You’ve been hearing of a looming food safety crisis triggered by the presence of antibiotic-resistant bacteria in meat and vegetables for some time now. Now, this has hit close to home, right here in Chennai, with new found evidence.

A study that examined samples of vegetables, fruit, fish, chicken and mutton from households, market and fish and meat outlets has found the presence of colistin-resistant bacteria in 44 of the 100 samples. The study has also unravelled the mechanism by which a gene responsible for antibiotic-resistance can be transmitted to humans, with worrying consequences.

Colistin is known as the ‘antibiotic of last resort’ and is used to treat patients who have developed resistance to other antibiotics. Rapid spreading of colistin-resistant bacteria may hamper treatment and recovery among critically ill patients with no alternative.

Dr Abdul Gafur, one of the authors of the study and the coordinator of Chennai Declaration, a coming together of medical societies across the country to address antibiotic resistance, says, “The results were expected. They are likely to be the same across food families in any of our cities. It is just that this is the first time we have looked for colistin-resistant bacteria in the samples.”

This is not the first instance of detection of antibiotics-resistant bacteria in food samples in the country as an earlier study by the Centre for Disease Dynamics found that the use of growth promoters in cattle and poultry feed resulted in resistance to 11 antibiotics – ampicillin, ceftriaxone, cefuroxime, chloramphenicol, ciprofloxacin, co-trimoxazole, gentamicin, imipenem, nalidixic acid, nitrofurantoin and tetracycline. These antibiotics are broadly used in the treatment of UTIs, diarrhoea, respiratory infections and other common infectious diseases.

How does resistance to antibiotics develop?

The ability of bacteria and other microorganisms to develop resistance against antibiotics that they were previously sensitive to is a major cause for concern across the globe.

Bacteria develop resistance to antibiotics intrinsically or through acquired means, such as through mutations or by obtaining genes from other bacteria which are resistant. Resistance genes can develop in bacteria as a result of what can be viewed as its survival mechanism as it evolves in the presence of antibiotics in the environment; these bacteria eventually multiply.

With increased resistance to antibiotics, even common ailments become difficult to treat. According to the WHO, antibiotic resistance makes diseases such as pneumonia, gonorrhea, tuberculosis and salmonella treatment tough and more expensive. It also leads to increase in mortality rates.

The development of resistance to antibiotics stems from many causes. Over-prescription and overuse have been found to be among the primary reasons for the rapid development of antibiotics resistance. According to a study by Van Boeckel TP et al on the global consumption of antibiotics between 2000 and 2010, BRICs nations were found to responsible for 73% of the growth of antibiotics in the time period, based on data from pharmaceutical sales.

In 2010, India was the foremost consumer of antibiotics in the world, at 10.7 units per person. While antibiotics do not work on viruses that cause cold or flu, a large section of the population relies on readily available over-the-counter antibiotics to treat such viral infections due to lack of knowledge and misinformation.

But things turn really scary when it is not just the drugs that we consume that make us resistant, but also the food that we eat that exposes us to multi-drug resistant bacteria. This is the result of the indiscriminate use of antibiotics in animal husbandry for promotion of growth and to prevent diseases, primarily through animal feed.

A large number of antibiotics pumped into animal and poultry feed are the same that are used to treat humans. Resistant bacteria that thrive in food animals is then transmitted to humans through animal products when they are consumed. With unregulated use of veterinary antibiotics and even growth promoters, resistance to antibiotics has been on the rise.

The development and spread of antibiotics resistant bacteria is not limited to animal husbandry. The surrounding environment — soil, surface and groundwater — all have a role to play. The use of litter from animal farms (where use antibiotics is rampant) as manure in fruit and vegetable farming has resulted in the spread of antibiotic resistant bacteria in fruits and vegetables we consume.

FSSAI regulations

The Food Safety and Standards Authority of India (FSSAI) is the regulatory body that is responsible for setting and maintaining standards for food items in the country. Efforts were made to regulate the use of antibiotics in seafood through the Food Safety and Standards (Contaminants, Toxins and Residues) Regulations, 2011 setting tolerance limits for four antibiotics, while prohibiting the use of 28 other antibiotics and pharmacologically active substances in fish, shrimp, prawn and other seafood.

Close to seven years after the rules came into effect, the FSSAI invited suggestions for amendments with a view to setting more stringent limits on the use of antibiotics. The Food Safety and Standards (Contaminants, toxins and Residues) Amendment Regulations, 2018 — notified in August this year — has been expanded to finally include meat, meat products, poultry and milk, in addition to seafood.

The notification expanded on the existing category to set tolerance limits for a total of 103 antibiotics and veterinary drugs. The amendments included setting of tolerance limits for the last-resort antibiotic, Colistin. However, the food business operators are required to comply with the regulations only by January 1, 2019.

Pawan Agarwal, the CEO of FSSAI said, “We have notified the MRL (Maximum Residue Level) for antibiotics including Colistin. The onus of enforcement, however, lies on the authorities at the state level.”

Will the future be healthier, then?

Interactions with the Commissioner of Food Safety and Drug Administration, Department of Health and Family Welfare, P. Amudha, however, raise concerns about the preparedness for enforcement of the rules.

“Our testing is based on the FSSAI standards. We do not do any suo moto testing for antibiotics. Our officers are trained for detecting chemical contamination, checking for expired products and improper storage. We have not been trained for antibiotics resistant detection. If somebody complains, then we test the food items. People consume different kinds of food, so if we can zero in on a particular reason for concern, we conduct thorough tests,” she says.

While the framing of rules and enforcement have made glacial progress, the use of antibiotics in animal husbandry continues to thrive. Speaking on condition of anonymity, a poultry farm owner in Chennai said, “We do not really have any inspections of the kind of food we feed the chicken. I try to keep my business practices ethical but I am certain that there are all kinds of harmful growth promoters being used to increase profits, while keeping the costs low.”

The new provisions, if followed stringently, can significantly reduce the risk of overuse of antibiotics that leads to resistance, but the gap between policy and enforcement must be addressed on war footing. Only strict monitoring and penalties for violation can address the issue of contamination before large scale or irreversible effects can be seen on public health.