In a nutshell: Antimicrobial resistance is not only a public health issue, but also a threat to food safety. To effectively combat "superbugs" in food, the public and food businesses should follow the "Five Keys to Food Safety" and maintain good personal and environmental hygiene when handling food. Susceptible populations should pay special attention to the food safety risks of raw or undercooked food.

What is antimicrobial resistance?

Antimicrobial resistance (AMR) is the ability of a microorganism, most significantly bacteria, to stop an antimicrobial agent, such as antibiotics, from working against it. As a result, standard treatments become ineffective, infections persist and may spread to others. AMR bacteria, otherwise known as "superbugs", are not necessarily pathogens. They can also be commensal bacteria that derive benefits from their association with humans and are generally harmless. As such, people infected by "superbugs" can be asymptomatic. Nevertheless, AMR is a natural phenomenon. Microorganisms gain resistance spontaneously by gene mutation or gene transfer among each other.

AMR and food safety

AMR is also a food safety concern. "Superbugs" developed in animal gut can spread through the food chain. When the food-producing animals are slaughtered, meat and their products can be contaminated by the excreta colonised with "superbugs". "Superbugs" can also enter the food chain through faecal contamination of soil or water, and spread to fruits, vegetables or other produce that are irrigated with contaminated water. People may be exposed to "superbugs" when they consume contaminated food without being thoroughly cooked, prepare food with poor food hygiene practice, or contact with animal manure.

What kind of food is riskier?

In general, foods of animal origin represent the major route that humans come into contact with foodborne "superbugs". Raw or uncooked food is more likely to have bacteria, including "superbugs", derived from the primary production than thoroughly cooked foods. Susceptible individuals should avoid eating them.

Follow Five Keys to Food Safety

While inappropriate food-handling encourages the spread of AMR, education in safe food handling is a key measure for prevention of foodborne diseases, including containing AMR. The Centre for Food Safety (CFS) has all along been promoting "Five Keys to Food Safety" to the public and food businesses, reminding them to maintain good personal and environmental hygiene during all food preparation and handling processes.

Five Keys to Food Safety

From the food safety perspective, following the Five Keys can reduce the risk of both "superbugs" and foodborne illnesses.

Five Keys

Advice(s)

Why important?

Choose
  • Without heat treatment, raw or undercooked food can contain "superbugs"

Cook
  • Cooking is effective to kill "superbugs" in food

Clean
  • Washing can partially remove "superbugs" from food's surface
  • Prevent cross-contamination of cooked or ready-to-eat foods with "superbugs"

Separate
  • Store cooked or ready-to-eat foods and raw foods separately
  • Handle cooked or ready-to-eat foods and raw foods with separate utensils
  • Prevent cross-contamination of cooked or ready-to-eat foods with "superbugs" from raw food

Safe Temperature
  • Keep cold food cold at 4°C or below and hot food hot over 60°C if not consumed at once

Also, food handlers should avoid preparing food if suffering from vomiting and diarrhoea.

The works of the CFS

Locally, the Government of HKSAR has launched the “Hong Kong Strategy and Action Plan on Antimicrobial Resistance 2023-2027” (Action Plan). The Centre for Food Safety (CFS) has been actively participating in the initiative of the Action Plan and has participated in the Working Group on AMR One Health Surveillance under the Action Plan.

A comprehensive surveillance programme of AMR is an integral part of the risk analysis framework from the perspective of food safety. Surveillance data of foodborne AMR, together with data of antimicrobial use, may help to identify potential relationship between the prevalence of foodborne AMR and the use of antimicrobials in animal sector. In Hong Kong, the CFS implements a routine surveillance programme on AMR in raw meat as well as ready-to-eat food.

While the proportion of meropenem-resistant organisms (MRO) positive ready-to-eat food samples has increased from 1.6% in the pilot survey in 2019/2020 to 2.5% in the routine surveillance programme in 2022, it should be noted that the pilot survey had included only sashimi and vegetables as ready-to-eat food samples, and in the routine surveillance programme cut fruits and sandwiches were added. If only sashimi and vegetables are counted, the proportion of MRO positive ready-to-eat food samples has actually slightly dropped from 1.6% to 1.5%. Although a direct comparison between all ready-to-eat food samples in the pilot survey and the routine surveillance programme is inappropriate, the 0.9% increment is not statistically significant.

In terms of education, the CFS promotes the "Five Keys to Food Safety" to the public and the trade to combat "superbugs" in food through various channels.  Every year, the CFS rides on global event like "World Antimicrobial Awareness Week" in November to promote our messaging on AMR in food.  Furthermore, the CFS has issued a set of trade guidelines aiming to facilitate food businesses in informing consumers of the increase risk of consuming raw/undercooked foods and ingredients in ready-to-eat foods served to them.  Consumers can be informed by brochures, advisories on signs or menus, table tents, labelling or other effective written means.  The following is an example of consumer advice that restaurants can provide, and it applies to raw or undercooked high-risk foods.

Hong Kong's actions on addressing AMR

In view of the threat of AMR to global public health, the Government announced in the 2016 Policy Address to set up a High Level Steering Committee on AMR to formulate strategies and implement actions. As stipulated in the Chief Executive's Policy Address 2021 and 2022, the Government have drawn up the second Action Plan to map out response strategies for the next phase, covering the years from 2023 to 2027.

Under the "One Health" approach, this Action Plan highlighted clear objectives, priority interventions and target indicators to enable the Government and stakeholders to focus resources and address the threat of AMR more effectively.