Fecal carriage of extended-spectrum β-lactamase-producing Enterobacteriaceae among hospital food handlers: Implications for institutional food safety management and infection control

The aim of this study was to determine the prevalence and persistence of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) carriage among hospital food handlers. A prospective, single-center study was conducted in Sagamihara, Japan, from July to December 2021. Residual fecal specimens from routine examinations of 119 hospital food handlers were analyzed for ESBL-E and carbapenem-resistant Enterobacteriaceae (CRE). ESBL-E were detected in 32 isolates from 11 participants (9.2%), with Escherichia coli as the predominant species and a mean monthly positivity rate of 4.48%. The frequency of ESBL-E carriage was higher in individuals younger than 40 years of age (17.5%) than in those aged 40 years or above (5.1%). Highly homologous strains were detected within and between participants; the most common resistance genes were blaCTX-M-1 group and blaCTX-M-9 group. Six participants showed persistent ESBL-E carriage but CRE was not detected. These findings suggest that ESBL-E carriage is common among hospital food handlers, particularly among younger individuals, highlighting the need for enhanced surveillance and targeted hygiene interventions to limit ESBL-E transmission in healthcare food services.