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Beefman--Drug Resistant Bacteria? Real Science

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Econ101

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email to a colleague | support our research

March 16, 2005

Drug-Resistant Bacteria on Poultry Products Differ by Brand

The presence of drug-resistant, pathogenic bacteria on uncooked poultry products varies by commercial brand and is likely related to antibiotic use in production, according to researchers at the Johns Hopkins Bloomberg School of Public Health. Their study is the first to directly compare bacterial contamination of poultry products sold in U.S. supermarkets from food producers who use antibiotics and from those who claim they do not. The study focused on antibiotic resistance, specifically fluoroquinolone-resistance in Campylobacter, a pathogen responsible for 2.4 million cases of food-borne illness per year in the U.S., according to the Centers for Disease Control and Prevention. The study is published online in the journal Environmental Health Perspectives.

“Our use of medically important classes of antibiotics in food-animal production creates a significant public health concern,” said the study’s lead author Lance Price, a doctoral candidate and fellow at the Bloomberg School of Public Health’s Center for a Livable Future. “Companies that use antibiotics foster the development of drug-resistant bacteria which can spread to the human population. Claims have been made that using antibiotics increases food safety by reducing pathogens on the meat. Interestingly, in addition to the results regarding fluoroquinolone-resistant Campylobacter, we also found that brands that do not use any antibiotics during production were no more likely to contain Campylobacter than those that do. In fact, the only brand with a significantly lower rate of Campylobacter contamination was actually an antibiotic-free brand.”

Price explained that previous epidemiological studies have indicated that fresh poultry products are a major source of Campylobacter infections in humans. Exposure can occur from undercooked products or through cross-contamination during food preparation, when raw poultry is handled in the kitchen. The danger of infection is heightened when this pathogen is resistant to antibiotics. Not only can the bacteria itself cause illnesses such as diarrhea in humans, but fluoroquinolones are some of the most important drugs used to treat a variety of infections, including those caused by Campylobacter. The widespread presence of this drug-resistant form of the bacteria makes the antibiotic less effective in human medicine. Especially vulnerable are the very young, the elderly and people whose immune systems are compromised.

In 2000, the Food and Drug Administration proposed to withdraw approval of fluoroquinolone drugs for use in poultry production. That effort has since been stalled by legal objections from Bayer, one of the pharmaceutical companies manufacturing the drug. In the meantime, two major U.S. poultry producers, Tyson Food and Perdue Farms, separately announced in 2002 that they would immediately stop using fluoroquinolones to treat poultry flocks.

One year after the Tyson and Perdue announcements, Price and his team began a survey of Campylobacter isolates on uncooked chicken products from Tyson and Perdue and from two other producers, Eberly and Bell & Evans, who claim their production methods are completely antibiotic-free. Using both standard isolation methods and new methods modified to enhance detection of fluoroquinolone-resistant Campylobacter, they compared retail products purchased at grocery stores in Baltimore, Md. A high percentage of the products from the two conventional brands were contaminated with fluoroquinolone-resistant Campylobacter (96 percent from Tyson and 43 percent from Perdue) while significantly lower proportions of ‘antibiotic-free’ products were contaminated with fluoroquinolone-resistant Campylobacter (5 percent from Eberly and 13 percent from Bell & Evans).

“These results suggest that fluoroquinolone-resistance may persist in the food supply for a substantial period of time even after antibiotic use is discontinued,” said Price. “Assuming that what we are observing are lingering resistant strains rather than the result of continued drug use, then one has to conclude that fluoroquinolone use in poultry production presents a long-term threat to people.”

The study was supported by the Johns Hopkins Center for a Livable Future and by the Heinz Family Foundation.

E. Johnson, R. Vailes, and E. Silbergeld from the Johns Hopkins Bloomberg School of Public Health, co-authored this study "Fluoroquinolone-Resistant Campylobacter Isolates from Conventional and Antibiotic-free Chicken Products."

Public Affairs contact for the Johns Hopkins Center for a Livable Future: Donna Mennito at 410-502-7578 or [email protected]

Public Affairs media contacts for the Johns Hopkins Bloomberg School of Public Health: Tim Parsons or Kenna Lowe at 410-955-6878 or [email protected]
 

Econ101

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Here is the link.

http://www.jhsph.edu/publichealthnews/press_releases/2005/price_campylobacter_chicken.html
 

Econ101

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http://www.baltimoresun.com/news/health/bal-te.md.antibiotics31aug31,1,7632384.story?coll=bal-home-headlines
Poultry farms' use of antibiotics raises concerns about drug-resistant germs
Hopkins researcher studying effect on humans, environment


By Tom Pelton
Sun Staff

August 31, 2004

Donald Ross worked for years in poultry plants on the Eastern Shore, hanging chickens on hooks, weighing them, packing them and wielding a knife in the "kill room."

About four months ago, he nicked the middle finger on his left hand. The tiny cut should have healed quickly, but it ballooned instead into a festering golf ball-size lesion. Months of antibiotic treatments failed to shrink it, and it had to be surgically removed.
< br> Ross, 46, and a Johns Hopkins Bloomberg School of Public Health researcher suspect his infection was caused by drug-resistant bacteria in chickens at the Temperanceville, Va., plant where he worked. They point to the poultry industry's routine use of millions of pounds of antibiotics to make chickens plumper.

Toxicologist Ellen K. Silbergeld plans to include Ross among more than 100 current and former Eastern Shore poultry handlers in a study of whether the industry's growing use of antibiotics is harming human health and the environment.

Although Ross' injury was minor, Silbergeld says it hints at a broader problem: that antibiotics in chicken feed might be creating tough, drug-resistant bacteria that cling to workers' hands and wash off farms into rivers. Other researchers have found that antibiotic-resistant bacteria are making their way into meat sold in grocery stores.

"This is a very serious issue. I believe there is a lot of antibiot ic-resistant bacteria that is getting out into the community and into the environment, and nobody is paying attention to what it's doing," said Silbergeld, who has also studied lead poisoning in Baltimore and mercury contamination in the Amazon.

Antibiotics in animal feed have become a national concern, with McDonald's restaurants recently pledging to work with poultry suppliers to phase out growth-promoting antibiotics that are also used in human medicine.

The drugs are a significant issue for the poultry industry on the Delmarva peninsula, which last year included 1,900 farms selling 576 million chickens that were processed by 14,100 workers.

Richard L. Lobb, spokesman for the National Chicken Council, a trade group that represents companies that process most of the 8.7 billion chickens sold in the United States every year, defended the industry's use of antibiotics.

Farmers have been routinely adding microbe-killing formulas to chic ken feed since the 1950s, Lobb said.

When a few birds develop bacterial infections, farmers add antibiotics such as virginiamycin and tetracycline to the drinking water of an entire flock, which can often exceed 200,000 birds, Lobb said. Farmers then wait a number of days specified by the drug makers before selling the birds to prevent medications from being passed on in the meat, he said.

"There's been a lot of rhetoric about this issue, but there's not a lot of science to back it up," Lobb said. "Decades of use of virginiamycin in animals, for example, has resulted in no impact on human health."

But representatives of poultry workers insist that there is a link between workers' health problems and antibiotics.

Pilot study

A pilot study Silbergeld conducted on 60 poultry workers in the areas of Pocomoke City and Georgetown, Del., two years ago found that 80 percent of them were car rying bacteria from the intestines of chickens. And 60 percent of the workers had antibiotic-resistant strains of the bacteria, compared to 10 percent of the general population in those locations, she said.

Her new study will involve interviews with current and former workers, examinations of their medical records, lungs, blood and stool samples. She will also study some of their family members and neighbors to determine how often they suffer stomach or intestinal illnesses.

To assess the impact on the environment, Silbergeld is also testing catfish caught in the Pocomoke River for antibiotic-resistant bacteria. The presence of the bacteria would be evidence that microbes from chicken manure are being washed into the river from farms, which use the manure as fertilizer.

By sampling bacteria from the hands of fishermen, Silbergeld hopes to discover if they are also being exposed to drug-resistant bacteria from chicken farms.

Of the firs t 15 catfish she and her colleagues caught, four had drug-resistant strains of bacteria with the same genetic markings as germs found in chicken intestines.

"There are about a billion chickens being raised on the Delmarva peninsula, and each of them produces about 2.5 pounds of waste. That's 2.5 billion pounds of waste going out into the environment," Silbergeld said. "We're basically following the bacteria in the chicken waste."

