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This chapter proposes a medical school leadership curriculum that is context-driven, dovetails seamlessly with the medical student experience, and goes beyond managerial and professional interests by developing purposeful physician-leaders and focusing leadership knowledge on patient outcomes.

Increased antimicrobial resistance (AMR), or antibiotic resistance, has resulted in initiatives to reduce the use of antibiotics in food production animals (1,2), but quantification of the public health effects of [...]

There is an increasing awareness in the field of Salmonella epidemiology that focusing control eorts on those serotypes which cause severe human health outcomes, as opposed to broadly targeting all Salmonella, will likely lead to the greatest advances in decreasing the incidence of salmonellosis. Yet, little guidance exists to support validated, scientific selection of target serotypes. The goal of this perspective is to develop an approach to identifying serotypes of greater concern and present a case study using meat- and poultry-attributed outbreaks to examine challenges in developing a standardized framework for defining target serotypes. [ABSTRACT FROM AUTHOR]

Integrated quantitative descriptions of the transmission of β-lactam-resistant Escherichia coli (BR-EC) from commercial beef products to consumers are not available. Here, a quantitative microbial exposure assessment model was established to simulate the fate of BR-EC in a farm-to-fork continuum and provide an estimate of BR-EC exposure among beef consumers in the U.S. The model compared the per-serving exposures from the consumption of intact beef cuts, non-intact beef cuts, and ground beef. Additionally, scenario analysis was performed to evaluate the relative contribution of antibiotic use during beef cattle production to the level of human exposure to BR-EC. The model predicted mean numbers of BR-EC of 1.7 × 10−4, 8.7 × 10−4, and 6.9 × 10−1 CFU/serving for intact beef cuts, non-intact beef cuts, and ground beef, respectively, at the time of consumption. Sensitivity analyses using the baseline model suggested that factors related to sectors along the supply chain, i.e., feedlots, processing plants, retailers, and consumers, were all important for controlling human exposure to BR-EC. Interventions at the processing and post-processing stages are expected to be most effective. Simulation results showed that a decrease in antibiotic use among beef cattle might be associated with a reduction in exposure to BR-EC from beef consumption. However, the absolute reduction was moderate, indicating that the effectiveness of restricting antibiotic use as a standalone strategy for mitigating human exposure to BR-EC through beef consumption is still uncertain. Good cooking and hygiene practices at home and advanced safety management practices in the beef processing and post-processing continuum are more powerful approaches for reducing human exposure to antibiotic-resistant bacteria in beef products. [ABSTRACT FROM AUTHOR]

Third-generation cephalosporins (3GCs) are preferred treatments for serious human Salmonella enterica infections. Beef cattle are suspected to contribute to human 3GC-resistant Salmonella infections. Commensal 3GC-resistant Escherichia coli are thought to act as reservoirs of 3GC resistance because these strains are isolated more frequently than are 3GC-resistant Salmonella strains at beef cattle feedyards. During each of 24 consecutive months, four samples of pen surface material were obtained from five pens (N = 480) at a Nebraska feedyard to determine to the contribution of 3GC-resistant E. coli to the occurrence of 3GC-resistant Salmonella. Illumina whole genome sequencing was performed, and susceptibility to 14 antimicrobial agents was determined for 121 3GC-susceptible Salmonella, 121 3GC-resistant Salmonella, and 203 3GC-resistant E. coli isolates. 3GC-susceptible Salmonella isolates were predominantly from serotypes Muenchen (70.2%) and Montevideo clade 1 (23.1%). 3GC-resistant Salmonella isolates were predominantly from serotypes Montevideo clade 2 (84.3%). One bla gene type (blaCMY-2) and the IncC plasmid replicon were present in 100 and 97.5% of the 3GC-resistant Salmonella, respectively. Eleven bla gene types were detected in the 3GC-resistant E. coli, which were distributed across 42 multilocus sequence types. The blaCMY-2 gene and IncC plasmid replicon were present in 37.9 and 9.9% of the 3GC-resistant E. coli, respectively. These results suggest that 3GC resistance in Salmonella was primarily due the persistence of Salmonella Montevideo clade 2 with very minimal or no contribution from 3GC-resistant E. coli via horizontal gene transfer and that 3GC-resistant E. coli may not be a useful indicator for 3GC-resistant Salmonella in beef cattle production environments. [ABSTRACT FROM AUTHOR]

Antibiotics used during food animal production account for approximately 77% of U.S. antimicrobial consumption by mass. Ground beef products labeled as raised without antibiotics (RWA) are perceived to harbor lower levels of antimicrobial-resistant bacteria than conventional (CONV) products with no label claims regarding antimicrobial use. Retail ground beef samples were obtained from six U.S. cities. Samples with an RWA or U.S. Department of Agriculture Organic claim (n = 299) were assigned to the RWA production system. Samples lacking these claims (n = 300) were assigned to the CONV production system. Each sample was cultured for the detection of five antimicrobial-resistant bacteria. Genomic DNA was isolated from each sample, and a quantitative PCR assay was used to determine the abundance of 10 antimicrobial resistance (AMR) genes. Prevalence of tetracycline-resistant Escherichia coli (CONV, 46.3%; RWA, 34.4%; P < 0.01) and erythromycin-resistant Enterococcus (CONV, 48.0%; RWA, 37.5%; P = 0.01) was higher in CONV ground beef. Salmonella was detected in 1.2% of samples. The AMR gene blaCTX-M (CONV, 4.1 log-normalized abundance; RWA, 3.8 log-normalized abundance; P < 0.01) was more abundant in CONV ground beef. The AMR genes mecA (CONV, 4.4 log-normalized abundance; RWA, 4.9 log-normalized abundance; P = 0.05), tet(A) (CONV, 3.9 log-normalized abundance; RWA, 4.5 log-normalized abundance; P < 0.01), tet(B) (CONV, 3.9 log-normalized abundance; RWA, 4.5 log-normalized abundance; P < 0.01), and tet(M) (CONV, 5.4 log-normalized abundance; RWA, 5.8 log-normalized abundance; P < 0.01) were more abundant in RWA ground beef. Although these results suggest that antimicrobial use during U.S. cattle production does not increase human exposure to antimicrobial-resistant bacteria via ground beef, quantitative microbiological risk assessments are required for authoritative determination of the human health impacts of the use of antimicrobial agents during beef production. [ABSTRACT FROM AUTHOR]

