# The Invisible Threat of Antibiotic Resistance in Food
## 3 Antibiotic Resistance in Traditional Foods
### Antibiotic Resistance in Dairy/Fermented Foods
Phenotypic characterization of AR patterns among LAB strains derived from traditional fermented foods reveals significant variability, depending on LAB species and antimicrobial agents [228; 233]. Antibiotic resistance in wild and commercial LAB is observed worldwide. Resistance to various antibiotics, including ampicillin, vancomycin, erythromycincin, tetracycline, chloramphenicol, and ciprofloxacin, was demonstrated in _Streptococcus thermophilus_ strains that are currently used as starters in the dairy industry [224; 234; 235; 236]. According to the review of [PERSON] et al. [237], resistance to gentamicin, kanamycin, chloramphenicol, tetracycline, and erythromycincin is most commonly found in starter cultures and industrially important strains. Several studies have shown that the prevalence of antibiotic-resistant LAB isolates is greater than 50%. In more detail, the analysis of _Lactobacillus_ spp. demonstrated a 58% resistance to vancomycin, while _Bifidobacterium_ spp. exhibited 60% resistance to vancomycin, whereas all tested strains of _Enterococcus_ spp. showed 100% resistance to vancomycin, erythromycincin, rifamp, and ciprofloxacin [238]. Vancomycin resistance in enterococci poses a major challenge in the treatment of infections as it signifies the absence of effective antibiotic treatment for multi-resistant enterococci infections [239; 240]. Previous research has documented the identification of _Enterococcus_ strains that are resistant to antibiotics and carry virulence factors in cheeses [241; 242; 243]. Nowadays, raw milk consumption has become a common practice in developed countries [244; 245] due to its perceived health benefits. It is noteworthy that antibiotic residues were found to be present in unpasteurized milk samples (23.8%) from the same region more frequently than in pasteurized samples (6.8%). Cheeses produced from unpasteurized milk are favored by some consumers for their more diverse flavors and aromas. However, such products may contain harmful foodborne pathogens like staphylococci, _L. monocytogenes_, and _E. coli_[246; 247]. [PERSON] et al. [248] found high levels of multi-resistant _Lactococcus lactis_ in cheese samples made of raw milk, along with relatively elevated concentrations of _E. coli_ and _Salmonella enterica_ subsp. _enterica_. Antibiotic-resistant bacteria were also found in various fermented milk products. In a study that investigated _Lactobacillus_ isolated from traditional dairy products, 19 vancomycin-resistant, 10 ciprofloxacin-resistant, and 1 tetracycline-resistant bacteria were detected in fermented yak, cow, and mare milk [249]  
A recently published study has confirmed that LAB strains from fermented foods and human sources exhibit significant phenotypic resistance to cephalosporporins, aminoglycosides, quinolones, and glycoptides [250], regardless of their origin. All strains of lactic acid bacteria isolated from Brazilian dairy products demonstrated resistance to oxacillin and sulfa trimethoprim [250]. During a study of fermented food products (including meat and dairy) in Turkey, the research uncovered a high prevalence of vancomycin-resistant lactic acid bacteria (VRLAB) with an existing resistance of 57.45%, 53.19%, and 44.68% to ciprofloxacin, norfloxacin, and teicoplanin, respectively [251]. [PERSON] et al. [252] demonstrated a prevalence of 92% for MDR LAB isolates in Malaysian fermented food. All _Pediococcus_ and _Weissella_ isolates and 53.85% of the _Enterococcus_ derived from fermented dairy and meat products exhibited multiple AR [251]. _Bifidobacterium_ species exhibited resistance to vancomycin at a rate of 60% [238], along with tetracycline and ciprofloxacin [228] and chloramphenicol [237].