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April 9, 2019

How Arizona hospitals helped uncover the source of 30,000 antibiotic-resistant infections each year

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    There's mounting research that drug-resistant bacteria can shift from animals to humans via meat consumption—and the latest findings could open the door to a new, more detailed bacterial monitoring system, Maryn McKenna writes for Wired.

    The 80/20 of care variation reduction: Profiles of organizations reducing unwarranted care variation

    Public health experts for years have warned that the use of antibiotics in farm animals could be fueling outbreaks of drug-resistant foodborne illnesses that can kill hundreds of people. But that connection has not been "universally accepted," McKenna writes. Until recently there's been few experimental studies that have been able to make a direct connection between the antibiotics fed to animals and the antibiotic resistant bacteria that can afflict humans.

    But one years-long study "eliminates the uncertainty at the center of that bacterial flow" by delving deep into the "genomics of bacterial adaptation in food animals and humans," McKenna writes. 

    Study details

    The researchers behind the study, Cindy Liu and Lance Price of the Antibiotic Resistance Action Center at George Washington University, focused their work on Flagstaff, Arizona, a small urban area that serves as a "self-contained natural laboratory" because there's limited migration in and out, McKenna reports.

    For the study, the researchers bought meat every two weeks for a year at supermarkets in the city, while also collecting and analyzing bacteria from blood and urine samples at local hospitals. According to McKenna, their goal was to create a bacterial timeline of when strains arrived in Flagstaff and how they spread, ultimately hoping to determine the strains' origin and direction.

    After analyzing the blood and urine samples, Liu and Price found a connection: E. coli was found on nearly 82% of the meat samples and 72% of the patient samples. And while E. coli is an "ubiquitous gut-dwelling pathogen," the researchers found that of the many different E. coli strains identified, one known as H22 was discovered on both chicken meat and in humans. A closer look at the genomics revealed the H22 strain also carried genetic markers showing it had first been in the guts of poultry before adapting to humans, McKenna writes.

    While the H22 strains represented just about .5% of all the strains the researchers identified, they estimated that on a national level, that figure represents between 30,000 and 40,000 UTI and kidney infections per year.

    In particular, the study found that people were contracting urinary tract infections (UTI) from E. Coli that originated in poultry, a finding that's particularly significant because a UTI is often the first sign of a particular strain of E. coli, called "extra-intestinal" pathogenic E. coli, or EXPEC. EXPEC has "a significant public health impact," McKenna explains, because it can jump from the gut and infect other parts of the body, causing "more serious illness than foodborne infections, all the way up to septic shock and death."

    "I think this is the first time that we can truly establish the direction of transmission," Price said, adding, "This shows clearly that people are getting UTI) from E. coli that originate in poultry." And backing up that finding, McKenna writes, the researchers found that the E. coli strains that made their way from birds to humans were more likely to be resistant to tetracycline and gentamicin—two antibiotics used in poultry production.

    The potential for a new monitoring system

    The results from this study could open a pathway toward a new monitoring system for bacteria in meat, McKenna writes.

    She explains that Price and Liu in their research delved into the genomics of the strains they identified, which found that the H22 strains were located within a larger subset of E. coli strains that typically are not associated with animals. That's significant, McKenna writes, because most research on foodborne bacteria conducted outside of academic labs do not investigate to the same depth, including "the most important federal analysis conducted every year in the United States by the CDC, FDA, and USDA." That analysis, called the National Antimicrobial Resistance Monitoring System (NARMS), monitors for foodborne bacteria with data starting at slaughterhouses rather than the farms where they're grown, McKenna writes.

    If NARMS's access was expanded to the include the farms where the animals are raised, and combined with the data from Liu and Price's study, it could give birth to a new monitoring system that could better protect our food, McKenna writes. This new monitoring system could trace bacteria all the way back to the farms or even individual flocks it originated from, which, according to McKenna, is "the direction we should move in, if we want our meals to be safe" (McKenna, Wired, 9/7/2018).

    The 80/20 of care variation reduction

    Care variation reduction (CVR) remains a top priority for physician executives aiming to reduce costs while improving quality. The challenge most organizations face is to prioritize the right clinical conditions for standardization—and then scale standards system-wide—to unlock significant savings.

    By analyzing more than 20 million patient discharges (from over 450 hospitals), our team has quantified the potential of CVR to generate critically needed cost savings while also improving care quality.

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