Controlling Foodborne Antimicrobial-Resistant Bacteria: The Gen(i)e is Out of the Bottle

As a conduit between the environment and human and animal populations, food sits at the nexus of One Health and is a major vehicle for the transmission of pathogenic and nonpathogenic antibiotic-resistant bacteria. To alleviate the associated public health burden, it is therefore critical to reduce human exposure to antibiotic-resistant bacteria via food consumption. The objective of this narrative literature review was to demonstrate that while reduction of antibiotic use in agriculture is necessary, it is not sufficient to protect humans from exposure to antibiotic-resistant foodborne infections. To support this argument, we collected, analyzed, and synthesized information from published literature. The rising use of antibiotics in humans and in animal- and plant-sourced food production contributes to the rising prevalence of antibiotic-resistant bacteria in natural and man-made environments, including soils, waterways, farms, and food processing facilities. This means that even in the absence of intentional antibiotic use in food production, food may be exposed to contamination at multiple stages, highlighting the importance of coordinated control across the food chain. This review outlines the importance of two complementary strategies to control the contamination of food with antibiotic-resistant bacteria: (i) targeted antimicrobial stewardship in agrifood systems to minimize the emergence and enrichment of resistant bacteria (AMR-specific interventions), and (ii) stringent hygiene and contamination control across the food chain to broadly reduce bacterial loads (AMR-sensitive interventions). We will provide examples of how these interventions are implemented globally, from food production to food service, to decrease the risk of contamination of food with antibiotic-resistant bacteria. We conclude that reducing the prevalence of antibiotic-resistant bacteria in the food supply demands a collaborative One Health approach, with food hygiene at its core.