retail markets, they were not surprised to find evidence of fecal contamination in 69% of the pork and beef and 92% of the poultry samples as evidenced by E. coli contamination. We know meat products are crawling with intestinal bugs. In fact, animal manure has been found to be the source of more than 100 pathogens, including bacteria, parasites and viruses that could be transmitted from animals to humans.[2] 

More surprising was that ">80% of their E. coli isolates from beef, pork, and poultry exhibited resistance to >=1 antimicrobial agent, and >50% of isolates from poultry were resistant to >5 drugs!"[3] One rarely finds exclamation points in the medical literature. 

But what was most surprising was that, for example, half of the poultry samples were contaminated with the extraintestinal E. coli bacteria. It seems that the UTI-type E. coli are food-borne pathogens as well, "found in many retail foods," the researchers write, "particularly poultry but also beef or pork...." 

The researchers conclude: "The highest prevalences and densities of resistant E. coli and ExPEC [Extraintestinal Pathogenic E. Coli] were found in meat products. This is consistent with contamination of animal carcasses with the host's fecal flora during slaughter and processing and with use of antimicrobial agents in food-animal production." The researchers go so far as to say that the extraintestinal pathogenic E. coli "may rival (or exceed) E. coli O157:H7 as a foodborne pathogen."[4] Science News comments on a 2005 California study which found the same thing:[5] "According to new research, this wave of multidrug-resistant UTIs may have a surprising source: eating meat."[6] 

The scientists suspect by eating chicken and other meat, women infect their lower intestinal tract with these antibiotic-resistant bacteria which can then creep up into their urethra. Commonsense hygeine measures to prevent UTI's have always included wiping from front to back after bowel movements and urinating after intercourse to flush any infiltrators out. Now perhaps we can add a third measure: avoiding meat. 

 SUPERBUGS: Campylobacter Joins the Resistance 

Campylobacter is the most common bacterial cause of food poisoning in the United States. One study found Campylobacter contaminating 98% of retail chicken meat, the most common cause of Campylobacter poisoning.[7] And the bacterium is growing dangerously resistant to multiple classes of antibiotics. But we still have a few big-gun antibiotics left to deal with resistant bugs. So, for the time being (before the bacteria outsmart these new antibiotics as well), do we have good evidence showing that partially resistant bugs like Campylobacter currently pose a particular threat? We do now. 

Typically, Campylobacter only causes a self-limited diarrheal illness ("stomach flu") which doesn't require antibiotics. If the gastroenteritis is particularly severe or if doctors suspect that the bug may be working it's way from the gut into the bloodstream, the initial drug of choice is typically a quinolone antibiotic like Cipro. Quinolone antibiotics have been used in human medicine since the 1980s, but widespread antibiotic-resistant Campylobacter didn't arise until after quinolones were licensed for use in animal feed as growth promoters in the early 1990s. In countries like Australia, which reserved quinolones for human use only, resistant bacteria simply do not exist.[8] 

When the FDA announced they were intending to join other countries and ban quinolone antibiotic use on U.S. poultry farms, the drug manufacturer, Bayer, sued the FDA. Bayer lost the lawsuit last year, but is currently appealing the decision. Meanwhile, poultry factories continue to spike the chickens' water supply with these antibiotics critical to human medicine. Evidence released in May 2005 found that retail chicken samples from such factories are more than 450 time more likely to carry antibiotic-resistant bugs. Even companies like Tyson and Purdue which supposedly stopped using antibiotics years ago are still churning out antibiotic-resistant bacteria-infected chicken. Scientists think the bacteria that became resistant years before are still hiding within the often dirt floors of the massive broiler sheds or within the piping of the water supply. Another possibility is that the carcasses of the chickens raised under so-called "Antibiotic Free" conditions are contaminated with resistant bacteria from slaughterhouse equipment which can process over 200,000 birds in a single hour.[8] 

