Human Deaths and Third-Generation Cephalosporin use in Poultry, Europe

Cephalosporin use in Poultry, EuropeTo the Editor: Globally, antimicrobial drug resistance is rapidly rising, with resultant increased illness and death.Of particular concern is Escherichia coli, the most common bacterium to cause invasive disease in humans (1).In Europe, increasing proportions of bloodstream infections caused by E. coli are resistant to thirdgeneration cephalosporins (1,2).Resistant E. coli can be transmitted to humans from animals.A large proportion of resistant isolates causing human infections are derived from food animals (3-6).However, lack of data has made it difficult to quantify the proportion of antimicrobial drug resistant E. coli infecting persons through food sources and the resultant effects on human health.Recent data from the Netherlands now make such estimates possible (2,6).The additional illness and death among humans resulting from bloodstream infections caused by third-generation cephalosporin-resistant E. coli (G3CREC) has been calculated for Europe (2).In the Netherlands, there were 205 G3CREC cases during 2007 (4% of all E. coli bloodstream infections) (2).Another study in the Netherlands revealed that 56% of the resistance genes in G3CREC in humans were identical to genes derived from E. coli isolated from retail chicken samples (6).Using the findings of Overdevest et al. ( 6) and de Kraker et al. (2), we calculated that, in the Netherlands, infections in humans