Dutch doctors warn of dangers of overuse of antibiotics in farming

BMJ 2010; 341 doi: (Published 11 October 2010) Cite this as: BMJ 2010;341:c5677
  1. Tony Sheldon
  1. 1Utrecht

Public health experts in the Netherlands are calling for an urgent reduction in the use of antibiotics in farming as evidence mounts of transmission of antimicrobial resistance to humans through the food chain.

Dutch agriculture tops a European league table of the use of antibacterial agents per weight of slaughtered animal (Journal of Antimicrobial Chemotherapy 2010;65:2037-40, doi:10.1093/jac/dkq247). Amid concerns that this has caused a rise in numbers of bacteria producing extended spectrum β lactamase (ESBL)—an enzyme that confers resistance to modern antibiotics, including cephalosporins—the government this year ordered a 50% cut in antibiotic use by farmers within four years.

This followed a call by Roel Coutinho, director of the Centre for Infectious Disease Control of the Dutch Institute for Public Health and the Environment, for drastic short term action. This week Professor Coutinho told the BMJ that the evidence of transmission was now even stronger.

Details have recently emerged of the first documented case of a death in the Netherlands resulting from infection by multidrug resistant Escherichia coli bacteria that produce ESBL, which appeared to be indistinguishable from the type of ESBL found in poultry.

Maurine Leverstein-van Hall, a medical microbiologist and project leader of the institute’s national infectious disease surveillance information system for antibiotic resistance, explained that in January an 85 year old woman died from urosepsis soon after being admitted to hospital. She failed to respond to the recommended treatment, cephalosporins.

The woman had not recently visited a hospital, nor had she been prescribed antibiotics, so was not considered at risk of antibiotic resistance. However, her blood culture strain showed ESBL-producing E coli bacteria that carried a CTX-M-1 gene, the same as the predominant ESBL strain found in poultry meat.

Research by Dr Leverstein-van Hall at Utrecht University Medical Centre, to be published this autumn, shows strong evidence of a genetic link between ESBL-producing E coli in humans and chickens. In 2009 in the Netherlands one in three human isolates of E coli carried the same gene as that found in retail chicken.

In addition, the proportion of urine samples and of blood cultures with E coli that are resistant to third generation cephalosporins have risen from 2.7% and 3.6%, respectively, in 2008 to 3.4% and 5.6% in the first half of 2010.

Dik Mevius, Dr Leverstein-van Hall’s co-researcher and professor in veterinary science at Utrecht University, said, “Antibiotic use in animals is complex and economically driven. We have organised our animal production system in such a way that once an organism emerges it can be easily distributed throughout the country and the world.”

Meanwhile the Dutch Journal of Medicine last month reported that 87% of retail poultry meat contained bacteria that produce ESBL (Nederlands Tijdschrift voor Geneeskunde 2010;154;A2261).

Jan Kluytmans, from the department of medical microbiology at the VU University Medical Centre, Amsterdam, who led the research, said, “The ubiquitous presence of ESBL in chicken meat is likely to contribute to the recent increase of ESBL in the community.”

Professor Coutinho said, “Everyone agrees that there is overuse of antibiotics in intensive farming. We have to do everything to reduce this as fast as possible.”

The national egg and poultry product board said it took the ESBL problem very seriously and was acting with greater urgency to exclude from poultry farming antibiotics essential for human health.


Cite this as: BMJ 2010;341:c5677

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