In someone infected with Campylobacter, if the initial quinolone antibiotic isn't effective, doctors switch to stronger antibiotics reserved as a last resort. Does this delay lead to poorer patient outcomes? Scientists recently studied thousands of patients with Campylobacter infection to answer that question, and, indeed, the delay in treatment caused by quinolone-resistant Campylobacter led to up to ten times more complications--infections of the brain, the heart, and the most frequent serious complication they noted, death.[9] 

SUPERBUGS: The Hard-Boiled Truth: Salmonella and Eggs 

In June 2005, the Centers for Disease Control released data showing resistant Salmonella led to serious complications as well.[10] Foodborne Salmonella emerged in the Northeast in the late 1970s and has now spread throughout North America. Salmonella hospitalizes thousands of people every year and kills hundreds. And Salmonella infection can be the gift that keeps on giving: Salmonella infections can lead to chronic conditions such as arthritis, bone infections, cardiac inflammation and neurological disorders.[11] 

In the United States, more than one in five "broiler" chickens may be Salmonella infected (at least in Russian roulette, there are six chambers).[12] But it's even more of a problem with egg-laying hens. Eggs are the primary vehicle for the spread of Salmonella bacteria to humans, causing an estimated 80% of outbreaks. This year, the CDC published the first estimate of how many Americans get Salmonella from eggs every year. According to the best data we have, eating Salmonella-infected eggs may cause 168,000 illnesses every year in the United States alone.[13] 

Can't you just wash off the eggs? Unfortunately, no. Many of the tainted eggs are infected within the hens' ovaries even before the shell forms, so you can't wash away the infection. And, as we'll see, washing meat doesn't work either. 

SUPERBUGS: Don't Wash Your Meat 

Can't you just wash off meat like one rinses off fruits and vegetables? No. In fact, the new federal dietary guidelines specifically recommend that "meat and poultry should not be washed or rinsed." The USDA explains: "Bacteria in raw meat and poultry juices can be spread to other foods, utensils, and surfaces." Juices? Animals are not fruits. They don't have juice. In chickens, for example, the "juice" is a fecal soup of bloody serum absorbed in the scalding and cooling tanks in the slaughter house. Further, the infection is actually inside these animals. 

Millions of chickens are drowned alive in the scalding tanks (the federal Humane Slaughter Act exempts all birds), which may introduce the pathogens into their lungs. However new research from the USDA's chief scientific research agency suggests that the primary source of lung contamination with bacteria like Campylobacter is inhaled manure during production (where up to tens of thousands of chickens are overcrowded into broiler sheds) or during transport.[14] 

The June 2005 issue of the Tufts University Health and Nutrition Letter notes: "Your own hands, where they grasped the meat while washing it, could become just as bacteria-laden as the surface of the food....The best bet is to leave meat or poultry untouched until you start cooking it"[15] (what are you supposed to do--levitate it into the oven?) New research, though, suggests that even this precaution may not be enough. 

In March 2005, researchers published a study in which they swabbed the external surface of prepackaged raw meat in the grocery stores for fecal contamination. And did they ever find it. Even though most of the packages looked clean on the outside, they found Salmonella, Campylobacter and multidrug-resistant E. coli on the outer surface of packages of meat. Just picking up a package of meat in the store could put one at risk. 

Poultry beat out the competition for the most contamination, followed by lamb, pork and beef. One swab of a single Q-tip picked up over 10,000 live E. Coli bacteria. As few as 10 bacteria of the hemorrhagic type (E. coli 0157:H7) can lead to a potentially fatal infection.[16] The researchers conclude, "The external packaging of raw meats is a vehicle for potential cross-contamination by Campylobacter, Salmonella, and E. coli in retail premises and consumers' homes."[17] 

OK, fine, but what if you handled the meat like they do in the lab--first wiping the package off with rubbing alcohol using sterile gloves, then cutting it open with a disposable blade before lifting a piece out with sterile forceps into the oven--once it's cooked to the proper temperature it's safe, right? Unfortunately, the internal temperature required to cook the fecal contamination dead (160 degrees F) is the same temperature which produces carcinogenic compounds called heterocyclic amines. 

SUPERBUGS: Bacteria or Cancer? 

