Risk factors and spatial distribution of extended spectrum β-lactamase-producing- Escherichia coli at retail poultry meat markets in Malaysia: a cross-sectional study

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Abstract

Background

The significant role of retail poultry meat as an important exposure pathway for the acquisition and transmission of extended spectrum β-lactamase-producing Escherichia coli (ESBL-EC) into the human population warrants understanding concerning those operational practices associated with dissemination of ESBL-EC in poultry meat retailing. Hence, the objective of this study was to determine the prevalence, spatial distribution and potential risk factors associated with the dissemination of ESBL-EC in poultry meat retail at wet-markets in Selangor, Malaysia.

Methods

Poultry meat (breast, wing, thigh, and keel) as well as the contact surfaces of weighing scales and cutting boards were sampled to detect ESBL-EC by using culture and disk combination methods and polymerase chain reaction assays. Besides, questionnaire was used to obtain data and information pertaining to those operational practices that may possibly explain the occurrence of ESBL-EC. The data were analysed using logistic regression analysis at 95 % CI.

Results

The overall prevalence of ESBL-EC was 48.8 % (95 % CI, 42 – 55 %). Among the risk factors that were explored, type of countertop, sanitation of the stall environment, source of cleaning water, and type of cutting board were found to be significantly associated with the presence of ESBL-EC.

Conclusions

Thus, in order to prevent or reduce the presence of ESBL-EC and other contaminants at the retail-outlet, there is a need to design a process control system based on the current prevailing practices in order to reduce cross contamination, as well as to improve food safety and consumer health.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3377-2) contains supplementary material, which is available to authorized users.

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Most cited references 28

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Extended-spectrum β-lactamases in Gram Negative Bacteria

Deepti Rawat, Deepthi Nair (2010)

Extended-spectrum β-lactamases (ESBLs) are a group of plasmid-mediated, diverse, complex and rapidly evolving enzymes that are posing a major therapeutic challenge today in the treatment of hospitalized and community-based patients. Infections due to ESBL producers range from uncomplicated urinary tract infections to life-threatening sepsis. Derived from the older TEM is derived from Temoniera, a patient from whom the strain was first isolated in Greece. β-lactamases, these enzymes share the ability to hydrolyze third-generation cephalosporins and aztreonam and yet are inhibited by clavulanic acid. In addition, ESBL-producing organisms exhibit co-resistance to many other classes of antibiotics, resulting in limitation of therapeutic option. Because of inoculum effect and substrate specificity, their detection is also a major challenge. At present, however, organizations such as the Clinical and Laboratory Standards Institute (formerly the National Committee for Clinical Laboratory Standards) provide guidelines for the detection of ESBLs in Klebsiella pneumoniae, K. oxytoca, Escherichia coli and Proteus mirabilis. In common to all ESBL-detection methods is the general principle that the activity of extended-spectrum cephalosporins against ESBL-producing organisms will be enhanced by the presence of clavulanic acid. Carbapenems are the treatment of choice for serious infections due to ESBL-producing organisms, yet carbapenem-resistant isolates have recently been reported. ESBLs represent an impressive example of the ability of gram-negative bacteria to develop new antibiotic-resistance mechanisms in the face of the introduction of new antimicrobial agents. Thus there is need for efficient infection-control practices for containment of outbreaks; and intervention strategies, e.g., antibiotic rotation to reduce further selection and spread of these increasingly resistant pathogens.

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Survival of foodborne pathogens on stainless steel surfaces and cross-contamination to foods.

H. Kusumaningrum (2003)

The retention of bacteria on food contact surfaces increases the risk of cross-contamination of these microorganisms to food. The risk has been considered to be lowered when the surfaces are dry, partly because bacterial growth and survival would be reduced. However, some non-spore-forming bacteria might be able to withstand dry conditions on surfaces for an extensive period of time. In this study the survival of Salmonella enteritidis, Staphylococcus aureus and Campylobacter jejuni on stainless steel surfaces at different initial levels was determined at room temperature. The transfer rates of these pathogens from kitchen sponges to stainless steel surfaces and from these surfaces to foods were also investigated. Staph. aureus was recovered from the surfaces for at least 4 days when the contamination level was high (10(5) CFU/cm2) or moderate (10(3) CFU/cm2). At low levels (10 CFU/cm2), the surviving numbers decreased below the detection limit (4 CFU/100 cm2) within 2 days. S. enteritidis was recovered from surfaces for at least 4 days at high contamination levels, but at moderate level, the numbers decreased to the detection limit within 24 h and at low level within 1 h. C. jejuni was the most susceptible to slow-air-drying on surfaces; at high contamination levels, the numbers decreased below the detection limit within 4 h. The test microorganisms were readily transmitted from the wet sponges to the stainless steel surfaces and from these surfaces to the cucumber and chicken fillet slices, with the transfer rates varied from 20% to 100%. This study has highlighted the fact that pathogens remain viable on dry stainless steel surfaces and present a contamination hazard for considerable periods of time, dependent on the contamination levels and type of pathogen. Systematic studies on the risks of pathogen transfer associated with surface cleaning using contaminated sponges provide quantitative data from which a model of risks assessment in domestic setting could lead.