A 2001 study by the U.S. Food and Drug Administration and the University of Maryland found that a fifth of 200 samples of ground chicken, beef, turkey and pork sold in supermarkets in the Washington area were contaminated by salmonella, which causes food poisoning. And 84 percent of these bacteria samples were resistant to antibiotics.

Other scientists are investigating whether the bacteria and drugs are seeping into ground water on the Eastern Shore, Silbergeld said.

The Union of Concerned Scientists reported recently that the annual use of antibiotics in the food and drink of healthy farm animals grew from 16 million pounds in the mid-1980s to 25 million pounds in 2001. That total was more than eight times the 3 million pounds of antibiotics used to treat humans for diseases that year.

The nonprofit scientific advocacy group outlined the dangers of excessive use of antibiotics in a recent report. "As more bacterial strains develop resistance [to the drugs], more people will die because ... the bacteria causing the disease are resistant to all available antibiotics," the report said.

Beth McGee, a senior scientist with the Chesapeake Bay Foundation, said that research she conducted in 2000 and 2001 found antibiotics from chicken manure in tributaries to the Nanticoke River and other waterways on the Eastern Shore.

"One concern is the potential impact on aquatic resources. Will fish get sick more if there are really virulent forms of bacteria out there?" McGee asked. "But the more pressing concern is the public health impact."

Workers' ailments

Carole Morison, executive director of the Delmarva Poultry Justice Alliance, a nonprofit organization that lobbies for better working conditions for poultry workers, said many farmers and laborers have complained about frequent stomach and intestinal ailments that didn't respond to drugs. Many workers are afraid to speak out because they worry they'll be fired, Morison said.

"This [study] is important work, because for a long time, people who worked around chickens were always saying, 'I got a touch of the bug again,'" said Morison, who owns a 54,400-chicken farm in Worcester County. "But they were having this bug six, eight, 10 times a year, which isn't normal. It's just too much of people being sick."< br>
Ross, who lives in Wattsville, Va., said he earned $9.05 an hour at his job. He worked from 4:45 a.m. to 1:45 p.m. at the plant, hanging chickens on hooks after they tumbled out of a machine that scalded them to loosen their feathers.

It was a "nasty job," Ross said, adding he contracted several infections in his hands and fingers.

Silbergeld said she has examined documents and photos detailing Ross' infections. "I have looked at his medical records, and they clearly say he had repeated drug-resistant infections in his hands," said Silbergeld.

Ross said he missed about three months of work because of his recent infection and surgery. This absence contributed to an argument with his supervisor and his dismissal on Aug. 19, he said.

"I had four infections like that, and you know, I've known other workers who've gotten sick, too," said Ross. "This is something that should be looked into ... because this food we're handling is go ing out to the public. People eat this stuff."


Copyright (c) 2004, The Baltimore Sun
 

flounder

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Morrell Farm
12/12/05
New York District Office New Animal Drugs/Extralabel Drug Use in Animals/Adulterated/Misbranded [PDF]
HTML:
 http://www.fda.gov/foi/warning_letters/g5666d.htm
No
  Michael Mumbulo 
12/08/05
New York District Office New Animal Drugs/Extralabel Drug Use in Animals/Adulterated/Misbranded [PDF] 
[HTML] http://www.fda.gov/foi/warning_letters/g5665d.htm
No
  WaJa Farms, Inc 
12/06/05
New York District Office New Animal Drugs/Extralabel Drug Use in Animals/Adulterated/Misbranded [PDF] 
[HTML] http://www.fda.gov/foi/warning_letters/g5664d.htm
No
=========



THESE WARNING LETTERS are just one weeks worth. there are literally 100s of these if you do a good search.

MY point here,

a serious bout with MRSA;



 
Subject: FSIS TO HOLD INTERNATIONAL MEAT AND POULTRY FOOD SAFETY MEETING
Date: Mon, 10 Mar 2003 15:41:55 -0600
From: "Terry S. Singeltary Sr." 
To: [email protected]
CC: [email protected], [email protected], [email protected], [email protected]

Greetings FSIS,

in response to public meeting on March 27 on
food safety;

My name is Terry S. Singeltary Sr. and i wish to make
submission to this meeting. i am disabled from neck
injury and cannot come to meeting. i wish my submission
to be made public at the meeting please.

> Topics will include global perspectives on multi-drug
> resistant pathogens, assisting small plants in meeting
> food safety requirements and biosecurity.

i wish to comment on all topics.

i will try and make my nightmare as short as possible.

my mother died on 12-14-97 of Heidenhain Variant Creutzfeldt
Jakob Disease, an exceedingly rare strain of sporadic CJD,
now documented at 6 known phenotypes. i have researched human
animal TSEs for almost 6 years. i am no doctor, i have no
PhDs and i am President of nothing. i will get to food
safety and bio-security last...

1st -- milti-drug resistant pathogens

Nov. 30, 2001, i went in for my 3rd neck surgery,
second inter body fusion (always use my own blood
and bone). this time around they were to fuse all
my neck and add a titanium plate. since there is
no, I REPEAT NO questions on hospital admittance
forms of any kind asking about CJD/TSEs, i thought i
should inform him my situation with my mother and hvCJD.
i cannot give blood, be a donor of any kind and since
mom did die from hvCJD, they did use some disposable
items and did use a bone grinder that would not be used
on anyone else and i did share a lot of data with my
neurosurgeon about all this (with reference).
now, as my neurosurgeon said, damn terry, this was not
suppose to happen to you. i refused blood and bone
due to CJD/TSEs, and what do you suppose happened,
somehow (as with TSEs, nobody knows), they infected
with MRSA (methicillin resistant _Staphylococcus aureus_),
damn near killed me. about 7 weeks of vancomycin with long
line straight to heart. course nobody would fess up to it,
but every nurse i spoke with said it was hospital acquired,
and the week i was in there i was told there were 7 cases
from that hospital room? i have never been the same since,
but who's asking.

now, as my nightmare through the world of TSEs continued,
i began searching data on MRSA. while looking for
ruminant-to-ruminant feed ban warning letters aka mad cow
feed ban warning letters (before FDA stopped issuing
them, all this will be documented below), i began seeing
these warning letters on antibiotic and hormone use of
all sorts in cattle. the more i researched, the more disgusted
i got. human drugs (or equal) being used in mass proportion
by the cattle industry, on animals to sick to slaughter.
i have often wondered why young girls are maturing at such
young ages (hormones in cattle/dairy products), and why humans
were becoming resistant to antibiotics (antibiotic use in cattle),
then it all began to make sense. so, i would like to submit
the below data with reference's. i will first reference
the warning letters on antibiotics and hormones, then
will post url with much more data on the topic. please
look at where the data is referenced from. then i will
post data on meat safety (TSEs) and finally something
i submitted to the documents on bio-security in the USA
with potentially TSE/BSE tainted products entering the USA
through a BIG hole (passenger air traffic and TSE/BSE
SUITCASE BOMBS)...

DEPARTMENT OF HEALTH & HUMAN SERVICES

Food and Drug Administration

Dallas District

4040 North Central Expressway

Dallas, Texas 75204-3145

March 18, 2002

Ref: 2002-DAL-WL-12

CERTIFIED MAIL

RETURN RECEIPT REQUESTED

Mr. Richard L. Hayes, Owner

Richard Hayes Cattle Company

Route 4, Box 186B

Hereford, Texas 79045

Dear Mr. Hayes:

An inspection conducted by our investigator at your cattle buyer/dealer 
operation located at Hereford, Texas, on February 11-12, 2002, confirmed 
that you offered animals for slaughter as food in violation of Sections 
402(a)(2)(C)(ii), and 402(a)(4) of the Federal Food, Drug, and Cosmetic 
Act (the Act).

On or about June 29, 2001, you delivered and offered for slaughter as 
human food, a steer identified with ear tag 667490 to [redacted]. USDA 
analysis of tissue samples collected from that animal identified the 
presence of 9.90 ppm of tilmicosin in the liver, and 13.70 ppm 
tilmicosin in the muscle tissue. A tolerance of 1.2 ppm has been 
established for residues of tilmicosin in the edible tissues of cattle 
[Title 21, Code of Federal Regulations

(CFR) Part 556.7351. The presence of this drug in edible tissue from 
this animal

causes the food to be adulterated.

