# The Invisible Threat of Antibiotic Resistance in Food
## 3 Antibiotic Resistance in Traditional Foods
### Antibiotic Resistance in Dairy/Fermented Foods
These data raise critical public health concerns and highlight the need for incessant screening of probiotics and fermented foods for AR to ensure food safety. Scientific evidence has prompted EFSA to establish criteria for evaluating the safety of microorganisms used in food production [264]. Furthermore, the EFSA FEEDAP Panel has recently developed a microbiological cut-off value (mg/L) that can distinguish between resistant and susceptible LAB and _Bifidobacterium_ strains [225]. The EFSA-Feedap [225] guidelines on the characterization of microorganisms used as feed additives or production organisms provide further insight. Moreover, both EFSA and WHO have advised the exclusion of bacterial strains with MGEs containing ARGs from use in feed, food fermentation, and probiotics to prevent the transfer of resistant genes through HGT from non-pathogenic to pathogenic bacteria, thereby increasing antibiotic resistance in humans and posing a threat to public health. Therefore, from the perspective of food safety, the phenotypic AR pattern is a crucial criterion for selecting probiotic strains for the preparation of nonhazardous fermented dairy foods. Strains exhibiting desirable AR profiles ensure that they do not contribute to the potential transfer and spread of AR genes while maintaining the probiotic benefits for fermentation processes, gut health, and food preservation [265; 266]. Research suggests that countries without or with recently implemented antibiotic restrictions have a higher incidence of isolation of resistant strains. Conversely, in European nations, bacteria displaying phenotypic resistance were predominantly observed in handicraft products that were constrained to a specific geographic region [237]. Based on the information presented, it can be concluded that though the major starter culture companies are continuously working to screen commercial cultures for resistance and eliminating antibiotic-resistant strains from their product lines [237], the starter cultures with the potential to transfer antibiotic resistance are currently used in industrial dairy products in certain regions of the world. In Figures 1 and 2, the phenotypic antimicrobial resistance of seven LAB genera and the existence pattern of twelve antibiotic class resistance genes in seven LAB genera are shown. Figure 1: A complex heatmap with hierarchical clustering that depicts the phenotypic antimicrobial resistance profiles of seven LAB genera. The X-axis displays LAB servovars (n = 37), while the \(Z\)-axis represents the panel of antibiotic disks tested (n = 24). The cells with red diamonds indicate resistance and turquoise cells, signify either susceptibility or an unidentified characteristic [5,216,219,228,256,267,268,269,270,271,272,273,274,275,276,277,278,2790]. Figure 2: A complex heatmap with hierarchical clustering that illustrates the existence pattern of twelve antibiotic class resistance genes in seven LAB genera. The \(X\)-axis displays LAB Serovars (57), while the \(Z\)-axis represents the panel of M-PCR amplified resistant genes (n = 35). The cells with red diamonds indicate existence and turquoise cells signify either gene absence or an unidentified characteristic; [26,219,228,256,267,268,269,270,281].