Prevalence, Drug Resistance Patterns, and Associated Factors of Extended-Spectrum Beta-Lactamase-Producing Enterobacterales Among Food Handlers in Student Cafeterias at Arba Minch University, Southern Ethiopia.

内容摘要

The emergence and spread of antimicrobial-resistant Enterobacterales, particularly extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-PE), represent the major global public health concern. The objective of this study was to determine the fecal carriage, antimicrobial resistance pattern, and associated factors of ESBL-PE among apparently healthy food handlers who work in the students' cafeteria at Arba Minch University, Ethiopia. An institution-based cross-sectional study was conducted from May 1 to August 30, 2025. A pretested, semistructured questionnaire was used to collect sociodemographic, clinical, behavioral, and other related data. Stool samples were collected from participants and inoculated on MacConkey agar. Bacterial colonies on the MacConkey agar were identified using standard biochemical tests. Screening and confirmation of extended-spectrum &#x3b2;-lactamase production was done by Kirby Bauer's disk diffusion method on Mueller-Hinton agar. The Statistical Package for the Social Sciences (SPSS) Version 25 was used to analyze the data. Bivariate and multivariate binary logistic regression analyses were used to assess the presence of association, and then the strength of the association was determined by using AOR and 95% confidence intervals, and p values at < 0.05 were considered statistically significant. Overall prevalence of fecal carriage of ESBL-PE was 51/319 (16%; CI 12.2-20.1). The most predominant ESBL-PE was Escherichia coli (34/51, 66.7%) and Klebsiella pneumonia (14/51, 27.5%), followed by Citrobacter freundii (2/51, 3.9%) and Proteus mirabilis (1/51, 1.9%). All ESBL-PE isolates in the present study were found to be multidrug-resistant (MDR). High-level resistance among ESBL-producing Enterobacterales was observed against trimethoprim-sulfamethoxazole (88.2%), whereas meropenem remained highly effective with susceptibility ranging from 76.5% to 100% across different genera. Antibiotic use in the last three months (AOR&#x2009;=&#x2009;2.485; CI: 1.12-5.51), lack of knowledge on the principle of safe food handling practice (AOR&#x2009;=&#x2009;0.325; CI: 0.128-0.828), consumption of raw meat (AOR&#x2009;=&#x2009;2.706; CI: 1.22-5.99), and drinking unpasteurized milk (AOR&#x2009;=&#x2009;2.014; CI: 1.03-3.96) were significantly associated with fecal carriage of ESBL-PE among food handlers. This study revealed a high prevalence of extended-spectrum &#x3b2;-lactamase-producing and MDR Enterobacterales among food handlers. Antibiotic use in the last three months, lack of knowledge of the principle of safe food handling practices, consumption of raw meat, and drinking unpasteurized milk were significantly associated with fecal carriage of ESBL-PE among food handlers. Therefore, routine screening, health education, and strict infection prevention and control measures are essential to prevent the spread of ESBL-PE and MDR-resistant Enterobacterales from food handlers to the student community.