On or about June 29, 2001, you delivered and offered for slaughter as 
human food, a steer identified with ear tag 1076 to [redacted]. USDA 
analysis of tissue samples collected from that animal identified the 
presence of 0.36 ppm penicillin in the kidney, and 0.07 ppm penicillin 
in the liver tissue. A tolerance of 0.05 ppm has been established for 
residues of penicillin in the edible tissues of cattle (21 CFR 556.510). 
The presence of this drug in edible tissue from this animal causes the 
food to be adulterated.

On or about October 5, 2001, you delivered and offered for slaughter as 
human

food, a steer identified with ear tag COR632 to [redacted]. USDA 
analysis of tissue samples collected from that animal identified the 
presence of 0.34 ppm sulfadimethoxine in the muscle tissues. A tolerance 
of 0.1 ppm has been established for residues of sulfadimethoxine in the 
edible tissues of cattle (21 CFR 556.640). The presence of this drug in 
edible tissue from this animal causes the food to be adulterated.

On or about October 26, 2001, you delivered and offered for slaughter as 
human food, a steer identified with back tag 1203 and ear tag 9705 to 
[redacted]. USDA analysis of tissue samples collected from that animal 
identified the presence of 2.90 ppm of sulfadimethoxine in the muscle 
and 2.96 ppm in the liver tissue. A tolerance of 0.1 ppm has been 
established for residues of sulfadimethoxine in the edible tissues of 
cattle (21 CFR 556.640). The presence of this drug in edible tissue from 
this animal causes the food to be adulterated.

On or about November 6, 2001, you delivered and offered for slaughter as 
human food, a steer identified with back tag 3811 to [redacted]. USDA 
analysis identified the presence of 0.07 ppm penicillin in the kidney. A 
tolerance of 0.05 ppm has beep established for residues of penicillin in 
the edible tissues of cattle (21 CFR 556.510). The presence of this drug 
in edible tissue from this animal causes the food to be adulterated.

On or about November 13, 2001, you delivered and offered for slaughter 
as human food, a steer identified with ear tag 227 to [redacted]. USDA 
analysis of tissue samples collected from that animal identified the 
presence of 63.78 ppm gentamicin sulfate in the kidney, and 12.97 
gentamicin sulfate in the liver tissue. No tolerance has been 
established for residues of gentamicin sulfate in the edible tissues of 
cattle (21 CFR 556.300). The presence of this drug in edible tissue from 
this animal causes the food to be adulterated.

Prior to the most recent inspection of February 11-12, 2002, you had 
been inspected by a representative of the Texas Department of Health on 
two previous occasions, January 24 and June 8, 2000. Those inspections 
revealed that you have no system in place to determine whether an animal 
you purchase and subsequently offer for slaughter as human food, has 
been medicated, and whether it should be withheld from slaughter in 
order to allow for potentially harmful drug residues to be depleted.

During the February 1l-12, 2002, inspection, our investigator found 
essentially the

same objectionable conditions observed by the Texas Department of 
Health. Our

investigator also found that you hold animals under conditions so 
inadequate that

diseased animals and/or medicated animals bearing potentially harmful drug

residues are likely to enter the food supply. For example, you lack a 
system to

identify and quarantine treated animals you purchase from cattle 
sellers. Also,

you lack a system for assuring that animals, medicated prior to your 
purchase

have been withdrawn from medication for appropriate periods of time to 
permit

depletion of potentially hazardous residues of drugs from edible 
tissues. Food

from animals held under such conditions is adulterated within the meaning

402(a)(4) of the Act.

The above is not intended to be an all-inclusive list of violations. As 
a buyer/dealer of animals offered for use as food, you are responsible 
for assuring that your overall operation and the foods you distribute 
are in compliance with the law. As a dealer of animals, you are 
frequently the individual who introduces or offers for introduction into 
interstate commerce, the adulterated animal. As such, you share the 
responsibility for violating the Federal Food, Drug and Cosmetic Act. To 
avoid future illegal residue violations you should take precautions such as:

1. implementing a system to identify the animals you purchase with 
records to establish traceability to the source of the animal;

2. implementing a system to determine from the source of the animal 
whether the animal has been medicated and with what drug(s); and

3. if the animal has been medicated, implementing a system to withhold 
the animal from slaughter for an appropriate period of time to deplete 
potentially hazardous residues of drugs from edible tissue. If you do 
not want to hold the medicated animal then it should not be offered for 
human food, and it should be clearly identified and sold as a medicated 
animal.

You should take prompt action to correct the above violations and to 
establish procedures whereby such violations do not recur. Failure to do 
so may result in regulatory action without further notice such as 
seizure and/or injunction.

It is not necessary for you to personally ship an adulterated animal in 
interstate commerce to be responsible for a violation of the Federal 
Food, Drug, and Cosmetic Act. The fact that you caused the adulteration 
of an animal that was offered for sale to a slaughterhouse that ships in 
interstate commerce is sufficient to hold you responsible for a 
violation of the Act.

You should notify this office in writing within 15 working days of the 
steps you have, taken to bring your firm into compliance with the law. 
Your response should include each step that has been, or will be taken 
to correct the violations and prevent their recurrence. If corrective 
action cannot be completed within 15 working days, 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 reply should be directed to the Food and Drug Administration, 
Attention:

Reynaldo R. Rodriguez, Jr., Director, Compliance Branch, at the above

letterhead address.

Sincerely,

Dallas District Director

http://www.fda.gov/foi/warning_letters/g3156d.htm
=================================================

another example;

snip...

Our investigation found that you hold animals under conditions which are 
so inadequate that diseased animals and/or medicated animals bearing 
potentially harmful drug residues are likely to enter the food supply. 
For example, you lack a system for assuring that drugs are used in a 
manner not contrary to label instructions, and for assuring animals 
medicated on your farm have been withheld from slaughter for appropriate 
periods of time to permit depletion of potentially hazardous drug 
residues from edible tissues. Food from animals held under such 
conditions adulterated within the meaning of Section 402(a)(4) of the Act.

Our investigation also revealed that you caused a drug oxytetracycline 
hydrochloride injection (Agrimycin 100) to be unsafe within the meaning 
of Section 512 of the Act and adulterated under Section 501(a)(5) of the 
Act when you used the drug in an extralabel manner without veterinary 
supervision. This drug is indicated for use in non-lactating dairy 
cattle and for intravenous use only. Your use of this drug for treatment 
of mastitis by intramuscular injection or for treatment of a retained 
placenta by intrauterine injection in a lactating cow in an amount not 
indicated causes the drug to be unsafe to use.

snip...

http://www.fda.gov/foi/warning_letters/g3763d.htm

Greetings again FSIS,

those are just two examples of _many_ warning letters
of this nature, there are many more. these are just two
of the month of March 2002, there were 14 such warning
letters in this month that i found and that were documented;

http://63.75.126.221/scripts/wlcfm/subject.cfm?FL=I

now this super-bug is getting meaner, now we have VRSA;

Staphylococcus aureus
Methicillin Resistant to Vancomycin Resistant
United States, 2002

snip...

In June 2002, VRSA was isolated from a swab obtained from a catheter 
exit site from a Michigan resident aged 40 years with diabetes, 
peripheral vascular disease, and chronic renal failure. The patient 
received dialysis at an outpatient facility (dialysis center A). Since 
April 2001, the patient had been treated for chronic foot ulcerations 
with multiple courses of antimicrobial therapy, some of which included 
vancomycin. In April 2002, the patient underwent amputation of a 
gangrenous toe and subsequently developed methicillin-resistant S. 
aureus bacteremia caused by an infected arteriovenous hemodialysis 
graft. The infection was treated with vancomycin, rifampin, and removal 
of the infected graft. In June, the patient developed a suspected 
catheter exit-site infection, and the temporary dialysis catheter was 
removed; cultures of the exit site and catheter tip subsequently grew S. 
aureus resistant to oxacillin (MIC >16 µg/mL) and vancomycin (MIC >128 
µg/mL). A week after catheter removal, the exit site appeared healed; 
however, the patient's chronic foot ulcer appeared infected. VRSA, 
vancomycin-resistant Enterococcus faecalis (VRE), and Klebsiella oxytoca 
also were recovered from a culture of the ulcer. Swab cultures of the 
patient's healed catheter exit site and anterior nares did not grow 
VRSA. To date, the patient is clinically stable, and the infection is 
responding to outpatient treatment consisting of aggressive wound care 
and systemic antimicrobial therapy with trimethroprim/sulfamethoxazole.

