No reliable treatment is available for humans infected with carbapenem-resistant Enterobacteriaceae (CREs; see Nature 499, 394–396; 2013). Because these antibiotic-resistant bacterial pathogens are already entering the food chain (J. Fisher et al. J. Antimicrob. Chemother. 68, 478–480; 2013) and can be transmitted through oral consumption (A. R. Manges and J. R. Johnson Clin. Infect. Dis. 55, 712–719; 2012), we call for a zero-tolerance ruling on CREs in retail food to stop the situation from getting out of control.
It was estimated that in 2007 more than 1,500 people in Europe died from an invasive infection caused by a strain of Escherichia coli that was resistant to third-generation cephalosporins and originated in poultry (P. Collignon et al. Emerg. Infect Dis. 19, 1339–1340; 2013). Mortality from CREs is expected to be much higher if it spreads in poultry on a comparable scale.
Current regulations on antimicrobial usage are largely ineffective — mainly because they operate only at a national level, whereas antimicrobial sales and consumption are global. An international ban on the sale of food items containing CREs could force imported and locally produced food to meet the same standards.
Such a ban would also comply with the guidelines of the Codex Alimentarius Commission, which sets international food standards under the World Trade Organization's Agreement on the Application of Sanitary and Phytosanitary Measures.
Given that CREs can be detected rapidly and reliably in culture-based or molecular assays, routine testing of meat products should be achievable. We urge politicians and decision-makers to protect public health by acting promptly, before the problem becomes widespread and unmanageable.
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Kluytmans, J. Ban resistant strains from food chain. Nature 501, 316 (2013). https://doi.org/10.1038/501316b