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

Published online by Cambridge University Press:  10 May 2016

Andrew J. Stewardson ,
Gesuele Renzi ,
Nathalie Maury ,
Celia Vaudaux ,
Caroline Brassier ,
Emmanuel Fritsch ,
Didier Pittet ,
Max Heck ,
Kim van der Zwaluw  and
E. Ascelijn Reuland
...Show all authors
Andrew J. Stewardson*
Affiliation:
Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
Gesuele Renzi
Affiliation:
Clinical Microbiology Laboratory, Service of Infectious Diseases, University of Geneva Hospitals, Geneva, Switzerland
Nathalie Maury
Affiliation:
Food Control Authority of Geneva, Geneva, Switzerland
Celia Vaudaux
Affiliation:
Catering Service, University of Geneva Hospitals, Geneva, Switzerland
Caroline Brassier
Affiliation:
Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Emmanuel Fritsch
Affiliation:
Staff Health Service, University of Geneva Hospitals, Geneva, Switzerland
Didier Pittet
Affiliation:
Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Max Heck
Affiliation:
National Institute for Public Health and the Environment, Bilthoven, the Netherlands
Kim van der Zwaluw
Affiliation:
National Institute for Public Health and the Environment, Bilthoven, the Netherlands
E. Ascelijn Reuland
Affiliation:
Department of Medical Microbiology and Infection Control, VU University Medical Centre, Amsterdam, the Netherlands
Thijs van de Laar
Affiliation:
Department of Medical Microbiology and Infection Control, VU University Medical Centre, Amsterdam, the Netherlands
Eveline Snelders
Affiliation:
Amphia Hospital, Breda, the Netherlands
Christina Vandenbroucke-Grauls
Affiliation:
Department of Medical Microbiology and Infection Control, VU University Medical Centre, Amsterdam, the Netherlands
Jan Kluytmans
Affiliation:
Department of Medical Microbiology and Infection Control, VU University Medical Centre, Amsterdam, the Netherlands Amphia Hospital, Breda, the Netherlands
Patrick Edder
Affiliation:
Food Control Authority of Geneva, Geneva, Switzerland
Jacques Schrenzel
Affiliation:
Clinical Microbiology Laboratory, Service of Infectious Diseases, University of Geneva Hospitals, Geneva, Switzerland
Stephan Harbarth
Affiliation:
Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
*
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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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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 4: Special Topic Issue: Carbapenem-Resistant Enterobacteriaceae and Multidrug-Resistant Organisms , April 2014 , pp. 375 - 383
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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