The VRSA isolate recovered from the catheter exit site was identified 
initially at a local hospital laboratory using commercial MIC testing 
and was confirmed by the Michigan Department of Community Health and 
CDC. Identification methods used at CDC included traditional biochemical 
tests and DNA sequence analysis of gyrA and the gene encoding 16S 
ribosomal RNA. Molecular tests for genes unique to enterococci were 
negative. The MIC results for vancomycin, teicoplaninin, and oxacillin 
were >128 µg/mL, 32 µg/mL, and >16 µg/mL, respectively, by the broth 
microdilution method. The isolate contained the vanA vancomycin 
resistance gene from enterococci, which is consistent with the 
glycopeptide MIC profiles. It also contained the oxacillin-resistance 
gene mecA. The isolate was susceptible to chloramphenicol linezolid, 
minocycline, quinupristin/dalfopristin, tetracycline, and 
trimethoprim/sulfamethoxazole.

Epidemiologic and laboratory investigations are under way to assess the 
risk for transmission of VRSA to other patients, health-care workers, 
and close family and other contacts. To date, no VRSA transmission has 
been identified.

snip...

http://jama.ama-assn.org/issues/v288n7/ffull/jwr0821-1.html

for the medical and scientific community, i would not
_flounder_ around with these agents either. i know!
you continue to let the industries involved and the
politicians/lobbyist dictate science, these super-bugs
will spread across the world as did TSEs. The USA cannot
hide TSE in USA cattle much longer. please let me move
on...

now to move on to animal TSEs and the risk to the
USA food supply from within and abroad. the USA
has flagrantly violated the 8/4/97 ruminant-to-ruminant
_voluntary_ feed ban, which is still violated today.
i have well documented this below, but first i must ask, ...snip...end...TSS



snip...




On or about October 26, 2001, you sold a cow (identified as cow #485 in your

records) for slaughter as human food to [redacted]. USDA analysis of
tissue samples collected from that animal identified the presence of
penicillin at 1.11 ppm in the kidney. A tolerance of 0.05 ppm has been
established for residues of penicillin in the edible tissues of cattle
(Title 21, Code of Federal Regulations, Part 556.510). The presence of
this drug in edible tissue from this animal causes the food to be
adulterated within the meaning of Section 402(a)(2)(C)(ii) of the Act.

Our investigation also found that you hold animals under conditions that
are so inadequate that diseased animals and/or medicated animals bearing
potentially harmful drug residues are likely to enter the food supply.
For example, you lack an adequate system for assuring that animals
medicated by you have been withheld from slaughter for appropriate
periods of time to permit depletion of potentially hazardous residues of
drugs from edible tissues. As noted in form FDA-483 issued to you on
January 2, 2002, you did not follow the labeled withdrawal time of 10
days after treating your cow #485 with penicillin. Foods from animals
held under such conditions are adulterated within the meaning of Section
402(a)(4) of the Act.

You are adulterating the penicillin drug that your firm uses on cows
within the meaning of Section 50 1 (a)(5) when you fail to use the drug
in conformance with its approved labeling. Your use of the drug without
following the labeled withdrawal period causes the drug to be unsafe to use.

snip...



http://www.fda.gov/foi/warning_letters/g30



more examples;

On or about October 24, 2001, you sold a cow, identified by U.S.
Department of Agriculture (USDA) sample number 407433 and back tag
number 63IW 7890, for slaughter as human food at [redacted], through
[redacted]. USDA analysis of tissue samples collected from that cow
identified the presence of 7.12 parts pea-million (PPM) of gentamicin in
the kidney tissue. There is no established tolerance for gentamicin in
cattle (Title 21, Code of Federal Regulations (21 CFR), 556.300). The
presence of this

drug in the edible tissue from this animal causes the food to be
adulterated.

Our investigation also found that you hold animals under conditions,
which are so inadequate that diseased animals and/or medicated animals
bearing potentially harmful drug residues are likely to enter the food
supply. For example, you lack an adequate system for assuring that drugs
are used in a manner not contrary to the directions contained in the
labeling; and for assuring that animals medicated by you have been
withheld from slaughter for appropriate periods of time to permit
depletion of potentially

hazardous residues of drugs from edible tissues. Foods from animals held
under such conditions are adulterated.



http://www.fda.gov/foi/warning_letters/g3035d.htm



http://www.accessdata.fda.gov/scripts/wlcfm/subject.cfm?FL=A



medicated feeds (skroll to bottom)



http://www.accessdata.fda.gov/scripts/wlcfm/subject_archive.cfm?FL=M



streptomycin in the kidney;



http://www.fda.gov/foi/warning_letters/m869n.pdf



Twelve years ago, the European Union banned growth hormone use in both
domestic and imported meat because of worries that these compounds could
have human health effects.

http://europa.eu.int/abc/doc/off/bull/en/9604/p103109.htm

21 3. PREVALENCE OF ANTIMICROBIAL RESISTANCE IN PATHOGENS FROM HUMANS,
ANIMALS AND PLANTS, AND ITS IMPACT ON HEALTH AND PRODUCTIVITY
...........................................................................
Opinion of the SCAN on the criteria for assessing the safety of
micro-organisms resistant to antibiotics of human, clinical and
veterinary importance

Criteria for assessing the safety of micro-organisms resistant to
antibiotics of human, clinical and veterinary importance



http://europa.eu.int/comm/food/fs/sc/ssc/out50_en.pdf



http://europa.eu.int/comm/food/fs/sc/scan/out64_en.pdf



http://www.fda.gov/oc/opacom/hottopics/anti_resist.html



Bovine Embryos and Live Cattle: Imports from North America

The Earl of Caithness asked her Majesty's Government:

When the ban on the importation of embryos and live cattle from
North America will be lifted; and [HL3912]

What is the scientific evidence for the imposition of a ban on
the importation of embryos and live cattle from North America. [HL3913]

Lord Whitty: Her Majesty's Government have not imposed a ban on imports
of bovine embryos and live cattle from North America.

The European Parliament and European Council introduced legislation in
May last year laying down rules for the prevention, control and
eradication of certain transmissible spongiform encephalopathies (TSEs).
The legislation was introduced in response to the recommendations of the
Office International des Epizooties (OIE--the international animal health
organisation) and advice from the Commission's scientific comittees. The
legislation (and the transitional measures which came into effect in
October last year) includes requirement that imports into the EU of
bovine embryos and live cattle must be accompanied by certification
confirming that the feeding of ruminants with protein derived from
mammals has been banned and that the ban has been effectively enforced.
Some exporting countries, such as Canada and the USA, are currently
unable to meet these new requirements.



http://www.publications.parliament.uk/pa/ld199697/ldhansrd/pdvn/lds02/text/20425w04.htm#20425w04_sbhd2



thank you,
kind regards,



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



CJD WATCH


http://www.fortunecity.com/healthclub/cpr/349/part1cjd.htm

ProMED-mail wrote:

