(Circulation. 2001;104:e9037.)
© 2001 American Heart Association, Inc.
Circulation Newswriter
Life Expectancy in United States Reaches 76.9 Years
The life expectancy of US citizens has reached an all time high—76.9 years—according to information released October 9, 2001, by the US Centers for Disease Control and Prevention (CDC) in Atlanta. The agency also reported decreased death rates from murder, suicide, accidents, stroke, diabetes, chronic lower respiratory diseases, chronic liver disease, and AIDS for the year 2000.
As the population ages, however, more people are dying from diseases of old age. The CDC reported that deaths from Alzheimer’s disease, influenza, pneumonia, kidney disease, high blood pressure, and septicemia increased in the year 2000.
"Americans on average are living longer than ever before, and much of this is due to the progress we’ve made in fighting diseases that account for a majority of deaths in the country," said US Department of Health and Human Services Secretary Tommy G. Thompson. "But we can do even more by eating right, exercising regularly, and taking other simple steps to promote good health and prevent serious illness and disease."
In addition, the preliminary infant mortality rate in the United States fell to its lowest level ever in 2000—6.9 infant deaths per 1000 live births, down from a rate of 7.1 in 1999. The report can be found at http://www.cdc.gov/nchs/releases/01news/mort2k.htm.
Studies Indict Antibiotics in Feed
Three studies published in the October 18, 2001, issue of the New England Journal of Medicine demonstrate the presence of resistant strains of bacteria in various forms of ground meat and chicken and show that such bacteria can colonize, at least transiently, the intestinal tracts of healthy human volunteers. In an editorial accompanying the 3 articles, Sherwood. L. Gorbach, MD, of Tufts University School of Medicine, wrote that the findings of the 3 studies "represent the proverbial ‘smoking gun’" (N Engl J Med. 2001;345:1202–1203).
In the first study, a team from the US Food and Drug Administration and the Department of Nutrition and Food Science at the University of Maryland found that 20% of samples of ground chicken, turkey, beef, and pork bought in Washington, DC, supermarkets contained salmonella of 13 different serotypes; 84% percent of the salmonella isolates were resistant to at least one antibiotic, and more than half were resistant to at least 3 antibiotics (N Engl J Med. 2001;345:1147–1154).
The second study found that chickens purchased at supermarkets in 4 states were resistant to quinupristin-dalfopristin, a drug combination approved 2 years ago for the treatment of Enterococcus faecium infections that were resistant to vancomycin, a problem that had caused considerable concern in the infectious disease community. Cultures from the chickens identified the resistant bacteria in at least 17% of samples in each state. Since 1974, a similar drug called virginiamycin has been used to promote the growth of farm animals, including chickens.
The study was actually conducted before the approval of quinupristin-dalfopristin for human use. The authors from the National Center for Infectious Diseases of the CDC, the University of Maryland at Baltimore, the Minnesota Department of Health, the Oregon Health Division, and the Georgia Division of Public Health in Atlanta wrote that the study "suggests that the use of virginiamycin in farm animals has created a reservoir of streptogramin-resistant E faecium in our food supply." However, they noted that there is as-yet little resistance to quinupristin-dalfopristin in the population. "The FDA has recently requested data for an assessment of the effect on human health of the use of streptogramins in food animals and the resulting resistance." They called for additional studies looking at hospitalized patients, who are most likely to be treated with the new drug combination, and the effects of animal husbandry, meat processing, cooking, and infection control on the frequency of human contact with the resistant organisms and the acquisition of resistance. "If such studies demonstrate a role for food-borne transmission in the emergency of quinupristin-dalfopristin-resistant E faecium in humans, restriction on the continued use of virginiamycin in food animals should be considered (N Engl J Med. 2001;345:155–160).
Danish researchers from the department of microbiological research and development at the Statens Serum Institut in Copenhagen conducted a randomized, double-blind study of 18 healthy volunteers to determine if their intestinal tracts could be colonized by resistant bacteria. Six of the subjects ingested a mixture of 10 million colony-forming units of 2 glycopeptide-resistant strains of E faecium obtained from chicken purchased at a grocery store. Another 6 ingested 10 million colony-forming units of a streptogramin-resistant strain of the bacteria obtained from a pig at slaughter, and the last 6 ingested 10 million colony-forming units of a glycopeptide-susceptible and streptogramin-susceptible stain of the bacteria. The suspensions of the enterococci were prepared in 250 milliliters of whole milk and were within the amount considered acceptable by Danish food regulations.
Researchers collected stool specimens 1 week, 14 days, and 35 days after ingestion. None of the subjects were colonized with resistant strains of the bacterium at the beginning of the study. However, after ingestion, the resistant strains of the bacterial could be isolated from the stool of all subjects in varying concentrations. However, all stool samples were negative at 35 days. The authors concluded that the organisms survive gastric passage and can multiply (N Engl J Med. 2001;345:1161–1166). They concluded: "Our findings provide support for the recommendation that the use of antimicrobial agents for growth promotion in animals be discontinued. The only remaining step needed to show a direct effect of this practice on human health is to demonstrate the actual molecular transfer of the resistance determinant from the ingested bacteria to a human pathogen (ie, a glycopeptide-resistant enterococcus) in a human."
Dr Gorbach wrote in his editorial: "The subtherapeutic use of these agents to promote growth and feeding efficiency should be banned—a move that would decrease the burden of antimicrobial resistance in the environment and provide health-related benefits to both humans and animals."
Costs Mount at New York-Area Hospitals in Wake of World Trade Center Attacks
The Greater New York Hospital Association estimates that the costs in the wake of terrorist attacks on the World Trade Center on September 11, 2001, exceed $340 million. Hospitals affected include those in New York City, Long Island, Westchester County, and the Hudson Valley areas. The impact on New York City hospitals alone will be $313 million.
The estimates include emergency expenses, unreimbursed standby costs, and the continuing fiscal impacts resulting from the attacks. They do not include the cost of putting new security and disaster plans into the effect. The report can be found at http://www.gnyha.org.
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