Fluoroquinolone resistance in Campylobacter absent from isolates, Australia.Fluoroquinolone fluoroquinolone /flu·o·ro·quin·o·lone/ (-kwin´o-lon) any of a subgroup of fluorine-substituted quinolones, having a broader spectrum of activity than nalidixic acid.fluor·o·quin·o·lone n. resistance was detected in 12 of 370 Australian human Campylobacter Campylobacter Genus of gram-negative spiral-shaped bacteria infecting mammals. Many species, especially C. fetus, cause miscarriage in sheep and cattle. C. jejuni is a common cause of food poisoning. Sources include meats (particularly chicken) and unpasteurized milk. isolates; 10 of these were travel-associated, and for 2 isolates travel status was unknown. No resistance was found in isolates known to be locally acquired. In Australia, fluoroquinolones have not been licensed for use in food production animals, a policy that may have relevance for countries with fluoroquinolone-resistant Campylobacter. ********** In Australia, Campylobacter is the most commonly reported bacterial foodborne pathogen foodborne pathogen Public health A pathogen–especially bacteria, for which the 'vector' is itself a food. See Airline food. with an annual incidence of 125/100,000 population (1). Fluoroquinolone resistance in this pathogen is recognized as an emerging public health problem related to the use of these antimicrobial agents Antimicrobial agents Chemical compounds biosynthetically or synthetically produced which either destroy or usefully suppress the growth or metabolism of a variety of microscopic or submicroscopic forms of life. in food production animals. Data from many regions (United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. , Europe, and Thailand) that have licensed fluoroquinolones for therapeutic use in animals have shown that such use results in the emergence of fluoroquinolone resistance in Campylobacter jejuni Campylobacter jejuni Vibrio jejuni, Campylobacter fetus ssp jejuni A curved or spiral gram-negative bacillus with a single polar flagellum Epidemiology Linked to contact with domestic and farm animals, unpasteurized milk, primates, day care and C. coli isolates obtained from both humans and animals (2-4). Increasing resistance in campylobacter may lead to infections that are unresponsive to antimicrobial drug treatment and more severe disease. Smith (2) demonstrated that resistant C. jejuni caused more prolonged diarrhea in patients than susceptible strains. Fluoroquinolone resistance may emerge during treatment in humans (3); however, Smith (2)and others (5) demonstrated that most detected resistant isolates come from patients who have not been exposed to fluoroquinolones. Furthermore, as human-to-human transmission of campylobacter is rare, patients infected with resistant campylobacter are not an important source of resistance for other humans (4). In Australia, fluoroquinolones have never been licensed for use in food production animals. A small amount is used in companion animals: imports of enrofloxacin began in 1995, and 49 kg was used in the financial year 1996-97 (6). In contrast, the average use of quinolones in humans was 3,200 kg per year from 1992 to 1997 (6). Australian data on fluoroquinolone resistance in human Campylobacter isolates are limited. As part of a case-control study case-control study, n an investigation employing an epidemiologic approach in which previously existing incidents of a medical condition are used in lieu of gathering new information from a randomized population. of risk factors for Campylobacter infection conducted in New South Wales New South Wales, state (1991 pop. 5,164,549), 309,443 sq mi (801,457 sq km), SE Australia. It is bounded on the E by the Pacific Ocean. Sydney is the capital. The other principal urban centers are Newcastle, Wagga Wagga, Lismore, Wollongong, and Broken Hill. from 1999 to 2001, patients infected with this pathogen were recruited, and information on various exposures was obtained by telephone interview. Patients were asked about local and international travel in the 4 weeks before onset of diarrhea. Isolates from patients were stored and subsequently tested for resistance to 10 antimicrobial agents by using the National Committee for Clinical Laboratory Standards method for Helicobacter species (7). The Table shows proportions of fluoroquinolone-resistant isolates from this case-control study. In addition, results of two laboratory-based surveys of antimicrobial resistance, one conducted on isolates from Western Australia and one conducted on isolates from the Australian Capital Territory Australian Capital Territory (1991 pop. 276,468), 939 sq mi (2,432 sq km), SE Australia, an enclave within New South Wales, containing Canberra, capital of Australia. It was called the Federal Capital Territory until 1938. , are included. In these last two studies, information on overseas travel was sought retrospectively. Fluoroquinolone-resistant human Campylobacter isolates were rarely detected in Australia. All ciprofloxacin-resistant isolates detected in the three regions were from patients who appeared to have acquired their infection outside the country (Table). Two locally acquired isolates in the New South Wales study were resistant to nalidixic acid nalidixic acid /nal·i·dix·ic ac·id/ (nal-i-dik´sik) a synthetic antibacterial agent used in the treatment of genitourinary infections caused by gram-negative organisms. na·li·dix·ic acid n. only (i.e., they were sensitive to fluoroquinolones). As Campylobacter infection is zoonotic Zoonotic A disease which can be spread from animals to humans. Mentioned in: Zoonosis , the absence of human, locally acquired infections attributable to fluoroquinolone-resistant organisms most likely reflects l) the lack of use of fluoroquinolones in Australian poultry (the most common source for C. jejuni) and other potential meat sources and 2) the presence of little or no viable Campylobacter organisms on imported chicken, which has been a source of resistant campylobacter infections in the United Kingdom (5). Only cooked chicken products can be imported into Australia. Fluoroquinolones are critical therapeutic agents for many serious bacterial infections because, in many cases, they may be the only active oral agents available. Resistance following fluoroquinolone use can develop in many gram-negative bacteria (campylobacter, salmonellae, and Escherichia coli Escherichia coli (ĕsh'ərĭk`ēə kō`lī), common bacterium that normally inhabits the intestinal tracts of humans and animals, but can cause infection in other parts of the body, especially the urinary tract. ) carried by animals. These bacteria can be present in food. If they subsequently cause infections in humans (or transfer their resistance genes to other bacteria), no effective antimicrobial agents may be available for treatment when serious disease occurs. Thus, their use in animals should be avoided. Australia has never licensed the use of fluoroquinolone agents in livestock. In contrast with other nations that have licensed their use, fluoroquinolone resistance in Campylobacter isolates and subsequent infections in humans acquired from meats eaten within the country have not emerged in Australia. The Australian experience has implications for the continued licensing of these agents in other countries for food production animals.