> STAPH. AUREUS, VISA - UK (ENGLAND)
> **********************************
> A ProMED-mail post
>
> ProMED-mail is a program of the
> International Society for Infectious Diseases
>
>
> [1] Report of reduced susceptibility isolate
> [2] Comments on hospital cleanliness
>
>
> [1]
> Date: Fri 17 May 2002 10:06 AM EDT
> From: ProMED-mail
> Source: BBC news, 17 May 2002 [edited]
>
>
>
> [Our thanks to Martha Cosgriff for submitting this article as well. Mod.MPP]
>
> Tougher superbugs reach England
> ----------------------------------------------
> Doctors fear that their drug defenses against hospital superbugs are
> weakening after a patient was diagnosed with a new strain. Bacteria
> resistant to many classes of antibiotics are rife in many UK hospitals.
> However, even in the most extreme cases, doctors could turn to the
> antibiotic vancomycin to clear the infection [for organisms such as
> methicillin-resistant _Staph. aureus_ (MRSA) - Mod.LL].
>
> In the latest case, the unnamed patient [in an unnamed location - Mod.LL]
> developed an infection that had shown a low-level resistance even to this
> class of drugs. It is the first such case in England, although there have
> been vancomycin-resistant strains uncovered in Scotland, as well as in
> France, Japan, and the US. An earlier scare in Bristol involved bacteria
> which turned out to have insignificant resistance to the drug.
>
> The patient involved later died, although the infection is not thought to
> have been the cause. Hospital officials believe that no one else in the
> building has acquired the bacteria.
>
> "Superbugs" such as MRSA are thought to cost thousands of lives - and
> hundreds of millions of pounds to the NHS each year. Poor hospital hygiene
> practices are thought by many to contribute to the problem, and in July
> 2000, the government launched a 60-million-pound drive to improve cleanliness.
>
> However, another key factor is the heavy use of antibiotics, particularly
> in the hospital environment. Exposure to these drugs eventually leads to
> the survival of strains whose genetic makeup lends itself to drug
> resistance as weaker, competing strains are killed off. [Many
> antimicrobial-susceptible strains are not at all necessarily weaker; in
> many cases, the more resistant strain may be a weaker pathogen -Mod.LL].
>
> Dr Georgia Duckworth, from the Public Health Laboratory Service (PHLS),
> which monitors infectious disease in the UK, said: "With the development of
> antibiotic resistance, _Staph. aureus_ infections have become harder to
> treat as there are fewer antibiotics that are effective. Since the
> discovery of MRSA, vancomycin has been the first choice antibiotic used in
> its treatment. This first case in England is a serious development."
>
> Scientists are racing to develop new types of antibiotics as resistant
> strains of bacteria render existing drugs increasingly ineffective. New
> classes of drugs have been introduced in recent years, but doctors are
> still being urged to cut back on antibiotic usage wherever possible to slow
> down the arrival of resistance.
>
> Dr Duckworth said: "It underscores the fact that there is no cause for
> complacency in antibiotic usage - whenever we use an antibiotic, even if
> totally appropriately, we encourage the development of resistance to it."
>
> ******
> [2]
> Date: 17 May 2002
> From: ProMED-mail
> Source: The Scotsman (UK) [edited]
>
>
>
> Hospitals said to be dirtier than abattoirs
> ------------------------------------------------
> One of Scotland's leading infections experts last night criticized hygiene
> in NHS hospitals as being worse than that in slaughterhouses.
>
> Hugh Pennington, a professor of bacteriology at Aberdeen University, said
> abattoirs have better facilities to prevent infection than most hospitals.
> But as he spoke Scotland's health service was warned that further
> improvements in cleanliness would never eradicate superbugs, and new drugs
> would only buy time before they became resistant to those treatments as well.
>
> Professor James Naismith, from St Andrews University, warned the antibiotic
> vancomycin was the last line of defense against MRSA
> [(methicillin-resistant _Staph. aureus_)], but the superbug was already
> becoming resistant to the drug [at least less sensitive - Mod.LL].
>
> The scientists' comments followed a survey which revealed that over half of
> patients treated in NHS hospitals thought their homes were cleaner than the
> wards. Prof Pennington said: "If our hospitals were kept at the level of
> cleanliness that slaughterhouses currently observe, it would be a far
> better deal for the patients. 10 percent of people who go into hospital
> contract an infection while they're in there and all of these infections
> are preventable with improved hygiene [at least a goodly number of them -
> Mod.LL]. Staff who work in a modern slaughterhouse wash their hands every
> 5 minutes. The NHS do not always make it easy for their staff to wash their
> hands when they need to. Just having more hand-wash basins and putting
> them in the right place could make a huge difference."
>
> Meanwhile, Prof Naismith issued his warning over superbugs after receiving
> a GBP 637 000 grant from the Wellcome Trust for a study of the structure of
> vancomycin in an effort to find new ways of fighting MRSA.
>
> [Byline: Kate Foster and Alastair Dalton]
>
> --
> ProMED-mail
>
>
> [A number of reports of MRSA demonstrating reduced susceptibility to
> vancomycin have occurred since 1997 and are noted below. These isolates
> called VISA (vancomycin-intermediate _Staph. aureus_) or GISA
> (glycopeptide-intermediate _Staph. aureus_) have generally been isolated
> from patients who have had prolonged exposure to vancomycin in a hospital
> setting. Fortunately, serious life-threatening illness was not usually
> associated with this infection, and high doses of vancomycin were still
> effective. Many isolates of another organism (Enterococcus), however,
> previously uniformly sensitive to vancomycin, have developed high-grade
> resistance to the drug. Fortunately, the enterococcus is not always a
> significant pathogen in people, but it would be quite problematic if such a
> resistance pattern appeared in _Staph. aureus_ or _Strep. pneumoniae_ and
> those organisms were virulent. A new antimicrobial, linezolid, does have
> activity against the vancomycin-resistant enterococcus and is active
> against Staph. as well. However, only time and increasing use are needed
> for linezolid-resistant strains of these organisms to become
> prevalent. The 2 issues discussed in the reports, overuse of
> antimicrobials (especially in the hospital setting) and inadequately
> followed infection control procedures, contribute to the development and
> spread of resistant strains, respectively.
>
> Ultimately, it is not likely that we will eradicate such resistant strains,
> but judicious use of antimicrobials and aggressive enforcement of
> handwashing and other infection control procedures can limit the impact of
> these organisms. - Mod.LL]
>
> [see also:
> 1999
> ----
> Vancomycin resist. S. aureus - China (Hong Kong) (04) 19991109.2008
> Staph. Aureus, VISA - UK (Scotland) 19990621.1056
> 1998
> ----
> Staphylococcus aureus, vancomycin res. - USA (New York) 19980426.0791
> Vancomycin resistance, intermed., S. aureus - Europe 19980108.0057
> 1997
> ----
> Staph. Aureus, reduced susceptibility to Vancomycin (02) 19970907.1928
> Staph. Aureus, vancomycin resistant - USA 19970825.1775]
> ...........................ll/pg/mpp
>
> *##########################################################*
> ProMED-mail makes every effort to verify the reports that
> are posted, but the accuracy and completeness of the
> information, and of any statements or opinions based
> thereon, are not guaranteed. The reader assumes all risks in
> using information posted or archived by ProMED-mail. ISID
> and its associated service providers shall not be held
> responsible for errors or omissions or held liable for any
> damages incurred as a result of use or reliance upon posted
> or archived material.
> ************************************************************
> Visit ProMED-mail's web site at .
===============================================================

more warning letters....tss

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

SNIP...



http://www.fda.gov/foi/warning_letters/g2075d.pdf



may take some time to load, but worth reading.
check all the different antibiotics;

anitresistance antibiotics and animals usda


http://www.aphis.usda.gov/vs/ceah/cei/antiresist.entire.pdf



Medicated Feeds



http://63.75.126.221/scripts/wlcfm/subject.cfm?FL=M



Illegal Drug Residue/Adulterated



http://63.75.126.221/scripts/wlcfm/subject.cfm?FL=I



Illegal Drug Tissue Residue



http://63.75.126.221/scripts/wlcfm/subject.cfm?FL=I



Drug Residues/Edible Tissues/Adulterated



http://63.75.126.221/scripts/wlcfm/subject.cfm?FL=D



examples;

snip...

USDA testing revealed the presence of 0.23 ppm
(parts per million) penicillin in the kidney
tissue of the animal. This is considered to be
illegal tissue residue since the tolerance for
penicillin in edible bovine tissue is 0.05 ppm.
The presence of penicillin in the edible tissue
from your animal at the concentration level detected
renders the food from the animal to be adulterated
under section blah blah blah....

snip...



http://www.fda.gov/foi/warning_letters/m2268n.pdf



http://www.fda.gov/foi/warning_letters/g1225d.pdf



look under subject here;



http://63.75.126.221/scripts/wlcfm/sindex.cfm



or this url and search;



http://www.fda.gov/foi/warning.htm



most recent;



Van Haitsma Dairy Farm 12/14/01

Detroit District Office

Illegal Drug Tissue Residue/Adulterated

View File

http://www.fda.gov/foi/warning_letters/g2040d.pdf

LANCET
Volume 350, Number 9092
06 December 1997

Commentary



Vancomycin-resistant Staphylococcus aureus:
apocalypse now?

http://www.thelancet.com/



http://jama.ama-assn.org/issues/v283n5/ffull/jwr0202-1.html



http://wonder.cdc.gov/wonder/prevguid/m0049042/m0049042.asp



http://www.cdc.gov/ncidod/hip/ARESIST/mrsahcw.htm



http://www.scotland.gov.uk/library2/doc15/sim-01.asp



http://www.mbiotech.com/newsreleases/nr112800.htm



http://www.dent.ucla.edu/pic/members/antibiotics/vancomycin.html



http://www.nlm.nih.gov/medlineplus/druginfo/vancomycinsystemic202590.html



Morbidity and Mortality Weekly Report


Staphylococcus aureus Resistant to Vancomycin [mdash] United States, 2002

MMWR. 2002;51:565-567

Staphylococcus aureus is a cause of hospital- and community-acquired infections.1,2 In 1996, the first clinical isolate of S. aureus with reduced susceptibility to vancomycin was reported from Japan.3 The vancomycin minimum inhibitory concentration (MIC) result reported for this isolate was in the intermediate range (vancomycin MIC = 8 µg/mL) using interpretive criteria defined by the National Committee for Clinical Laboratory Standards.4 As of June 2002, eight patients with clinical infections caused by vancomycin-intermediate S. aureus (VISA) have been confirmed in the United States.5,6 This report describes the first documented case of infection caused by vancomycin-resistant S. aureus (VRSA) (vancomycin MIC 32 µg/mL) in a patient in the United States. The emergence of VRSA underscores the need for programs to prevent the spread of antimicrobial-resistant microorganisms and control the use of anti-microbial drugs in health-care settings.

