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Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae in Hospital Food: A Risk Assessment

  • Andrew J. Stewardson (a1) (a2), Gesuele Renzi (a3), Nathalie Maury (a4), Celia Vaudaux (a5), Caroline Brassier (a1), Emmanuel Fritsch (a6), Didier Pittet (a1), Max Heck (a7), Kim van der Zwaluw (a7), E. Ascelijn Reuland (a8), Thijs van de Laar (a8), Eveline Snelders (a9), Christina Vandenbroucke-Grauls (a8), Jan Kluytmans (a8) (a9), Patrick Edder (a4), Jacques Schrenzel (a3) and Stephan Harbarth (a1)...
Abstract
Objective.

Determine the prevalence of extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae (ESBL-PE) contamination of food and colonization of food handlers in a hospital kitchen and compare retrieved ESBL-PE strains with patient isolates.

Design.

Cross-sectional study.

Setting.

A 2,200-bed tertiary care university hospital in Switzerland.

Participants.

Food handlers.

Methods.

Raw and prepared food samples were obtained from the hospital kitchen, with a comparator group from local supermarkets. Fecal samples collected from food handlers and selectively pre-enriched homogenized food samples were inoculated onto selective chromogenic media. Phenotypic confirmation of ESBL production was performed using the double disk method. Representative ESBL-PE were characterized using polymerase chain reaction (PCR) and sequencing for blaCTX-M, blaSHV, and blaTEM genes, and Escherichia coli strains were typed using phylotyping, repetitive element palindromic PCR, and multilocus sequence typing. Meat samples were screened for antibiotic residues using liquid chromatography time-of-flight mass spectrometry.

Results.

Sixty (92%) of the raw chicken samples were ESBL-PE positive, including 30 (86%) of the hospital samples and all supermarket samples. No egg, beef, rabbit, or cooked chicken samples were ESBL-PE positive. No antibiotic residues were detected. Six (6.5%) of 93 food handlers were ESBL-PE carriers. ESBL-PE strains from chicken meat more commonly possessed blaCTX-M-1 and blaCTX-M-2, whereas blaCTX-M-14and blaCTX-M-15 were predominant among strains of human origin. There was partial overlap in the sequence type of E. coli strains of chicken and human origin. No E. coli ST131 strains or blaCTX-M-15 genes were isolated from meat.

Conclusions.

Although there is significant ESBL-PE contamination of delivered chicken meat, current preventive strategies minimize risks to food handlers, hospital staff, and patients.

Copyright
Corresponding author
Infection Control Program, University of Geneva Hospitals, and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland (andrew.stew@rdson.net)
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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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