Consumption of animal-derived meat products is suspected as an important exposure route to antimicrobial resistance, as the presence of antimicrobial-resistant bacteria (ARB) along the beef supply chain is well documented. A retail-to-fork quantitative exposure assessment was established to compare consumers' exposure to various ARB due to the consumption of ground beef with and without "raised without antibiotics" claims and to inform potential exposure mitigation strategies related to consumer practices. The microbial agents evaluated included Escherichia coli, tetracycline-resistant (TETr) E. coli, third-generation cephalosporin-resistant E. coli,Salmonella enterica, TETrS. enterica, third-generation cephalosporin-resistant S. enterica, nalidixic acid–resistant S. enterica, Enterococcus spp., TETrEnterococcus spp., erythromycin-resistant Enterococcus spp., Staphylococcus aureus, and methicillin-resistant S. aureus. The final model outputs were the probability of exposure to at least 0 to 6 log CFU microorganisms per serving of ground beef at the time of consumption. It was estimated that tetracycline resistance was more prevalent in ground beef compared with other types of resistance, among which the predicted average probability of ingesting TETrEnterococcus was highest (6.2% of ingesting at least 0 log CFU per serving), followed by TETrE. coli (3.1%) and TETrSalmonella (0.0001%), given common product purchase preferences and preparation behaviors among beef consumers in the United States. The effectiveness of consumer-related interventions was estimated by simulating the differences in exposure as a result of changes in consumer practices in purchasing, handling, and preparing ground beef. The results indicated that proper use of recommended safe cooking and food preparation practices mitigates ARB exposure more effectively than choosing raised without antibiotics compared with conventional beef. Tetracycline-resistant bacterial exposure via ground beef is higher than other ARB. Exposure to pathogens resistant to clinically important drugs via ground beef is low. Choosing "raised without antibiotics" ground beef may not eliminate ARB exposure. Increasing cooking doneness of ground beef may effectively mitigate ARB exposure. [ABSTRACT FROM AUTHOR]

Shiga toxin-producing Escherichia coli (STEC) is a foodborne pathogen that has a significant impact on public health, with strains possessing the attachment factor intimin referred to as enterohemorrhagic E. coli (EHEC) and associated with life-threatening illnesses. Cattle and beef are considered typical sources of STEC, but their presence in pork products is a growing concern. Therefore, carcasses (n=1,536) at two U.S. pork processors were sampled once per season at three stages of harvest (poststunning skins, postscald carcasses, and chilled carcasses) and then examined using PCR for Shiga toxin genes (stx), intimin genes (eae), aerobic plate count (APC), and Enterobacteriaceae counts (EBC). The prevalence of stx on skins, postscald, and chilled carcasses was 85.3, 17.5, and 5.4%, respectively, with 82.3, 7.8, and 1.7% of swabs, respectively, having stx and eae present. All stx-positive samples were subjected to culture isolation that resulted in 368 STEC and 46 EHEC isolates. The most frequently identified STEC were serogroups O121, O8, and O91 (63, 6.7, and 6.0% of total STEC, respectively). The most frequently isolated EHEC was serotype O157:H7 (63% of total EHEC). Results showed that scalding significantly reduced (P < 0.05) carcass APC and EBC by 3.00- and 2.50-log10 CFU/100 cm2, respectively. A seasonal effect was observed, with STEC prevalence lower (P <0.05) in winter. The data from this study show significant (P <0.05) reduction in the incidence of STEC (stx) from 85.3% to 5.4% and of EHEC (stx plus eae) from 82.3% to 1.7% within the slaughter-to-chilling continuum, respectively, and that potential EHEC can be confirmed present throughout using culture isolation. [ABSTRACT FROM AUTHOR]

Culled beef cows (cows that have reached the end of their productive life span in cow-calf operations) and culled dairy cows represent approximately 18% of the cattle harvested in the United States annually, but data on antimicrobial resistance (AMR) in these cull cattle are extremely limited. To address this data gap, colon contents were obtained from 180 culled conventional beef cows, 179 culled conventional dairy cows, and 176 culled organic dairy cows (produced without using antimicrobials). Sponge samples were also collected from 181 conventional beef, 173 conventional dairy, and 180 organic dairy cow carcasses. These samples were obtained on 6 days (3 days each at two beef harvest and processing establishments). At one establishment, 30 samples of beef manufacturing trimmings from conventional cows and 30 trim samples from organic dairy cows were acquired. All 1,129 samples were cultured for Escherichia coli, tetracycline-resistant (TETr ) E. coli, third-generation cephalosporin-resistant (3GCr ) E. coli, Salmonella, and 3GCr Salmonella. Metagenomic DNA was isolated from 535 colon content samples, and quantitative PCR assays were performed to assess the abundances of the following 10 antimicrobial resistance genes: aac(6')-Ie-aph(2")-Ia, aadA1, blaCMY-2, blaCTX-M, blaKPC-2, erm(B), mecA, tet(A), tet(B), and tet(M). For colon contents, only TETr E. coli (P <0.01), 3GCr E. coli (P< 0.01), and erm(B) (P=0.03) levels were higher in conventional than in organic cows. Sampling day also significantly affected (P <0.01) these levels. Production system did not affect the levels of any measured AMR on carcasses or trim. The human health impact of the few significant AMR differences could not be determined due to the lack of standards for normal, background, safe, or basal values. Study results provide key heretofore unavailable data that may inform quantitative microbial risk assessments to address these gaps. [ABSTRACT FROM AUTHOR]

