Virulence and Antimicrobial Resistance Traits of Escherichia coli Retrieved from Fermented Dairy Products During Ramadan in Egypt: Seasonal Public Health Implications

Background: Rayeb milk and yogurt provide lasting energy and maintain hydration during fasting. The surge in demand during Ramadan (the holiest month of the year across the Islamic world) increases production to meet consumer needs, potentially compromising strict adherence to safety standards. Data on the prevalence and characterization of Escherichia coli (E. coli) in fermented dairy products during Ramadan, a model of increased batch turnover, remain to be investigated. Objectives: This study aimed to identify the AMR profile and molecularly characterize the AMR and virulence traits of E. coli isolates prevalent in fermented milk products. Methods: A total of 34 E. coli isolates, representing eight distinct serotypes, were recovered from 150 fermented milk samples; rayeb milk (n = 75) and yogurt (n = 75) collected from densely populated towns in the Dakahlia Governorate, Egypt. Results: The most prevalent serotypes were O153:H2, O125:H21, and O119:H6, followed by O111:H2, O26:H11, and O127:H6. The virulence genes stx1 and stx2 were detected in 76.47% of isolates, while eaeA and hlyA were found in O26:H11, O119:H6, and O55:H7 serotypes. In total, 73.53% (25/34) of E. coli isolates were classified as MDR, while 26.47% (9/34) exhibited XDR. Resistance was most prevalent against penicillin, tetracycline, ciprofloxacin, ampicillin, kanamycin, chloramphenicol, and trimethoprim. The kan, dfrA, blaOXA-1, tetA(A), and van(A) AMR genes were positive in 70.59%, 67.65%, 61.76%, 100%, and 47.06% of isolates, respectively. Conclusions: Identified E. coli AMR and virulence panels reflect that production pressure can challenge strict adherence to hygiene control measures and cold-chain maintenance. Subsequently, authorities must enforce proper quality assurance protocols to minimize the risk of food poisoning.