Table. Fluoroquinolone resistance data for Australian Campylobacter
isolates
Isolate source and Total no.
Study location collection period tested
New South Wales Human feces 180 (b)
1999-2001
Western Australia Human feces 50 (b)
1999-2000
Australian Capital Human feces/blood 140 (d)
Territory 2001-2002
Proportion (a) of fluoroquinolone-resistant
isolates (%)
Unknown
Locally Overseas acquisition
Study location acquired acquired status
New South Wales 0/144 (0) 3 (c)/7 (43) 2 (c)/29 (6.9)
Western Australia 4 (c) 0/46 (0)
Australian Capital 3 0/137 (0)
Territory
(a) No. of resistant isolates by acquisition status/total no. isolates
tested in acquisition status category.
(b) Testing by agar dilution, Mueller-Hinton agar with 5% lysed sheep
blood (7).
(c) Resistant to ciprofloxacin (MIC [greater than or equal to] 4 mg/L).
(d) Testing by disc-susceptibility method (8).
Antimicrobial testing of isolates from the New South Wales case-control study was funded by OzFoodNet, enhanced surveillance program of the Department of Health and Ageing Health and Ageing is a research programme set up by the Geneva Association, also known as the International Association for the Study of Insurance Economics. The Geneva Association Research Programme on Health and Ageing seeks to bring together facts, figures and analyses , Australia. Ms. Unicomb is an epidemiologist with OzFoodNet, the Australian enhanced foodborne disease surveillance program with particular involvement in studies of the risk factors for campylobacter infection and subtyping methods for that organism. References (1.) Blumer C, Roche P, Spencer J, Lin M, Milton A, Bunn C, et al. Annual report of the National Notifiable Diseases Surveillance System. Commun Dis Intell 2003;27:1-78. (2.) Smith KE, Besser KM, Hedberg CW, Leano FT, Bender JB, Wicklund JH, et al. Quinolone-resistant Campylobacter jejuni infections in Minnesota, 1992 1998. N Engl J Med 1999:340:1525 32. (3.) Wegener HC. The consequences for food safety of the use of fluoroquinolones in food animals. N Engl J Med 1999;340:1581-2. (4.) Engberg J, Aarestrup FM, Taylor DE, Gamer-Smidt P, Nachamkin I. Quinolone and macrolide resistance hi Campylobacter jejuni and C. coli: resistance mechanisms and trends in human isolates. Emerg Infect Dis 2001;7:24-34. (5.) Gaunt PN, Piddock LJ. Ciprofloxacin ciprofloxacin /cip·ro·flox·a·cin/ (sip?ro-flok´sah-sin) a synthetic antibacterial effective against many gram-positive and gram-negative bacteria; used as the hydrochloride salt. cip·ro·flox·a·cin n. resistant Campylobacter spp. in humans: an epidemiological and laboratory study. J Antimicrob Chemother 1996;37:747-57. (6.) Commonwealth of Australia Commonwealth of Australia: see Australia. . The use of antibiotics in food-producing animals food-producing animals see food animals. : antibiotic resistant bacteria in animals and humans. Report of the .Joint Expert Advisory Committee on Antibiotic Resistance antibiotic resistance, n the ability of certain strains of microorganisms to develop resistance to antibiotics. antibiotic resistance (JETACAR). 1999 [accessed 2003 Feb]. Available from: URL URL in full Uniform Resource Locator Address of a resource on the Internet. The resource can be any type of file stored on a server, such as a Web page, a text file, a graphics file, or an application program. : http://www.health.gov.au/pubs/jetacar.htm (7.) Sharma H, Unicomb L, Forbes W, Djordjevic S, Valcanis M, Dalton C, et al. Antibiotic resistance in Campylobacter jejuni isolated from humans in the Hunter Region, New South Wales. Commun Dis Intell 2003;27(Suppl):S80-8. (8.) Huysman MB, Turnidge JD. Disc susceptibility testing for thermophilic ther·mo·phil·ic adj. Requiring high temperatures for normal development, as certain bacteria. Campylobacters. Pathology 1997;29:209 16. Address for correspondence: L. Unicomb, OzFoodNet, Hunter Public Health Unit, Locked Mail Bag 119, Wallsend NSW NSW New South Wales Noun 1. NSW - the agency that provides units to conduct unconventional and counter-guerilla warfare Naval Special Warfare 2287, Australia; fax: 61-2-49246490; email: lunic@doh.health.nsw.gov.au Leanne Unicomb, * John Ferguson, [dagger] Thomas V Riley, [double dagger] and Peter Collignon [section] OzFoodNet, Newcastle, Australia [dagger] University of Newcastle University of Newcastle can refer to:
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