Ground beef can be a reservoir for a variety of bacteria, including spoilage organisms, and pathogenic foodborne bacteria. These bacteria can exhibit antimicrobial resistance (AMR) which is a public health concern if resistance in pathogens leads to treatment failure in humans. Culture-dependent techniques are commonly used to study individual bacterial species, but these techniques are unable to describe the whole community of microbial species (microbiome) and the profile of AMR genes they carry (resistome), which is critical for getting a holistic perspective of AMR. The objective of this study was to characterize the microbiome and resistome of retail ground beef products labeled as coming from conventional or raised without antibiotics (RWA) production systems. Sixteen ground beef products were purchased from 6 retail grocery outlets in Fort Collins, CO, half of which were labeled as produced from cattle raised conventionally and half of products were from RWA production. Total DNA was extracted and isolated from each sample and subjected to 16S rRNA amplicon sequencing for microbiome characterization and target-enriched shotgun sequencing to characterize the resistome. Differences in the microbiome and resistome of RWA and conventional ground beef were analyzed using the R programming software. Our results suggest that the resistome and microbiome of retail ground beef products with RWA packaging labels do not differ from products that do not carry claims regarding antimicrobial drug exposures during cattle production. The resistome predominantly consisted of tetracycline resistance making up more than 90% of reads mapped to resistance gene accessions in our samples. Firmicutes and Proteobacteria predominated in the microbiome of all samples (69.6% and 29.0%, respectively), but Proteobacteria composed a higher proportion in ground beef from conventionally raised cattle. In addition, our results suggest that product management, such as packaging type, could exert a stronger influence on the microbiome than the resistome in consumer-ready products. Metagenomic analyses of ground beef is a promising tool to investigate community-wide shifts in retail ground beef. Importantly, however, results from metagenomic sequencing must be carefully considered in parallel with traditional methods to better characterize the risk of AMR in retail products. [ABSTRACT FROM AUTHOR]

The macrolide class antimicrobial tylosin (trade name Tylan) is approved by the U.S. Food and Drug Administration for continuous inclusion in feed for liver abscess prevention. To address concerns that this antimicrobial application may threaten human health, a population of feedlot steers was split into a control treatment (n = 42) and a tylosin treatment (n = 42). Feed rations were identical except for the inclusion of tylosin at 60 to 90 mg per head per day. Fecal swab (n = 335), pen surface material (n = 256), feed (n = 56), and water trough (n = 32) samples were obtained over four sample occasions: November (1 day before the start of tylosin inclusion in feed), January (80 days of tylosin in feed), April (167 days), and June (253 days). These samples were cultured for Escherichia coli, tetracycline-resistant E. coli, third-generation cephalosporin-resistant E. coli, Enterococcus, tetracycline-resistant Enterococcus, and erythromycin-resistant Enterococcus. Metagenomic DNA was isolated from each June fecal swab and pen surface material sample. Metagenomic DNA samples were pooled by pen for 14 fecal and 14 pen surface material samples. Quantitative PCR was employed to assess the abundances of the following 10 antimicrobial resistance genes: aac(6′)-Ie-aph(2″)-Ia, aadA1, blaCMY-2, blaCTX-M, blaKPC-2, erm(B), mecA, tet(A), tet(B), and tet(M). Nasal swab samples (n = 335) were obtained from each steer during each sample period and cultured for the presence of Staphylococcus aureus and methicillin-resistant S. aureus. Of these measurements, only January and June mean fecal swab erythromycin-resistant Enterococcus colony counts for tylosin-treated cattle were significantly higher (P ≤ 0.05) than the range of mean values for control treatments. These results suggest that in-feed tylosin through the end of finishing has a narrow and minimal antimicrobial resistance impact. [ABSTRACT FROM AUTHOR]

Concerns exist that beef cattle manure amendment may increase antimicrobial resistance (AMR) in cropland soils and persist over time, potentially increasing food‐animal and human exposure via feed and produce. Manure and soil contain many types of antibiotic‐resistant bacteria. However, zoonotic pathogens and fecal indicators are most directly linked to human disease and environmental surveillance efforts. We measured the levels of eight antimicrobial resistant zoonotic pathogens and fecal indicators at experimental farms at three locations: Nebraska (silt loam), North Dakota (silty clay), and South Dakota (silty clay loam). Each location had four treatments: beef cattle manure, beef cattle manure with corn stover bedding, inorganic fertilizer, and unamended control. Tetracycline‐resistant (TETr), nalidixic‐acid resistant, and third‐generation cephalosporin‐resistant (3GCr) Salmonella enterica were not detected in any cropland samples. Treatments did not significantly affect cropland levels of TETrEscherichia coli, trimethoprim‐sulfamethoxazole‐resistant E. coli, 3GCrE. coli, TETrEnterococcus spp., or erythromycin‐resistant Enterococcus. Additionally, levels of 10 antimicrobial resistance genes (ARGs) were assessed in all soil samples. Except for erm(B) and tet(M) at Nebraska, ARG increases after manure application dissipated before planting occurred. Treatment did not affect the following ARGs: aac(6′)‐Ie‐aph(2′′)‐Ia, aadA1, blaCMY‐2, blaCTX‐M, mecA, tet(A), and tet(B). The replicated experimental design, quantification data, and paired genotypic and phenotypic information collected for this study can be used to inform risk assessment models. The common US Upper Midwest practice of land applying beef cattle manure in fall does not result in significantly higher levels of the AMR tested in spring cropland soils. Core Ideas: Beef manure amendment did not affect soil levels of resistant pathogens and indicator bacteria levels.Beef manure amendment minimally affected antimicrobial resistance gene levels.Sample occasion had a larger effect than amendment on soil antimicrobial resistance levels. [ABSTRACT FROM AUTHOR]