In May 2005, a major review of these cooked-meat carcinogens was published by researchers at the U.S. Department of Energy. When skeletal muscles are heated beyond a certain temperature--be it moist heat (boiling) or dry heat (broiling, frying, grilling)--the muscle creatine combines with blood sugars and amino acids to create heterocyclic amine carcinogens. Of all the meats tested, cooked chicken breast formed the highest levels of these toxins. 

Although there are cooking methods that result in lower carcinogen concentrations (marinating followed by a microwaving pretreatment and pouring off of the "juices," followed by relatively low temperature frying with frequent flipping), there does not seem to be a way to cook meat to an internal temperature necessary to kill off bacteria without producing at least some carcinogenic compounds. And even low doses have been shown to cause human DNA mutations which could lead to cancer. 

Human studies suggest that eating well-done meat can raise the risk of breast cancer, prostate cancer, and colon cancer by more than 400%. The researchers conclude, "There is a general consensus that human exposure to potent genotoxic heterocyclic amine carcinogens produced in meat during cooking is widespread."[18] Meat consumers are then faced with a dilemma, choosing between the risks of food poisoning or cancer.  

[1] Schoenl JL and MP Doyle. "Variable colonization of chickens perorally inoculated with Escherichia coli O157:H7 and subsequent contamination of eggs." Applied Environmental Microbiology 60(1994): 2958-62.

[2] Commission of European Communities. Communicable Diseases Resulting from Storage, Handling, Transport and Landspreading of Manures. Batiment Jean Monnet, Luxembourg (1982):139-47.

[3] Jones TF and W Schaffner. "Perspectives on the Persistent Scourge of Foodborne Disease." 205(2005):1029-31

[4] Johnson JR, et al. "Antimicrobial-Resistant and Extraintestinal Pathogenic Escherichia coli in Retail Foods." Journal of Infectious Diseases 205(2005):1040-9.

[5] Ramchandani M, et al. "Possible Animal Origin of Human-Associated, Multidrug-Resistant, Uropathogenic Escherichia coli." Clinical Infectious Diseases 40(2005):251-7.

[6] Brownlee C. "Beef About UTIs." Science News 15 January 2005.

[7] Stern NJ, Line JE. "Comparison of three methods for recovery of Campylobacter spp. from broiler carcasses." Journal of Food Protection 1992;55:663-6; Price LB, et al. "Fluoroquinolone-Resistant Campylobacter Isolates from Conventional and Antibiotic-Free Chicken Products." Environmental Health Perspectives 113(2005):557-60.

[8] Price LB, et al. "Fluoroquinolone-Resistant Campylobacter Isolates from Conventional and Antibiotic-Free Chicken Products." Environmental Health Perspectives 113(2005):557-60.

[9] Hemls M, et al. "Adverse Health Events Associated with Antimicrobial Drug Resistance in Campylobacter Species: A Registry-Based Cohort Study." Journal of Infectious Disease 191(2005):1051.

[10] Varma JK, et al. "Hospitalization and antimicrobial resistance in Salmonella outbreaks, United States, 1984-2002." Emerging Infectious Disease. June 2005.

[11] International Journal of Food Microbiology 24(1994):11-31.

[12] Journal of Infectious Disease 183(2001):1295-9.

[13] Schroeder CM, et al. "Estimate of Illnesses from Salmonella Enteritidis in Eggs, United States, 2000." Emerging Infectious Diseases 11(2005):113-5.

[14] "Finding the Source of Campylobacter." USDA Agriculture Research Service News 23 May 2005.

[15] "Why Not Wash Meat and Poultry Before Cooking?" Tufts University Health and Nutrition Letter 23(2005):7.

[16] Foodborne Pathogens: Risks and Consequences, Report No. 122, CAST- Council for Agricultural Science and Technology, September 1994.

[17] Burgess F, et al. "Prevalence of Campylobacter, Salmonella, and Escherichia coli on the External Packaging of Raw Meat." Journal of Food Protection 68(2005):469-75.

[18] Knize MG and JS Felton. "Formation and Human Risk of Carcinogenic Heterocyclic Amines Formed from Natural Precursors in Meat." Nutrition Reviews 63(2005):158-65.

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