In June 2002, VRSA was isolated from a swab obtained from a catheter exit site from a Michigan resident aged 40 years with diabetes, peripheral vascular disease, and chronic renal failure. The patient received dialysis at an outpatient facility (dialysis center A). Since April 2001, the patient had been treated for chronic foot ulcerations with multiple courses of antimicrobial therapy, some of which included vancomycin. In April 2002, the patient underwent amputation of a gangrenous toe and subsequently developed methicillin-resistant S. aureus bacteremia caused by an infected arteriovenous hemodialysis graft. The infection was treated with vancomycin, rifampin, and removal of the infected graft. In June, the patient developed a suspected catheter exit-site infection, and the temporary dialysis catheter was removed; cultures of the exit site and catheter tip subsequently grew S. aureus resistant to oxacillin (MIC >16 µg/mL) and vancomycin (MIC >128 µg/mL). A week after catheter removal, the exit site appeared healed; however, the patient's chronic foot ulcer appeared infected. VRSA, vancomycin-resistant Enterococcus faecalis (VRE), and Klebsiella oxytoca also were recovered from a culture of the ulcer. Swab cultures of the patient's healed catheter exit site and anterior nares did not grow VRSA. To date, the patient is clinically stable, and the infection is responding to outpatient treatment consisting of aggressive wound care and systemic antimicrobial therapy with trimethroprim/sulfamethoxazole.

The VRSA isolate recovered from the catheter exit site was identified initially at a local hospital laboratory using commercial MIC testing and was confirmed by the Michigan Department of Community Health and CDC. Identification methods used at CDC included traditional biochemical tests and DNA sequence analysis of gyrA and the gene encoding 16S ribosomal RNA. Molecular tests for genes unique to enterococci were negative. The MIC results for vancomycin, teicoplaninin, and oxacillin were >128 µg/mL, 32 µg/mL, and >16 µg/mL, respectively, by the broth microdilution method. The isolate contained the vanA vancomycin resistance gene from enterococci, which is consistent with the glycopeptide MIC profiles. It also contained the oxacillin-resistance gene mecA. The isolate was susceptible to chloramphenicol linezolid, minocycline, quinupristin/dalfopristin, tetracycline, and trimethoprim/sulfamethoxazole.

Epidemiologic and laboratory investigations are under way to assess the risk for transmission of VRSA to other patients, health-care workers, and close family and other contacts. To date, no VRSA transmission has been identified.

Infection-control practices in dialysis center A were assessed; all health-care workers followed standard precautions consistent with CDC guidelines.7 After the identification of VRSA, dialysis center A initiated special precautions on the basis of CDC recommendations,8 including using gloves, gowns, and masks for all contacts with the patient; performing dialysis with a dedicated dialysis machine during the last shift of the day in an area separate from other patients; having a dialysis technician dedicated to providing care for the patient; using dedicated, noncritical patient-care items; and enhancing education of staff members about appropriate infection-control practices. Assessment of infection-control practices in other health-care settings in which the patient was treated is ongoing.


Reported by:

DM Sievert, MS, ML Boulton, MD, G Stoltman, PhD, D Johnson, MD, MG Stobierski, DVM, FP Downes, DrPH, PA Somsel, DrPH, JT Rudrik, PhD, Michigan Dept of Community Health; W Brown, PhD, W Hafeez, MD, T Lundstrom, MD, E Flanagan, Detroit Medical Center; R Johnson, MD, Detroit; J Mitchell, Oakwood Health Care System, Dearborn, Michigan. Div of Healthcare Quality Promotion, Div of Bacterial and Mycotic Diseases, National Center for Infectious Diseases; S Chang, MD, EIS Officer, CDC.


CDC Editorial Note:

This report describes the first clinical isolate of S. aureus that is fully resistant to vancomycin. S. aureus causes a wide range of human infections and is an important cause of health-care associated infections. The introduction of new classes of antimicrobials usually has been followed by emergence of resistance in S. aureus. After the initial success of penicillin in treating S. aureus infection, penicillin-resistant S. aureus became a major threat in hospitals and nurseries in the 1950s, requiring the use of methicillin and related drugs for treatment of S. aureus infections. In the 1980s, methicillin-resistant S. aureus emerged and became endemic in many hospitals, leading to increasing use of vancomycin. In the late 1990s, cases of VISA were reported.

Although the acquired vancomycin-resistance determinants vanA, vanB, vanD, vanE, vanF, and vanG have been reported from VRE, these resistance determinants have not previously been identified in clinical isolates of S. aureus.9 Conjugative transfer of the vanA gene from enterococci to S. aureus has been demonstrated in vitro.10 The presence of vanA in this VRSA suggests that the resistance determinant might have been acquired through exchange of genetic material from the vancomycin-resistant enterococcus also isolated from the swab culture. This VRSA isolate is susceptible in vitro to several antimicrobial agents, including antimicrobials recently approved by the Food and Drug Administration (i.e., linezolid and quinupristin/dalfopristin) with activity against glycopeptide-resistant Gram-positive microorganisms.

In 1997, the Healthcare Infection Control Practices Advisory Committee published guidelines for the prevention and control of staphylococcal infection associated with reduced susceptibility to vancomycin8; plans to contain VISA/VRSA on the basis of CDC recommendations have been established in some state health departments. In the health-care setting, a patient with VISA/VRSA should be placed in a private room and have dedicated patient-care items. Health-care workers providing care to such patients should follow contact precautions (i.e., wearing gowns, masks, and gloves and using antibacterial soap for hand washing). These control measures were adopted by dialysis center A immediately following confirmation of the VRSA isolate. To date, there has been no documented spread of this microorganism to other patients or health-care workers.

Strategies to improve adherence to current guidelines to prevent transmission of antimicrobial resistant micro-organisms in health-care settings should be a priority for all health-care facilities in the United States. S. aureus should be tested for resistance to vancomycin using a MIC method. The isolation of S. aureus with confirmed or presumptive vancomycin resistance should be reported immediately through state and local health departments to the Division of Healthcare Quality Promotion, National Center for Infectious Diseases, CDC, telephone 800-893-0485.

References: 10 available

© 2002 American Medical Association. All rights reserved.

Epidemiology

First case of fully vancomycin-resistant S. aureus infection in the US reported

Last Updated: 2002-07-03 14:34:22 -0400 (Reuters Health)

By Mean Rauscher

NEW YORK (Reuters Health) - The first documented case in the US of infection caused by Staphylococcus aureus that is fully resistant to vancomycin has federal health officials at the Centers for Disease Control and Prevention (CDC) in Atlanta concerned.

In a telebriefing Wednesday, Dr. Steve Solomon, medical epidemiologist at the CDC, said, "this case serves to reinforce the absolute necessity of adhering to strict infection control precautions, as has been done in this case--and to continue to use antibiotics wisely."

Dr. Solomon also said this case represents an evolution in drug resistance in this particular microorganism, which has been going on for 50 years.

The first S. aureus isolate with reduced susceptibility to vancomycin (vancomycin-resistant Staphylococcus aureus, or VRSA) was reported in Japan in 1996, the CDC notes in the Morbidity and Mortality Weekly Report for July 5th. As of June 2002, eight confirmed cases of infections caused by S. aureus isolates with "intermediate" susceptibility to vancomycin have been reported in the US.