Pork products from animals "raised without antibiotics" (RWA) are assumed to harbor lower levels of antimicrobial resistance (AMR) than conventional (CONV) pork products with no claims regarding use of antimicrobial agents during production. A total of 372 pork chop samples from CONV (n = 190) and RWA (n = 182) production systems were collected over 13 months from three food service suppliers. The following bacteria were cultured: Escherichia coli, tetracycline-resistant (TETr) E. coli, third-generation cephalosporin-resistant (3GCr) E. coli, Salmonella enterica, TETrSalmonella, 3GCrSalmonella, nalidixic acid–resistant Salmonella, Enterococcus spp., TETrEnterococcus, erythromycin-resistant Enterococcus, Staphylococcus aureus, and methicillin-resistant S. aureus. Production system did not significantly impact the detection of cultured bacteria (P > 0.05). Metagenomic DNA was isolated from each sample, and equal amounts of metagenomic DNA were pooled by supplier, month, and production system for 75 pooled samples (38 CONV, 37 RWA). Quantitative PCR was used to assess the abundances of the following 10 AMR genes: aac(6′)-Ie-aph(2″)-Ia, aadA1, blaCMY-2, blaCTX-M, blaKPC-2, erm(B), mecA, tet(A), tet(B), and tet(M). For all 10 AMR genes, abundances did not differ significantly (P > 0.05) between production systems. These results suggest that use of antimicrobial agents during swine production minimally impacts the AMR of bacteria in pork chops. Levels of eight resistant bacteria in pork chops were similar regardless of antibiotic use claims. Levels of 10 AMR genes in pork chops were similar regardless of antibiotic use claims. Antibiotic use during swine production may not impact AMR levels in pork products. [ABSTRACT FROM AUTHOR]

U.S. ground beef with “raised without antibiotics” (RWA) label claims are perceived as harboring fewer bacteria with antimicrobial resistance (AMR) than are found in conventional (CONV) ground beef with no such label claim. A total of 370 ground beef samples from CONV (n = 191) and RWA (n = 179) production systems were collected over 13 months from three food service suppliers. The following bacteria were cultured: Escherichia coli, tetracycline-resistant (TETr) E. coli, third-generation cephalosporin-resistant (3GCr) E. coli, Salmonella enterica, TETr S. enterica, 3GCr S. enterica, nalidixic acid–resistant S. enterica, Enterococcus spp., erythromycin-resistant Enterococcus spp., TETr Enterococcus spp., Staphylococcus aureus, and methicillin-resistant S. aureus. TETr E. coli was more frequently detected in CONV ground beef (CONV, 54.2%; RWA, 35.2%; P < 0.01), but supplier (P < 0.01) and production system × suppler interaction (P < 0.01) effects were also significant. Metagenomic DNA was isolated from each sample, and equal amounts of metagenomic DNA were pooled by supplier, month, and production system for 75 pooled samples (38 CONV, 37 RWA). The abundance of aac(6′)-Ie-aph(2″)-Ia, aadA1, blaCMY-2, blaCTX-M, blaKPC-2, erm(B), mecA, tet(A), tet(B), and tet(M) genes was assessed by quantitative PCR. The tet(A) (2.9-log2-fold change, P = 0.04) and tet(B) (5.6-log2-fold change) (P = 0.03) genes were significantly more abundant in RWA ground beef. Phylogenetic analyses revealed that ground beef microbiomes differed more by supplier than by production system. These results were consistent with prior research suggesting antimicrobial use in U.S. beef cattle has minimal impact on the AMR of bacteria found in these products. These results should spur a reevaluation of assumptions regarding the impact of antimicrobial use during U.S. beef production on the AMR of bacteria in ground beef. [ABSTRACT FROM AUTHOR]

The U.S. beef industry must provide documentation to the U.S. Department of Agriculture, Food Safety and Inspection Service (USDA-FSIS) that the antimicrobial interventions implemented or any subsequent changes in the process are effective under the actual conditions that apply in its operation. The main objective of this study was to determine whether surface pH after application of diluted lactic acid solution on surfaces of fresh meat can be used as a control measure indicator for the reduction of E. coli O157:H7 and Salmonella. Samples (240 each) of lean and adipose beef tissues were inoculated with cocktail mixtures of Escherichia coli O157:H7 and Salmonella. Application parameters were varied such that lean and adipose tissues were spray treated with either 2 or 4.5% lactic acid solution at either 38 or 60°C for 1 to 10 s. Lean and adipose tissues were collected before and after spray treatments for enumeration of the pathogens. Based on the conditions of this study, there was no difference between spray treatments at 38 or 60°C, but 4.5% lactic acid solution reduced pathogens more effectively (P ≤ 0.05) than did 2% lactic acid solution. Spray treatment with lactic acid solution for 1 to 10 s reduced surface pH values of lean tissues (3 to 3.8) and adipose tissues (2.75 to 3.65). At surface pH values of 3.0 and 2.75, lactic acid reduced E. coli O157:H7 on surfaces of lean and adipose tissues by approximately 1.60 and 1.54 log CFU/cm2, respectively. At surface pH values of 3.8 and 3.65, lactic acid reduced E. coli O157:H7 on lean and adipose tissues by approximately 0.3 and 0.42 log CFU/cm2, respectively. The surface pH values after lactic acid treatment and the reductions of both pathogens showed a strong linear relationship; this indicates that a surface pH of 3.1 would provide at least 1-log reduction of E. coli O157:H7 and Salmonella, regardless of lactic acid application parameters. Therefore, surface pH after spray treatment with lactic acid could be used to validate pathogen reduction. [ABSTRACT FROM AUTHOR]

