Review of assessments of the human health risk associated with the use of antimicrobial agents in agriculture.

To our knowledge, no comprehensive risk assessment of agricultural uses of antimicrobial agents has been published. The published risk assessments of antimicrobial use in farm settings are all subject to multiple, serious limitations in scope, including (1) limitation to one species of microorganism; (2) limitation to one or a very few related antimicrobial agents; (3) limitation to a single outcome (death, hospital days, number of illnesses, etc.); (4) limitation to one species of farm animal (e.g., chicken or swine); and (5) limitation to therapeutic use, despite reason for concern about misstated, off-label, or illegal use. In addition, all of the risk assessments reviewed overlooked important issues by accepting 2 further limitations: (6) limiting the scope of the analysis to what has already happened and ignoring the effects of continuing the practices of recent years; and (7) examining only the effects on the species of microorganism that was initially affected and ignoring the cross-species spread of resistance by plasmid transfer. After our review of the risk assessments now available, we propose a comprehensive scheme for organizing existing knowledge and dealing with critical gaps.