The first fully resistant S. aureus infection in the US was confirmed in June. The patient is a 40-year-old Michigan resident with complicated diabetes, peripheral vascular disease, and chronic renal failure for which he receives regular hemodialysis at an outpatient center. The patient had been taking multiple antibiotics, including vancomycin, for chronic foot ulcerations.

In April 2002, he had a gangrenous toe amputated. When he later developed methicillin-resistant S. aureus bacteremia due to an infected hemodialysis graft, his physicians removed the infected graft and he initiated vancomycin and rifampin treatment.

Subsequently, a swab taken from a catheter exit site infection revealed VRSA (MIC >128 µg/mL). The isolate was also resistant to oxacillin (MIC >16 µg/mL). Swabs from the patient's infected chronic foot ulcer also revealed VRSA, as well as vancomycin-resistant Enterococcus faecalis (VRE) and Klebsiella oxytoca.

According to the CDC, the patient responded to aggressive wound care and trimethoprim/sulfamethoxazole. Dr. Solomon said it's "reassuring" that the VRSA isolate was also susceptible to chloramphenicol, linezolid, minocycline, quinupristin/dalfopristin, and tetracycline.

It's also reassuring, Dr. David Johnson, deputy director and chief medical executive for the Michigan Department of Community Health in Lansing, told Reuters Health, that "swab samples from several hundred potential contacts show no evidence that the VRSA isolate has been transmitted."

The CDC recommends that all S. aureus isolates be tested for resistance to vancomycin and those with confirmed or presumptive vancomycin resistance be reported through state and local health departments to the CDC.

MMWR 2002;51:565-567.

Copyright © 2002 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of th

Vancomycin

(van-koe-MY-sin)


Trade Name(s):
* Lyphocin Powder for Injection, lyophilized
* 500 mg Powder for Injection, lyophilized
* 1 g Powder for Injection, lyophilized
* 5 g Powder for Injection, lyophilized
10 g
* Vancocin Pulvules
* 125 mgPulvules
* 250 mgPowder for Oral Solution
* 1 gPowder for Oral Solution
* 10 gPowder for Injection
* 500 mg Powder for Injection
* 1 g Powder for Injection
10 g
* Vancoled Powder for Injection
* 500 mg Powder for Injection
* 1 gPowder for Injection
5 g
Indicates Canadian trade names.

Class: Anti-infectiveAntibiotic

Action:
Inhibits bacterial cellwall synthesis and alters cell-membrane permeability and RNA synthesis.

Indications:

Parenteral: Treatment of serious or severe infections due to susceptible bacteria not treatable with other antimicrobials (eg, staphylococcus).

Oral: Treatment of pseudomembranous colitis caused by Clostridium difficile; treatment of staphylococcal enterocolitis. Unlabeled use(s): IV prophylaxis against bacterial endocarditis in penicillin-allergic patients.

Contraindications:
Standard considerations.

Route/Dosage:

Adults:
PO 500 mg to 2 g/day in 3 or 4 divided doses for 7 to 10 days.

Children:
PO 40 mg/kg/day (up to 2 g/day) in 3 or 4 divided doses for 7 to 10 days.

Newborns:
PO 10 mg/kg/day in divided doses.

Adults:
IV 500 mg by IV infusion q 6 hr or 1 g q 12 hr.

Children:
IV 10 mg/kg/dose q 6 hr.

Infants & Newborns:
IV 15 mg/kg initially, followed by 10 mg/kg q 12 hr for newborns in first week of life, and q 8 hr for ages up to 1 mo.

Interactions:

Aminoglycosides: May increase risk of nephrotoxicity.

Neurotoxic and nephrotoxic agents: May give additive toxicity.

Nondepolarizing muscle relaxants: Neuromuscular blockade may be enhanced.

INCOMPATIBILITIES: IV solution is incompatible with alkaline injections.

Lab Test Interferences:
None well documented.

Adverse Reactions:

CV:
Hypotension.DERM:
Rash; urticaria; pruritus; inflammation at site of injection. EENT:
Hearing loss.GI:
Nausea.GU:
Increased serum creatinine and BUN; renal failure.HEMA:
Neutropenia; eosinophilia.RESP:
Wheezing; dyspnea.OTHER:
Anaphylaxis; drug fever; chills; Red Man Syndrome (hypotension with or without rash over face, neck, upper chest, and extremities).

Precautions:

Pregnancy: Category C.

Lactation: Excreted in breast milk.

Children: Confirming serum levels may be appropriate in newborns. Use of vancomycin with anesthetics may cause erythema and flushing.

Special risk patients: Use with caution in patients with preexisting hearing loss, patients receiving ototoxic or nephrotoxic drugs, patients receiving drugs that cause neutropenia; patients with renal impairment; elderly; newborns.

Hypotension: Too rapid IV infusion or bolus administration may be associated with exaggerated hypotension, including shock and cardiac arrest, with or without maculopapular rash over face, neck, upper chest, and extremities (Red Man or Redneck syndrome). Reaction has been rarely associated with slow infusion or oral or intraperitoneal administration.

Reversible neutropenia: May occur after total dose of 25 g.

Tissue irritation, thrombophlebitis: Give by secure IV route. May minimize thrombophlebitis by giving slowly as dilute infusion.
Patient Care Considerations

Administration/Storage:

* Prepare oral solution by adding 115 mL of water to 10 g vial or 20 mL of water to 1 g vial. Further dilute prepared oral solution dose with 30 mL of water or flavoring syrups may be used with oral solution.
* May give oral solution via nasogastric tube as indicated or ordered.
* Reconstitute parenteral form with Sterile Water for Injection.
* Further dilute parenteral medication with compatible solution (eg, 5% Dextrose Injection, 0.9% Sodium Chloride, Lactated Ringer's)
* Parenteral form may be administered by oral route.
* Reconstituted oral solution may be stored in refrigerator for 2 wk after bottle is opened.
* Dilute to minimum dilution of 2.5 mL and infuse parenteral solution over at least 60 min. Intermittent infusion preferred.
* Pretreat with antihistamine if patient has previously experienced Red Man Syndrome.
* Dosage or dosage interval may be changed based upon vancomycin serum levels.
* Reconstituted powder for injection is stable at room temperature for 2 wk.
* Dilute solutions (sodium chloride or D5W) are stable at room temperature for 24 hr.

Assessment/Interventions:

* Obtain patient history, including drug history and any known allergies.
* Assess results of culture and sensitivity to determine sensitivity.
* Assess hearing acuity before and after therapy. Anticipate ototoxicity.
* Monitor for signs of superinfection.
* Monitor skin for Red Man Syndrome with each dose infused.
* Notify health care provider of elevated BUN and creatinine, which indicate nephrotoxicity.
* Document hematuria and notify health care provider.
* Monitor I&O, BP for hypotension, and respirations for wheezing or dyspnea.
* Maintain adequate fluid intake.
* Obtain blood levels, new order, or protocol. Keep blood levels between 10 to 20 mcg/mL.
* Ensure that resuscitation equipment is available.


OVERDOSAGE: SIGNS & SYMPTOMS
Increase serum creatinine, increase BUN, hearing loss, ringing in ears, vertigo

Patient/Family Education:

* Explain that IV medication is given at regular intervals to maintain blood levels.
* Tell patient to report hearing loss, ringing in ears, or vertigo to health care provider.
* Explain signs of superinfection (eg, vaginitis).
* Identify symptoms of potential adverse reactions.
* Tell patient to maintain adequate fluid intake.

AtoZ Drug Facts · Copyright©2000 by Facts and Co



http://www.reutershealth.com/cgi-bin/frame2?top=/tops/med.html&left=/medl.html&right=/archive/2002/07/02/professional/links/20020702scie001.html



AJIC - American Journal of Infection Control
Vol. 30, No. 4, June 2002
ISSN: 0196-6553
EISSN: 1527-3296
SELECT:

Table of Contents ? Article(PDF)


Banning artificial nails from health care settings

pp. 252-254 (doi:10.1067/mic.2002.122102)
Lisa Saiman MD, MPHa , Audrey Lerner RN, BSN, CICa , Linda Saal MA, RNb , Elizabeth Todd RN, MPHa , Margaret Fracaro RN, MA, CICa , Nancy Schneider MSN, CICa , Joseph A. Connell JD, PA-Cc , Andria Castellanos MBAd , Brian Scully MDa , Lewis M. Drusin MD, MPHa

>From the Departments of Epidemiology,a Nursing,b Human Resources,c and Hospital Administration,d New York Presbyterian Hospital.