Concerns have been raised that in-feed chlortetracycline (CTC) may increase antimicrobial resistance (AMR), specifically tetracycline- resistant (TETr) Escherichia coli and third-generation cephalosporin-resistant (3GCr) E. coli. We evaluated the impact of a 5-day in-feed CTC prophylaxis on animal health, TETr E. coli, and 3GCr E. coli. A control group of cattle (n 150) received no CTC, while a CTC group (n150) received in-feed CTC (10 mg/lb of body weight/day) from the 5th to the 9th day after feedlot arrival. Over 25% (38/150) of the animals in the control group developed illnesses requiring therapeutic treatment with antimicrobials critically important to human medicine. Only two animals (1.3%) in the CTC group required such treatments. Fecal swab and pen surface occurrences of generic E. coli (isolated on media that did not contain antimicrobials of interest and were not isolated based on any specific resistance), TETr E. coli, and 3GCr E. coli were determined on five sampling occasions: arrival at the feedlot, 5 days posttreatment (5 dpt), 27 dpt, 75 dpt, and 117 dpt. On 5 dpt, TETr E. coli concentrations were higher for the CTC group than the control group (P<0.01). On 27 dpt, 75 dpt, and 117 dpt, TETr E. coli concentrations did not differ between groups. 3GCr E. coli occurrences did not differ between control and CTC groups on any sampling occasion. For both groups, generic, TETr, and 3GCr E. coli occurrences were highest on 75 dpt and 117 dpt, suggesting that factors other than in-feed CTC contributed more significantly to antimicrobial-resistant E. coli occurrence. [ABSTRACT FROM AUTHOR]

In the meat industry, a high-event period (HEP) is defined as a time period when beef processing establishments experience an increased occurrence of product contamination by Escherichia coli O157:H7. Our previous studies suggested that bacterial biofilm formation and sanitizer resistance might contribute to HEPs. We conducted the present study to further characterize E. coli O157:H7 strains isolated during HEPs for their potential to cause contamination and to investigate the genetic basis for their strong biofilm-forming ability and high sanitizer resistance. Our results show that, compared with the E. coli O157:H7 diversity control panel strains, the HEP strains had a significantly higher biofilm-forming ability on contact surfaces and a lower susceptibility to common sanitizers. No difference in the presence of disinfectant-resistant genes or the prevalence of antibiotic resistance was observed between the HEP and control strains. However, the HEP strains retained significantly higher copy numbers of the pO157 plasmid. A positive correlation was observed among a strain's high plasmid copy number, strong biofilmforming ability, low sanitizer susceptibility, and high survival and recovery capability after sanitization, suggesting that these specific phenotypes could be either directly correlated to gene expression on the pO157 plasmid or indirectly regulated via chromosomal gene expression influenced by the presence of the plasmid. Our data highlight the potential risk of biofilm formation and sanitizer resistance in HEP contamination by E. coli O157:H7, and our results call for increased attention to proper and effective sanitization practices in meat processing facilities. [ABSTRACT FROM AUTHOR]

We compared the occurrences of 3rd-generation cephalosporin-resistant (3GCr), tetracycline-resistant (TETr), and trimethoprim-sulfamethoxazole-resistant (COTr) Escherichia coli, 3GCr and nalidixic acid-resistant (NALr) Salmonella enterica, and erythromycin-resistant (ERYr) enterococci from the fecal samples of ceftiofur-treated ( n = 162) and nonantimicrobial-treated ( n = 207) comingled beef cows ≥8 years old, for which complete antimicrobial treatment records were available. The prevalence of 3GCr (17%; n = 369), TETr (88%), COTr E. coli (22%), and ERYr enterococci (69%) was not significantly ( p > 0.05) associated with ceftiofur treatment, prior history of other antimicrobial treatments, or duration of time between last antimicrobial treatment and sampling. 3GCr and NALr S. enterica were not detected. The prevalence of tetB was significantly ( p < 0.05) higher compared with tetA among TETr E. coli. However, the prevalence of tetA was significantly ( p < 0.05) higher than tetB among 3GCr and COTr E. coli. There was a significant ( p < 0.05) association between tetM and ermB among ERYr enterococci. In conclusion, occurrences of 3GCr, TETr, and COTr E. coli and ERYr enterococci in comingled antimicrobial-treated and nonantimicrobial-treated beef cows were not associated with ceftiofur or other antimicrobial use, indicating that other factors influenced the observed levels of antimicrobial-resistant bacteria in feces of beef cows. [ABSTRACT FROM AUTHOR]

