Fecal Carriage Rate of Extended-Spectrum Beta-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae Among Apparently Health Food Handlers in Dilla University Student Cafeteria

Abstract

Background

The rapid spread of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae among food handlers is a public health concern and has become a serious world threat. Klebsiella pneumoniae and Escherichia coli are the predominant ESBL-producing Enterobacteriaceae. This study aimed to assess the magnitude of ESBL producing K. pneumoniae and E. coli isolated from the stool of food handlers in the Dilla University Student Cafeteria.

Methods

A cross-sectional study was conducted from November to September 2018/2019. A total of 220 stool samples were cultured on MacConkey agar and a series of biochemical tests were performed for the identification of bacterial species. Double-disk synergy method was used for the detection of ESBL-producing strains.

Results

The rate of fecal carriage of E. coli and K. pneumoniae among the food handlers of the current study was 66.4%, of which 81.5% was E. coli, while 18.5% was K. pneumoniae. Of the total bacterial isolates, 25.3% were confirmed to be positive for ESBL production, of which 19.9% was E. coli, while 5.5% was K. pneumoniae. ESBL-producing fecal carriage showed high resistance to aztreonam, cefotaxime, ceftriaxone, cefuroxime, and ceftazidime, with resistance rates ranging from 88% to 100%, while the lowest resistance rate was observed against imipenem accounted <26.3%. In this study, 91.9% of ESBL-producers were co-resistant to β-lactams antibiotics plus at least one of the non-β-lactam antibiotics. ESBL carriers were more common among food handlers who used antibiotics repeatedly, drunk unpasteurized milk, and ate raw meat.

Conclusion

The magnitude of ESBL-producing E. coli and K. pneumoniae fecal carriage is alarmingly high and a threat to human health. MDR to third-generation cephalosporins and non-β-lactam antibiotics is more common among ESBL producers. Detecting ESBL-producing organisms has a remarkable importance in clinical decision-making. Hence, a coordinated effort should be implemented for the prevention and control of the disease.

Keywords:

• extended-spectrum β-lactamase
• Enterobacteriaceae
• antibiotic resistance
• Klebsiella pneumoniae
• Escherichia coli
• Ethiopia

Acknowledgments

The authors would like to acknowledge Dilla University for opening this opportunity for researchers to come with problem-solving project ideas and scientific questions, and Dilla University food and nutrition research center for funding this study. I acknowledge, Laboratory Department staff and all study participants for their cooperation during sample collection.

Data Sharing Statement

The data set used for analysis during the current study are available from the corresponding author on reasonable request.

Ethics Statement

A protocol for patient recruitment and participation in the study followed the principles of the Declaration of Helsinki and was approved by the Dilla University Health Research Ethics Review Committee under protocol unique number 005/2019-01, date 10-01-2019. During data collection, each child’s parent/guardian was informed about the aim of the study. Written consent was obtained from the parent/legal guardian for each patient before the start of data collection. The clinical samples were specifically collected for this research. Samples with positive culture results were communicated to physicians in order for patients to get treatment according to the drug susceptibility results of the isolates.

Additional Information

All data relevant to the study are included in the article.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no conflicts of interest.