DEPARTMENT OF HEALTH AND HUMAN SERVICE

Public Health Service

Food and Drug Administration
Kansas City District
Southwest Region
11630 West 80 Street
P.O. Box 15905
Lenexa. Kansas 662855905
Telephone: (913) 752-2100

CERTIFIED MAIL
RETURN RECEIPT REQUESTED
May 8, 2002
WARNING LETTER
KAN #2002-06

Brent J. Rus, Owner
Brent Rus Farm
3330 & 3287 Dogwood Avenue
Rock Valley, IA 51247

Dear Mr. Rus:

A tissue residue report received by the Food and Drug Administration (FDA) from the United States Department of Agriculture (USDA) reported the presence of illegal drug residues in a cow that originated from your cattle raising operation. As a follow-up to USDA?s finding, our investigator performed an inspection of your operation located in Rock Valley, Iowa, on March 21 to 25, 2002. The inspection revealed serious violations of Section 402 and 501 of the Federal Food, Drug, and Cosmetic Act (the Act).

A food is adulterated under Section 402(a)(2)(C)(ii) of the Act if it contains a new animal drug that is unsafe within the meaning of Section 512. On/about February 12, 2002, you offered a cow, identified with back tag number 41 MN 4358 (USDA laboratory report number 442053) for slaughter as human food. USDA analysis of tissue samples collected from that cow identified the presence of the drugs penicillin in the kidney at 0.55 parts per million (ppm), gentamicin in the kidney at 6.09 ppm, and sulfamethazine in the muscle at 6.22 ppm. Presently, the tolerance level for penicillin and sulfamethazine in the edible tissues of cattle is 0.05 ppm and 0.1 ppm respectively. There is no tolerance for gentamicin in the edible tissues of cattle.

A food is adulterated under Section 402(a)(4) of the Act "if it has been prepared, packed, or held under insanitary conditions.. . whereby it may have been rendered injurious to health." As it applies in the case, "insanitary conditions" means that you hold animals which are ultimately offered for sale for slaughter as food under conditions which are so inadequate that medicated animals bearing possibly harmful drug residues are likely to enter the food supply. For example, you lack an adequate system for assuring that animals have been treated only with drugs which have been approved for use in those species; for assuring that drugs are used in a manner not contrary to the directions contained in the labeling; and for assuring that animals medicated by you have been withheld from slaughter for appropriate periods of time to permit depletion of potentially hazardous residues of drugs from edible tissues.

You are adulterating the drugs penicillin, gentamicin and sulfamethazine that you use on cattle within the meaning of Section 501(a)((5) when you fail to use the drugs in conformance with its approved labeling. Your use of the drugs in a species for which it is not approved, at a higher than labeled dosage, or without following labeled withdrawal periods, causes the drugs to be unsafe to use.

This 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 assuring that your overall operation and the foods you distribute are in compliance with the law.

You should take prompt action to correct the above violations and to establish procedures whereby such violations do not recur. Failure to do so may result in regulatory action without further notice such as seizure and/or injunction.

You should be aware that it is not necessary for you to have personally shipped an adulterated animal in interstate commerce to be responsible for a violation of the Act. The fact that you offered an adulterated animal for sale to a slaughter facility where it was held for sale in interstate commerce is sufficient to make you responsible for violations of the Act.

You should notify our office in writing, within fifteen (15) working days of the receipt of this letter, of the specific steps you have taken to correct these violations and preclude their recurrence. If corrective action cannot be completed within fifteen working days, state the reason for the delay and the time frame within which corrections will be completed. Your response should address each discrepancy brought to your attention during the inspection and in this letter, and should include copies of any documentation demonstrating that corrections have been made. Please direct your reply to Clarence R. Pendleton, Compliance Officer, at the address listed above.

Sincerely,

Charles W. Sedgwick

District Director

Kansas City District



 

RESTRICT ANTIBIOTIC USE IN ANIMALS: SCIENTISTS

A federal science panel is calling for a crackdown in the use of 
antibiotics on farm animals. The panel says antibiotic-resistant 
bacteria is developing in humans because of what we eat. 
FULL STORY:

http://cbc.ca/stories/2002/10/07/Consumers/antibiotics_021007 


RESTRICT ANTIBIOTIC USE IN ANIMALS: SCIENTISTS



TSS
 

mrj

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Don't those many accounts of adulteration FOUND and meat REMOVED from the food chain an indication that the system IS working?

MRJ
 

Sandhusker

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MRJ said:
Don't those many accounts of adulteration FOUND and meat REMOVED from the food chain an indication that the system IS working?

MRJ

Do all the drug dealers in jail mean you can't buy a bag on the street?
 

mrj

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Sandhusker said:
MRJ said:
Don't those many accounts of adulteration FOUND and meat REMOVED from the food chain an indication that the system IS working?

MRJ

Do all the drug dealers in jail mean you can't buy a bag on the street?



IMO, Sandhusker, your slap at my comment really adds nothing to the discussion.

I've served on committees over many years, for SD Beef Council, SD Cattlemen, and NCBA Policy/Dues Payer division. Those committee members have discussed animal health, beef safety, and other questions and caused actions involving checkoff and many beef industry businesses adding their own money, which resulted in dramatic reduction in incidences of E coli, for one.

The last two organizations I named also were actively involved in getting HACCP put into place, over the strong opposition of Meat Inspectors Unions, I might add. HACCP requires actual testing and other modern improvements in inspections and operation of processing facilities, to find and eliminate bacterial contamination of meat. They also have supported research to find the facts about possible antibiotic resistance build-up.

What have you done, other than make cheap shot attacks on those organizations and people who have been working, with a great deal of success, to eliminate such problems in the cattle/beef industry?

MRJ
 

PORKER

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Flounders Point is that there is so much evidence that antibotics used in animals will not be used in human medicene.SOOOOO As a dealer-raiser of animals, you are
frequently the one who introduces or offers for introduction into
interstate commerce, the adulterated animal. As such, you share the
responsibility for violating the Federal Food, Drug and Cosmetic Act.
 

mrj

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PORKER said:
Flounders Point is that there is so much evidence that antibotics used in animals will not be used in human medicene.SOOOOO As a dealer-raiser of animals, you are
frequently the one who introduces or offers for introduction into
interstate commerce, the adulterated animal. As such, you share the
responsibility for violating the Federal Food, Drug and Cosmetic Act.


My point is that antibiotic use in poultry and other animals was originally introduced by well intentioned university level researchers as a means of producing a more healthful food product for consumers.

IF there are now problems arising from PROPER, LEGAL, uses of medications, with PROPER withdrawal times strictly followed, there should be intensive RESEARCH into all aspects of that problem by well qualified, unbiased researchers. People working to serve an anti-animal, or anti-medication bias, and I'm not saying that is where ALL of this is coming from, but that there is an element of that in SOME complaints of antibiotic usage in food animals.

Further, there should be some research into the OTHER than work conditions in the lives of the people with these strange, recurring health problems. It is easy and simplistic to assume cause and effect without checking out EVERYTHING that could be part of the problem.

ALL uses of antibiotics should be scrutinized and analyzed to determine the really necessary ones.

ALL possible sources of antibiotic levels in streams, etc. should be checked before attributing them all to one source (animal industry abuses), if legitimate results are wanted more than a way to attack animal production.

Any people producing animals had better not be too trusting of the advice of some here that there are not many activists out there who would attack beef (or any other food animal) production.

MRJ
 

Econ101

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In the case of the "chicken lady", the same type of antibiotics used in the poultry (the same class) IS used in humans. That is what causes the increased incidence of the "super bacteria". While all (I would assume) antibiotics have withdrawel periods for meat production to prevent them from being in the meat, the question of antibiotic resistant strains of bacteria is a different issue. If we had at our disposal a long list of antibiotic classes that could be used to combat bacterial infections, it would not be a huge concern to use antibiotics in a probiotic sense. The fact is that we do not. Bacteria that are able to develop resistance to a broad spectrum "higher level" antibiotic and then promote its spread in the environment is a cost we should reconsider when looking at its use in meat production.

I would submit that the use of antibiotics in poultry is probably a larger problem in poultry with respect to antibiotic resistance, than in beef. Both are externalized costs of production that the industry is not paying for and some people who get these infections are paying for.
 

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