Cattle are noted carriers of the foodborne pathogen Salmonella enterica. The perceived need to decrease the potential human health risk posed by excretion of this pathogen has resulted in numerous studies examining the factors that influence Salmonella shedding in cattle. Fecal grab (FG) samples have been the predominant method used to identify cattle colonized or infected with Salmonella; however, FG sampling can be impractical in certain situations, and rectoanal mucosal swabs (RAMS) are a more convenient sample type to collect. Despite a lack of studies comparing FG and RAMS for the detection and enumeration of Salmonella fecal shedding, RAMS is perceived as less sensitive because a smaller amount of feces is cultured. In a cross-sectional study to address these concerns, paired RAMS and FG samples were collected from 403 adult feedlot cattle approximately 90 days prior to harvest. Samples were processed for Salmonella enumeration (direct plating) and detection (enrichment and immunomagnetic separation). In all, 89.6% of RAMS and 98.8% of FG samples were positive for Salmonella, and concordant prevalence outcomes were observed for 90.8% of samples. Mean enumeration values were 3.01 and 3.12 log CFU/ml for RAMS and FG, respectively. The sensitivity and specificity of RAMS were 91% (95% confidence interval [CI]: 87.5 to 93%) and 100% (95% CI: 48 to 100%), respectively, for Salmonella detection. Furthermore, RAMS Salmonella enumeration was substantially concordant (ρc = 0.89; 95% CI: 0.86 to 0.91) with FG values. We conclude that RAMS are a reliable alternative to FG for assessing cattle Salmonella fecal shedding status, especially for cattle shedding high levels of Salmonella. [ABSTRACT FROM AUTHOR]

This study compared the populations of antimicrobial-resistant bacteria and the repertoire of antimicrobial resistance genes in four environments: effluent of three municipal wastewater treatment facilities, three cattle feedlot runoff catchment ponds, three swine waste lagoons, and two “low impact” environments (an urban lake and a relict prairie). Multiple liquid and solid samples were collected from each environment. The prevalences and concentrations of antimicrobial-resistant (AMR) Gram-negative (Escherichia coli and Salmonella enterica) and Gram-positive (enterococci) bacteria were determined from individual samples (n = 174). The prevalences of 84 antimicrobial resistance genes in metagenomic DNA isolated from samples pooled (n = 44) by collection date, location, and sample type were determined. The prevalences and concentrations of AMR E. coli and Salmonella were similar among the livestock and municipal sample sources. The levels of erythromycin-resistant enterococci were significantly higher in liquid samples from cattle catchment ponds and swine waste lagoons than in liquid samples from municipal wastewater treatment facilities, but solid samples from these environments did not differ significantly. Similarly, trimethoprim/sulfamethoxazole-resistant E. coli concentrations were significantly higher in swine liquid than in municipal liquid samples, but there was no difference in solid samples. Multivariate analysis of the distribution of antimicrobial resistance genes using principal coordinate analysis showed distinct clustering of samples with livestock (cattle and swine), low impact environment and municipal samples forming three separate clusters. The numbers of class A beta-lactamase, class C beta-lactamase, and fluoroquinolone resistance genes detected were significantly higher (P < 0.05) in municipal samples than in cattle runoff or swine lagoon samples. In conclusion, we report that AMR is a very widespread phenomenon and that similar prevalences and concentrations of antimicrobial-resistant bacteria and antimicrobial resistance genes exist in cattle, human, and swine waste streams, but a higher diversity of antimicrobial resistance genes are present in treated human waste discharged from municipal wastewater treatment plants than in livestock environments. [ABSTRACT FROM AUTHOR]

Several antimicrobial compounds have been used in commercial meat processing plants for decontamination of pathogens on beef carcasses, but there are many commercially available, novel antimicrobial compounds that may be more effective and suitable for use in beef processing pathogen-reduction programs. Sixty-four prerigor beef flanks (cutaneous trunci) were used in a study to determine whether hypobromous acid, neutral acidified sodium chlorite, and two citric acid-based antimicrobial compounds effectively reduce seven Shiga toxin-producing Escherichia coli (STEC) serogroups and Salmonella on the surface of fresh beef. Two cocktail mixtures were inoculated onto prerigor beef flank surfaces. Cocktail mixture 1 was composed of STEC serogroups O26, O103, O111, O145, and O157; and cocktail mixture 2 was composed of STEC serogroups O45, O121, and O157 and Salmonella. The inoculated fresh beef flanks were subjected to spray treatments with four antimicrobial compounds. Following antimicrobial treatments, both control and treated fresh beef samples were either enumerated immediately or were stored for 48 h at 4°C before enumeration. All four antimicrobial compounds caused 0.7- to 2.0-log reductions of STEC, Salmonella, aerobic plate counts, and Enterohacteriaceae. Results also indicated that the four antimicrobial compounds were as effective at reducing the six non-O157 STEC strains as they were at reducing E. coli O157:H7 on the surfaces of fresh beef. The recovery of all seven STEC strains and Salmonella in a low-inoculation study indicated that none of the four antimicrobial compounds eliminated all of the tested pathogens. [ABSTRACT FROM AUTHOR]

