# The Invisible Threat of Antibiotic Resistance in Food
## 3 Antibiotic Resistance in Traditional Foods  
### Antibiotic Resistance in Vegetables and Fruits  
The consumption of fresh vegetables and fruit is essential for human health and has increased in recent decades [140; 141; 142]. They are often consumed raw, without any processing steps [143; 144]. The number of foodborne illnesses associated with vegetables and fruits has increased in recent decades. This is due to the susceptibility of these plants to microbial contamination through a number of potential pathways, such as the use of animal manure, contaminated irrigation water, irrigation with wastewater, and so on [145; 146; 147; 148; 149]. Therefore, the safety of edible plants is dependent upon the quality and safety of the water and soil in which they are cultivated. In some cases, the products may be safe, whereas in others, they may pose a microbiological hazard [150]. Previous studies have shown that plant-based products, particularly when consumed raw, are identified as a potential vector for the transmission of pathogens, from the environment to humans [151; 152; 153; 154; 155; 156; 157]. These pathogens include ARB and ARGs, which pose a significant public health threat [140; 158; 159; 160; 161; 162]. The rationale behind this phenomenon pertains to the transportation of unmetabolized antibiotics from hospital wastewater to wastewater treatment plants, where the removal of antibiotics is incomplete and ARGs are eventually released into the natural aquatic environment [163]. Antibiotics are thus released into surface waters, where antibiotic concentrations in the range of micrograms per liter have been reported [164; 165]. Besides hospital wastewater, household wastewater also plays an important role in the spread of antibiotic resistance. A significant proportion of antibiotics is used in people's homes and thus enters the sewage treatment system through domestic wastewater. Urban wastewater treatment plants are increasingly acknowledged as critical sources of ARB and ARGs released into the environment. These facilities process sewage originating from a variety of sources, thereby amalgamating bacterial populations from diverse ecological niches. This amalgamation fosters interactions among bacteria and facilitates HGT [166]. Although antibiotic usage in plants has constituted less than 0.5% of the total antibiotic use [167], the recent approval of streptomycin and oxytetracycline for the prevention of citrus diseases (citrus canker and citrus greening disease) has resulted in an 18-fold increase in the agricultural use of these antibiotics [168]. The aforementioned infection pathways not only permit the transmission of pathogenic bacteria to plant foods but also help to increase the abundance of ARGs and facilitate the entry of these ARGs, especially into fresh vegetables [169; 170]. The utilization of manure-derived fertilizers, poor quality irrigation water, the recycling of containers for the transportation of agricultural products, and other factors are among the key factors of these entry routes [169; 170; 171; 172]. Therefore, it can be reasonably deduced that the ingestion of fresh vegetables may significantly contribute to the dissemination of antibiotic resistance in humans. The first report was published in 2014 on extended-spectrum \(\beta\)-lactamase (ESBL)-producing isolates from vegetables and fruits originating from the Netherlands [173]. In their study, the _blaFONA-5_ gene was identified in _Serratia fonticola_. The _blaRAHN-1_ and _blaRAHN-2_ genes were detected in _Rahmella aquatiils_ strains. Since this first report, the presence of ESBL-producing Gram-negative bacteria in fresh vegetables and fruits has been documented in numerous countries worldwide [174; 175; 176; 140; 177; 178]. [PERSON] et al. [179] found that the overall proportion of ESBL-producing _Enterobacteriaceae_ was 36.8% from fresh vegetables available in the Kyiv city markets (Ukraine). ESBL-producing pathogens were found in fresh produce in Japan [178].