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Clinical and economic impact of bacteremia with extended- spectrum-beta-lactamase-producing Enterobacteriaceae.

Mitchell J. Schwaber, Keith S. Kaye, Ronen Ben-Ami … (2006)

We studied outcomes of extended-spectrum beta-lactamase (ESBL) production in Enterobacteriaceae bacteremia. Inpatients with bacteremia caused by ESBL-producing Escherichia coli, Klebsiella spp., or Proteus spp. (cases) were compared with patients with bacteremia caused by non-ESBL producers (controls). Outcomes included mortality, mortality due to infection, length of stay (LOS), delay in appropriate therapy (DAT), discharge to a chronic care facility, and hospital cost. Ninety-nine cases and 99 controls were enrolled. Thirty-five percent of cases died, versus 18% of controls (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.3 to 4.7; P=0.01). Thirty percent of cases died due to infection, versus 16% of controls (OR, 2.3; 95% CI, 1.1 to 4.5; P=0.03). The median LOS after bacteremia for cases was 11 days (interquartile range, 5 to 21), versus 5 days for controls (interquartile range, 3 to 9) (P<0.001). DAT occurred in 66% of cases, versus 7% of controls (OR, 25.1; 95% CI, 10.5 to 60.2; P<0.001). Cases were more likely than controls to be discharged to chronic care (52% versus 21%; OR, 4.0; 95% CI, 1.9 to 8.3; P<0.001). The average hospital cost for cases was 65,509 Israeli shekels, versus 23,538 shekels for controls (P<0.001). After adjusting for differences between groups by using multivariable analysis, ESBL production remained a significant predictor of mortality (OR, 3.6; 95% CI, 1.4 to 9.5; P=0.008), increased LOS (1.56-fold; P=0.001), DAT (OR, 25.1; 95% CI, 10.5 to 60.2; P<0.001), and increased cost (1.57-fold; P=0.003). The mean increase in equivalent cost attributable to ESBL production was $9,620. ESBL production was associated with severe adverse outcomes, including higher overall and infection-related mortality, increased LOS, DAT, discharge to chronic care, and higher costs.

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Author and article information

Contributors

A. B. Aliyu: rasheedvet@gmail.com

A. A. Saleha: saleha@upm.edu.my

A. Jalila: jalila@upm.edu.my

Z. Zunita: zunita@upm.edu.my

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 2 August 2016

Publication date PMC-release: 2 August 2016

Publication date Collection: 2016

Volume: 16

Electronic Location Identifier: 699

Affiliations

[1 ]Department of Veterinary Pathology and Microbiology, Faculty of Veterinary Medicine, University Putra Malaysia, 43400 Serdang, Selangor Malaysia

[2 ]Department of Veterinary Clinical Studies, Faculty of Veterinary Medicine, University Putra Malaysia, 43400 Serdang, Selangor Malaysia

[3 ]Department of Pathology and Microbiology, Faculty of Veterinary Medicine, Veterinary Public health laboratory, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia

Article

Publisher ID: 3377

DOI: 10.1186/s12889-016-3377-2

PMC ID: 4971674

PubMed ID: 27484086

SO-VID: 1c3d11a1-bd24-488d-927a-80c345f75c4d

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 9 September 2015

Date accepted : 27 July 2016

Custom metadata

ScienceOpen disciplines: Public health

Keywords: esbl- e. coli,zoonosis,foodborne infection,antimicrobial resistance,poultry meat,wet-market,risk factor,malaysia

Data availability:

ScienceOpen disciplines: Public health

Keywords: esbl- e. coli, zoonosis, foodborne infection, antimicrobial resistance, poultry meat, wet-market, risk factor, malaysia

Risk factors and spatial distribution of extended spectrum β-lactamase-producing- Escherichia coli at retail poultry meat markets in Malaysia: a cross-sectional study

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Point-Of-Care Testing for AMR

Most cited references 28

Extended-spectrum β-lactamases in Gram Negative Bacteria

Survival of foodborne pathogens on stainless steel surfaces and cross-contamination to foods.

Clinical and economic impact of bacteremia with extended- spectrum-beta-lactamase-producing Enterobacteriaceae.

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