Specific concerns have been raised that third-generation cephalosporin-resistant (3GCr) Escherichia coli, trimethoprim-sulfamethoxazole- resistant (COTr) E. coli, 3GCr Salmonella enterica, and nalidixic acid-resistant (NALr) S. enterica may be present in cattle production environments, persist through beef processing, and contaminate final products. The prevalences and concentrations of these organisms were determined in feces and hides (at feedlot and processing plant), pre-evisceration carcasses, and final carcasses from three lots of fed cattle (n=184). The prevalences and concentrations were further determined for strip loins from 103 of the carcasses. 3GCr Salmonella was detected on 7.6% of hides during processing and was not detected on the final carcasses or strip loins. NALr S. enterica was detected on only one hide. 3GCr E. coli and COTr E. coli were detected on 100.0% of hides during processing. Concentrations of 3GCr E. coli and COTr E. coli on hides were correlated with pre-evisceration carcass contamination. 3GCr E. coli and COTr E. coli were each detected on only 0.5% of final carcasses and were not detected on strip loins. Five hundred and 42 isolates were screened for extraintestinal pathogenic E. coli (ExPEC) virulence-associated markers. Only two COTr E. coli isolates from hides were ExPEC, indicating that fed cattle products are not a significant source of ExPEC causing human urinary tract infections. The very low prevalences of these organisms on final carcasses and their absence on strip loins demonstrate that current sanitary dressing procedures and processing interventions are effective against antimicrobial-resistant bacteria. [ABSTRACT FROM AUTHOR]

This report reviews the use of the Cool-Cap device to apply selective therapeutic hypothermia to the brain of preterm infants, without causing systemic hypothermia. Four infants, 32-35 weeks gestation, with suspected Hypoxic Ischemic Encephalopathy (HIE) received treatment aimed at providing selective brain cooling. It was not possible to apply cold circulating water to the scalp of the preterm infant without systemic hypothermia unless a warming blanket was also used. All infants had severe HIE and all had either death, or neurologic disability despite cooling attempts. Therapeutic hypothermia cannot be recommended at this time for preterm infants outside clinical trials. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine the effect of immersing beef cheek meat in antimicrobial solutions on the reduction of O157:H7 Shiga toxin-producing Escherichia coli (STEC), non-O157:H7 STEC, and Salmonella enterica. Beef cheek meat was inoculated with O157:H7 STEC, non-O157:H7 STEC, and S. enterica on both the adipose and muscle surfaces. The inoculated cheek meat was then immersed in one of seven antimicrobial solutions for 1, 2.5, or 5 min: (i) 1% Aftec 3000 (AFTEC), (ii) 2.5% Beefxide (BX), (iii) 300 ppm of hypobromous acid (HOBR), (iv) 2.5% lactic acid (LA2.5), (v) 5% lactic acid (LA5), (vi) 0.5% levulinic acid and 0.05% sodium dodecyl sulfate (LEV-SDS), or (vii) 220 ppm of peroxyacetic acid (POA). Inoculated cheek meat was also immersed in 80°C tap water (HW) for 10 s. In general, increasing immersion duration in antimicrobial solutions did not significantly (P ≥ 0.05) increase effectiveness. Immersion in HW for 10 s was the most effective intervention, reducing STEC and S. enterica by 2.2 to 2.3 log CFU/cm² on the adipose surface and by 1.7 to 1.8 log CFU/cm² on the muscle surface. Immersion for I min in AFFEC, BX, LA2.5, LA5, or POA was also effective as an intervention, reducing STEC and S. enterica by 0.8 to 2.0 log CFU/cm² on the adipose surface and by 0.6 to 1.4 log CFU/cm² on the muscle surface. Immersion for 1 min in HOBR or LEV-SDS was not an effective intervention because STEC and S. enterica reductions ranged from 0.1 to 0.4 log CFU/cm² which were not significantly different (P ≥ 0.05) from the reductions obtained when cheek meat was immersed in room temperature tap water. We conclude that immersion of cheek meat in HW for 10 s and immersion for 1 min in AFTEC, BX, LA2.5, LA5, or POA effectively reduced levels of STEC and S. enterica. [ABSTRACT FROM AUTHOR]

Shiga toxin-producing Escherichia coli O157:H7 and Salmonella enterica serovar Typhimurium are important foodborne pathogens capable of forming single-species biofilms or coexisting in multispecies biofilm communities. Bacterial biofilm cells are usually more resistant to sanitization than their planktonic counterparts, so these foodborne pathogens in biofilms pose a serious food safety concern. We investigated how the coexistence of E. coli O157:H7 and Salmonella Typhimurium strains would affect bacterial planktonic growth competition and mixed biofilm composition. Furthermore, we also investigated how mixed biofilm formation would affect bacterial resistance to common sanitizers. Salmonella Typhimurium strains were able to outcompete E. coli strains in the planktonic growth phase; however, mixed biofilm development was highly dependent upon companion strain properties in terms of the expression of bacterial extracellular polymeric substances (EPS), including curli fimbriae and exopolysaccharide cellulose. The EPS-producing strains with higher biofilm-forming abilities were able to establish themselves in mixed biofilms more efficiently. In comparison to single-strain biofilms, Salmonella or E. coli strains with negative EPS expression obtained significantly enhanced resistance to sanitization by forming mixed biofilms with an EPS-producing companion strain of the other species. These observations indicate that the bacterial EPS components not only enhance the sanitizer resistance of the EPS-producing strains but also render protections to their companion strains, regardless of species, in mixed biofilms. Our study highlights the potential risk of cross-contamination by multispecies biofilms in food safety and the need for increased attention to proper sanitization practices in food processing facilities. [ABSTRACT FROM AUTHOR]

