PREVALENCE OF ESBL-PRODUCING ESCHERICHIA COLI AMONG FOOD HANDLERS AND HOUSEHOLD CONTACTS IN URBAN SETTINGS
Keywords:
Antibiotic Stewardship, Community-Acquired Infections, Escherichia coli, Extended-Spectrum Beta-Lactamases, Food Handlers, Gastrointestinal Diseases, Hygiene, Microbial Drug ResistanceAbstract
Background: Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli has emerged as a major public health concern, extending beyond hospital environments into community settings. Food handlers and household contacts represent potential reservoirs for resistant organisms, yet data on their colonization in urban areas remain limited.
Objective: To estimate the prevalence of ESBL-producing E. coli carriage among food handlers and their household contacts in an urban setting, and to examine its associations with recent antibiotic use, hygiene practices, and recent gastrointestinal illness.
Methods: A cross-sectional study was conducted in Lahore over four months. A total of 320 participants (160 food handlers and 160 household contacts) were enrolled. Stool specimens were collected and processed using standard microbiological techniques, and ESBL production was confirmed following CLSI guidelines. A structured questionnaire assessed sociodemographic information, antibiotic use in the past three months, hygiene practices, and recent gastrointestinal illness. Data were analyzed using SPSS version 26, with logistic regression performed to estimate adjusted odds ratios (AORs).
Results: Overall prevalence of ESBL-producing E. coli was 32.5%, with food handlers showing a slightly higher prevalence (35.6%) compared to household contacts (29.4%). Recent antibiotic use was strongly associated with carriage (AOR 3.21, 95% CI: 1.86–5.52), as were poor hygiene practices (AOR 2.48, 95% CI: 1.39–4.43) and gastrointestinal illness within the past month (AOR 1.87, 95% CI: 1.04–3.37). Carriage was inversely associated with higher educational level but not with sex or age.
Conclusion: ESBL-producing E. coli carriage was common among both food handlers and household contacts, with prevalence exceeding 30%. Antibiotic misuse, poor hygiene, and gastrointestinal illness emerged as key modifiable risk factors. Community-level interventions focusing on antibiotic stewardship and hygiene education are essential to reduce the burden and transmission of resistance.
References
1. Amare A, Eshetie S, Kasew D, Moges FJPo. High prevalence of fecal carriage of Extended-spectrum beta-lactamase and carbapenemase-producing Enterobacteriaceae among food handlers at the University of Gondar, Northwest Ethiopia. 2022;17(3):e0264818.
2. Dela H. Antimicrobial Resistance Of Foodborne Pathogens In Stool Of Diarrhoea Patients In Two Selected Health Facilities And Food From Vendors In Selected Communities In Ghana: University Of Ghana; 2021.
3. Diriba K, Awulachew E, Tekele L, Ashuro ZJI, Resistance D. Fecal carriage rate of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae among apparently health food handlers in Dilla University student cafeteria. 2020:3791-800.
4. Kuve SA. Screening for Carriage and Antimicrobial Resistance of HelicobacterPylori, Escherichia coli and Klebsiella species among Patients presenting with Gastritis in Kibera and Dagoretti areas in Nairobi, Kenya: JKUAT-COHES; 2023.
5. Ihorimbere T. Antimicrobial Susceptibility Profiles and Molecular Characterization of Archived Isolates of Escherichia coli from the Gut of Healthy Food Animals and Environmental Sources in Selected Counties in Kenya: JKUAT-COHES; 2020.
6. Riaz A, Mohiuddin A, Erum R, Bano QJFiM, Biotechnology. E. coli in the Era of Antimicrobial Resistance: A multidisciplinary approach to understanding and mitigating its impact in Healthcare and Community setups. 2023;1:1-13.
7. Sinha A, Mishra P, Sahoo A, Sahoo D, Sahu MCJM, Diseases I. Emergence of antimicrobial resistance in street vendor food: A global perspective on bacterial contamination, resistance mechanisms, and mitigation strategies. 2025.
8. Viale P, Giannella M, Bartoletti M, Tedeschi S, Lewis RJID, Therapy. Considerations about antimicrobial stewardship in settings with epidemic extended-spectrum β-lactamase-producing or carbapenem-resistant Enterobacteriaceae. 2015;4(Suppl 1):65-83.
9. Okoth ON. Epidemiology of antimicrobial resistance in non-typhoidal salmonella, and diarrhoeagenic escherichia coli from children, food and livestock in Dagoretti, Nairobi, Kenya: Kenyatta University; 2024.
10. Saisi HN. Antimicrobial Resistance Patterns in Extended-spectrum beta-lactamase Producing Klebsiella pneumoniae isolates from Children in Mukuru Slums, Nairobi, Kenya: JKUAT-COHES; 2021.
11. Cocker D. An investigation into the role of human, animal and environmental factors on transmission of ESBL E. coli and ESBL K. pneumoniae in southern Malawian communities: Liverpool School of Tropical Medicine; 2022.
12. Kipngeno Tigoi C. Acquisition and loss of carriage of antimicrobial resistant Enterobacterales among vulnerable children in Kenya: clinical and genomic determinants: University of Oxford; 2024.
13. Wairimu WD. UNRAVELING ANTIMICROBIAL RESISTANCE PHENOTYPES AND CARRIAGE OF EXTENDED-SPECTRUM β-LACTAMASE GENES IN Escherichia coli ISOLATED FROM DAIRY FARMS IN KIAMBU COUNTY, KENYA: Kenyatta University; 2023.
14. Chowdhury AM, Ekra MA, Jahan L, Alam AN, Noor R. Prevalence of carbapenem-resistant Escherichia coli in the drinking water system in Dhaka: BRAC University; 2024.
15. Bukari Z, Emmanuel T, Woodward J, Ferguson R, Ezughara M, Darga N, et al. The global challenge of Campylobacter: Antimicrobial resistance and emerging intervention strategies. 2025;10(1):25.
16. Al Shizawiyah NSH. Diagnostic and Antimicrobial Stewardship in Complicated Urinary Tract Infection in the Era of Mdr and Xdr Gram-Negative Bacilli: Sultan Qaboos University (Oman); 2023.
17. Paramitadevi YV, Priadi CR, Rahmatika I, Rukmana A, Moersidik SSJIJOH. Integration of water, sanitation, and hygiene program with biosecurity: A one health approach to reduce the prevalence and exposure of antibiotic-resistant bacteria in the livestock community. 2023;9:181-93.
18. Tasnim Y. Distribution, genetic relatedness, and rapid detection of Beta-lactam resistant Enterobacteriaceae at One Health interface 2025.
19. Zjajo A. The Influence of Antimicrobial Stewardship Measures on Outcome of Patients with Severe Infections treated in Intensive Care Unit: University of Zagreb. School of Medicine. Department of Infectious Diseases; 2024.
20. Anueyiagu KN, Agu CG, Umar U, Lopes BSJA. Antimicrobial resistance in diverse Escherichia coli pathotypes from Nigeria. 2024;13(10):922.
21. Zhang E. Poster Presentations-IMED 2018.
22. Coronado S. Prevalence of Community-Acquired Bloodstream Infections Caused by Multidrug-Resistant Gram-negative Bacteria in Adults in El Paso, Texas: The University of Texas at El Paso; 2024.
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