title: Extended-spectrum β-lactamase-producing Enterobacteriaceae in hospital food: a risk assessment.
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.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  A 2,200-bed tertiary care university hospital in Switzerland.
  
  
  METHODS
  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-14 and 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.
authors.affiliation: Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Stewardson
authors.forename: Gesuele
authors.initials: G
authors.lastname: Renzi
authors.forename: Nathalie
authors.initials: N
authors.lastname: Maury
authors.forename: Celia
authors.initials: C
authors.lastname: Vaudaux
authors.forename: Caroline
authors.initials: C
authors.lastname: Brossier
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Fritsch
authors.forename: Didier
authors.initials: D
authors.lastname: Pittet
authors.forename: Max
authors.initials: M
authors.lastname: Heck
authors.forename: Kim
authors.initials: K
authors.lastname: van der Zwaluw
authors.forename: E Ascelijn
authors.initials: EA
authors.lastname: Reuland
authors.forename: Thijs
authors.initials: T
authors.lastname: van de Laar
authors.forename: Eveline
authors.initials: E
authors.lastname: Snelders
authors.forename: Christina
authors.initials: C
authors.lastname: Vandenbroucke-Grauls
authors.forename: Jan
authors.initials: J
authors.lastname: Kluytmans
authors.forename: Patrick
authors.initials: P
authors.lastname: Edder
authors.forename: Jacques
authors.initials: J
authors.lastname: Schrenzel
authors.forename: Stephan
authors.initials: S
authors.lastname: Harbarth
mesh_terms: D003430:Cross-Sectional Studies; D004350:Drug Residues / Q000032:analysis; D004755:Enterobacteriaceae / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification*; D005516:Food Microbiology; D005521:Food Service, Hospital; D005798:Genes, Bacterial; D006785:Hospitals, University; D006801:Humans; D016133:Polymerase Chain Reaction; D018570:Risk Assessment; D013557:Switzerland; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D001618:beta-Lactamases