Abstract: Multiplex real-time PCR detection of Escherichia coli O157:H7 is an efficient molecular tool with high sensitivity and specificity for meat safety assurance. The Biocontrol GDS® and DuPont Qualicon BAX®-RT rapid detection systems are two commercial tests based on real-time PCR amplification with potential applications for quantification of specific E. coli O157:H7 gene targets in enriched meat samples. However, there are arguments surrounding the use of these tests to predict pre-enrichment concentrations of E. coli O157:H7, as well as arguments pertaining to the influence of non-viable cells causing false positive results. The present study attempts to illustrate the effects of different bacterial physiologic states and the presence of non-viable cells on the ability of these systems to accurately measure contamination levels of E. coli O157:H7 in ground beef. While the PCR threshold cycle (C T ) values of these assays showed a direct correlation with the number of bacteria present in pure cultures, this was not the case for ground beef samples spiked with various levels of injured or healthy cells. Furthermore, comparison of post-enrichment cell densities of bacteria did not correlate with injured or healthy cell numbers inoculated before enrichment process. Ground beef samples spiked with injured or healthy cells at different doses could not be distinguished by C T values from either assay. In addition, the contribution of nonviable cells in generating positive real-time PCR signals was investigated using both assays on pre-enriched and post-enriched beef samples, but only if inoculated at levels of 106 cells/sample or higher, which are levels not typically seen in ground beef. [Copyright &y& Elsevier]

In the United States, the blaCMY2 gene contained within incompatibility type AJC (IncA/C) plasmids is frequently identified in extended-spectrum-cephalosporin-resistant (ESCr) Escherichia coli strains from both human and cattle sources. Concerns have been raised that therapeutic use of ceftiofur in cattle may increase the prevalence of ESCr E. coli. We report that herd ESCr E. coli fecal and hide prevalences throughout the residency of cattle at a feedlot, including during the period of greatest ceftiofur use at the feedlot, were either not significantly different (P < 0.05) or significantly less (P < 0.05) than the respective prevalences at arrival. Longitudinal sampling of cattle treated with ceftiofur demonstrated that once the transient increase of ESCr E. coli shedding that follows ceftiofur injection abated, ceftiofur-injected cattle were no more likely than untreated members of the same herd to shed ESCr E. coli. Pulsed-field gel electrophoresis (PFGE) genotyping, antibiotic resistance phenotyping, screening for presence of the bIaCMYZ gene, and plasmid replicon typing were performed on 312 ESC E. coli isolates obtained during six sampling periods spanning the 10-month residence of cattle at the feedlot. The identification of only 26 unique PFGE genotypes, 12 of which were isolated during multiple sampling periods, suggests that clonal expansion of feedlot-adapted blaCMY2 E. coli strains contributed more to the persistence of blaCMY-2 than horizontal transfer of IncA/C plasmids between E. coli strains at this feedlot. We conclude that therapeutic use of ceftiofur at this cattle feedlot did not significantly increase the herd prevalence of ESCr E. coli. [ABSTRACT FROM AUTHOR]

Bacteria are known to be present in the air at beef processing plants, but published data regarding the prevalences of airborne Escherichia coli O157:H7 and Salmonella enterica are very limited. To determine if airborne pathogens were present in beef processing facilities, we placed sedimentation sponges at various locations in three commercial beef plants that processed cattle from slaughter through fabrication. For the 291 slaughter area air samples, E. coli O157:H7 was isolated from 15.8% and S. enterica from 16.5%. Of the 113 evisceration area air samples, E. coli O157:H7 was isolated from only one sample and S. enterica was not isolated from any sample. Pathogens were not isolated from any of the 87 air samples from fabrication areas. Pathogen prevalences, aerobic plate counts, and Enterobacteriaceae counts were highest for air samples obtained from locations near hide removal operations. The process of hide removal disperses liquid droplets, which may contact neighboring carcasses. Samples were obtained both from hide removal locations that were close enough to hide pullers to be contacted by droplets and from locations that were not contacted by droplets. Higher pathogen prevalences, aerobic plate counts, and Enterobacteriaceae counts were observed at locations with samples contacted by the hide removal droplets. We conclude that the hide removal processes likely introduce pathogens into the air via a dispersion of liquid droplets and that these droplets may be an underappreciated source of hide-to-carcass contamination. [ABSTRACT FROM AUTHOR]

Although numerous antimicrobial interventions targeting Escherichia coli O157:H7 have been developed and implemented to decontaminate meat and meat products during the harvesting process, the information on efficacy of these interventions against the so-called Big Six non-O157 Shiga toxin-producing E. coli (STEC) strains is limited. Prerigor beef flanks (160) were inoculated to determine if antimicrobial interventions currently used by the meat industry have a similar effect in reducing non-O157 STEC serogroups O26, O45, O103, Ol 11, O121, and O145 compared with E. coli O157:H7. A high (104 CFU/cm² or a low (101 CFU/cm² inoculation of two cocktail mixtures was applied to surfaces of fresh beef. Cocktail mixture 1 was composed of O26, O103, O111, O145, and O157, while cocktail mixture 2 was composed of O45, O121, and O157. The inoculated fresh beef flanks were subjected to spray treatments by the following four antimicrobial compounds: acidified sodium chlorite, peroxyacetic acid, lactic acid, and hot water. High-level inoculation samples were enumerated for the remaining bacteria populations after each treatment and compared with the untreated controls, while low-level inoculation samples were chilled for 48 h at 4°C before enrichment, immunomagnetic separation, and isolation. Spray treatments with hot water were the most effective, resulting in mean pathogen reductions of 3.2 to 4.2 log CFU/cm² followed by lactic acid. Hot water and lactic acid also were the most effective interventions with the low-level inoculation on surfaces of fresh beef flanks after chilling. Peroxyacetic acid had an intermediate effect, while acidified sodium chlorite was the least effective in reducing STEC levels immediately after treatment. Results indicate that the reduction of non-O157 STEC by antimicrobial interventions on fresh beef surfaces were at least as great as for E. coli O157:H7. However, the recovery of these low inoculation levels of pathogens indicated that there is no single intervention to eliminate them. [ABSTRACT FROM AUTHOR]