Impact of California's Senate Bill 27 on Antimicrobial-Resistant Escherichia coli Urinary Tract Infection in Humans: Protocol for a Study of Methods and Baseline Data

BACKGROUND

Overuse of antibiotics contributes to antimicrobial resistance (AMR) and is a growing threat to human health worldwide. Previous work suggests a link between antimicrobial use in poultry and human AMR extraintestinal pathogenic Escherichia coli (E coli) urinary tract infections (UTIs). However, few US-based studies exist, and none have comprehensively assessed both foodborne and environmental pathways using advanced molecular and spatial epidemiologic methods in a quasi-experimental design. Recently, California enacted Senate Bill 27 (SB27), which changed previous policy to require a veterinarian's prescription for the use of antibiotic drugs, and which banned antibiotic use for disease prevention in livestock. This provided an opportunity to evaluate whether SB27 will result in a reduction in antimicrobial-resistant infections in humans.

OBJECTIVE

We describe in detail the methods implemented to achieve the overarching objective of this study to evaluate the impact of SB27 on downstream antibiotic resistance rates in human UTIs.

METHODS

A summary of the overall approach and the partnerships between Columbia University, George Washington University (GWU), Johns Hopkins Bloomberg School of Public Health, Kaiser Permanente Southern California (KPSC) Research and Evaluation, the Natural Resources Defense Council, Sanger Institute at Stanford University, Sutter Health Center for Health Systems Research, the University of Cambridge, and the University of Oxford is presented. The collection, quality control testing, and shipment of retail meat and clinical samples are described. Retail meat (chicken, beef, turkey, and pork) was purchased from stores throughout Southern California from 2017 to 2021. After processing at KPSC, it was shipped to GWU for testing. From 2016 to 2021, after clinical specimens were processed for routine clinical purposes and immediately before discarding, those with isolated colonies of E coli, Campylobacter, and Salmonella from KPSC members were collected and processed to be shipped for testing at GWU. Detailed methods of the isolation and testing as well as the whole-genome sequencing of the meat and clinical samples at GWU are described. KPSC electronic health record data were used to track UTI cases and AMR patterns among the cultured specimens. Similarly, Sutter Health electronic health record data were used to track UTI cases in its Northern California patient population.

RESULTS

From 2017 to 2021, overall, 12,616 retail meat samples were purchased from 472 unique stores across Southern California. In addition, 31,643 positive clinical cultures were collected from KPSC members during the same study period.

CONCLUSIONS

Here, we presented data collection methods for the study, which was conducted to evaluate the impact of SB27 on downstream antibiotic resistance rates in human UTI. To date, it is one of the largest studies of its kind to be conducted. The data collected during this study will be used as the foundation for future analyses specific to the various objectives of this large body of work.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/45109.

Adoption of the 'planetary health diet' has different impacts on countries' greenhouse gas emissions

A worldwide shift from current diets to the planetary health diet proposed by the EAT-Lancet Commission would have direct implications for agricultural greenhouse gas (GHG) emissions. By modelling the trajectory of food from cradle to farm gate while accounting for international trade, we estimate that agricultural GHG emissions would decrease in 101 countries as well as globally. Yet, in primarily low- and middle-income countries, agricultural GHG emissions would increase by 12-283%. Country-specific impacts of dietary transitions should be considered in climate change mitigation policy.

Linkage of the 1999-2008 National Health and Nutrition Examination Surveys to traffic indicators from the National Highway Planning Network

OBJECTIVES

Growing evidence has shown the harmful effects of traffic-related pollution on human health, including adverse respiratory, cardiovascular, and pregnancy outcomes. This report describes the linkage of data from the 1999-2008 National Health and Nutrition Examination Surveys (NHANES) and traffic indicators from the 2005 National Highway Planning Network.

METHODS

The residential addresses of NHANES participants were used to assign the distance to the nearest road, the number of roads within concentric buffers of specific radii, and the average annual daily traffic. Summaries of these traffic indicators by participant characteristics, including urbanization of their county of residence, race and ethnicity, poverty status, and health status, were tabulated.

RESULTS

Using the traffic indicators, these data show differences in traffic exposure by several participant characteristics including poverty status. Further, reporting of fair or poor health was more common among NHANES respondents nearer to, compared with farther from, roads; this relationship was observed overall and for subgroups defined by urban county of residence, poverty status, and self-reported cigarette smoking.

CONCLUSIONS

These data may be a resource for understanding relationships between traffic exposure and adverse health, and for identifying subgroups that may be at increased risk. The NHANES-traffic data are restricted use and available to data users in the Research Data Center at the Centers for Disease Control and Prevention's National Center for Health Statistics.

The environmental and public health risks associated with arsenical use in animal feeds

Arsenic exposures contribute significantly to the burden of preventable disease worldwide, specifically related to increased risks of cancer, diabetes, and cardiovascular disease. Most exposures are associated with natural contamination of groundwater, which is difficult to mitigate when these sources are used for drinking water. An anthropogenic source of arsenic exposure stems from the widespread use of arsenical drugs in food-animal production in the United States and China, among many countries. This use results in residual contamination of food products from animals raised with the drugs, as well as environmental contamination associated with disposal of wastes from these animals. Land disposal of these wastes can contaminate surface and ground water, and the conversion of animal wastes into fertilizer pellets for home use as well as the introduction of animal waste incinerators may increase opportunities for exposure. As an intentional additive to animal feed, use of arsenical drugs is a preventable source of human exposure. The domestic practice of using these drugs in poultry production has been the subject of media attention and limited research, though the use of these drugs in domestic swine production and in the rapidly growing foreign animal production industry remains largely uncharacterized. This continued expansion of arsenical drug use may likely increase the burden of global human arsenic exposure and risk.