Prevalence of pathogenic bacteria in street vended ready-to-eat meats in Windhoek, Namibia

Analysis on Foodborne Pathogen Contamination of Food Samples in Longnan City from 2013 to 2022

The objective was to determine the prevalence of foodborne pathogens in food in Longnan City, Gansu Province, China. In this research, we conducted tests on baked foods, catering foods, meat, and fruits and vegetables sold in supermarkets, farmers' markets, restaurants, retail stores, street stalls, and school canteens from 2013 to 2022. We analyzed the variety of foodborne pathogens (Salmonella, Staphylococcus aureus, Listeria monocytogenes, Bacillus cereus, and diarrheagenic Escherichia coli) in different sites and food types. Once foodborne pathogens were detected in the sample, it was deemed unqualified. The total detection rates of foodborne pathogens were 1.559%, 3.349%, 1.980%, 1.040%, 3.383%, and 1.303% in food from supermarkets, farmers' markets, restaurants, retail stores, street stalls, and school canteens, respectively. No pathogenic bacteria were detected in baked foods. Salmonella, S. aureus, L. monocytogenes, B. cereus, and diarrheagenic E. coli were detected in catering foods, among which B. cereus had the highest detection rate. Salmonella was the most common pathogenic bacteria detected in meat, while the detection rate of pathogenic bacteria in fruits and vegetables was low, with only one positive sample for diarrheagenic E. coli. Among the six sites, street stalls (3.382%) and farmers' markets (3.349%) had higher detection rates of pathogens. In general, the detection rate of pathogens from 2013 to 2022 was not high, but there were also some hidden dangers. Catering food is vulnerable to pathogen contamination, and street stalls and farmers' markets are the main sites of pollution. According to the above findings, the regulatory authorities should continue to strengthen supervision, guarantee food safety through early warning, and reduce the risk of food contamination.

The Socioeconomic Factors of Street Food Vending in Developing Countries and Its Implications for Public Health: A Systematic Review

The sale of ready-to-eat (RTE) street food represents an important source of income in many developing countries. However, these foods are frequently implicated in outbreaks of gastrointestinal diseases. Street food vendors face several constraints that hamper improvement in the microbiological quality of their products. The aim of this review was to update knowledge about the main causes of foodborne illnesses in developing countries, including the growing concern with the microbial transmission of antibiotic resistance. Following PRISMA guidelines, this systematic review was conducted on original articles published from January 2010 to July 2023. The search was carried out using Scopus, PubMed, Web of Science, Food Science and Technology Abstracts (FSTA), the International Information System for Agricultural Sciences and Technology (AGRIS), as well as isolated searches of relevant articles from Google Scholar. The initial search identified 915 articles, 50 of which were included in this systematic review. The results indicate that, in the majority of the 15 countries examined, women constitute the predominant segment of street food vendors, representing more than 55% of the total number of these vendors. In 11 countries, street food vendors under the age of 18 were identified. Most vendors had a low level of education and, consequently, were unaware of good hygiene practices when handling food. The combination of factors such as poor hygiene practices on the part of food handlers and the lack of facilities, namely, the absence of available potable water, were frequently listed as the main causes of food contamination. Enterobacteriaceae such as Escherichia coli (61.9%), Salmonella (30.1%), and Shigella spp. (9.5%), as well as Staphylococcus aureus (30.1%) and Listeria monocytogenes (14.3%), were the most common pathogens found in RTE street foods. In 22 studies from 13 developing countries, 59% (13/22) reported high multidrug resistance in Enterobacteriaceae (40% to 86.4% in E. coli, 16.7 to 70% in Salmonella, and 31 to 76.4% in S. aureus). To address the challenges faced by street vendors and improve their economic activities, it is necessary for government entities, consumers, and vendors to work together collaboratively.

A South African Perspective on the Microbiological and Chemical Quality of Meat: Plausible Public Health Implications

Meat comprises proteins, fats, vitamins, and trace elements, essential nutrients for the growth and development of the body. The increased demand for meat necessitates the use of antibiotics in intensive farming to sustain and raise productivity. However, the high water activity, the neutral pH, and the high protein content of meat create a favourable milieu for the growth and the persistence of bacteria. Meat serves as a portal for the spread of foodborne diseases. This occurs because of contamination. This review presents information on animal farming in South Africa, the microbial and chemical contamination of meat, and the consequential effects on public health. In South Africa, the sales of meat can be operated both formally and informally. Meat becomes exposed to contamination with different categories of microbes, originating from varying sources during preparation, processing, packaging, storage, and serving to consumers. Apparently, meat harbours diverse pathogenic microorganisms and antibiotic residues alongside the occurrence of drug resistance in zoonotic pathogens, due to the improper use of antibiotics during farming. Different findings obtained across the country showed variations in prevalence of bacteria and multidrug-resistant bacteria studied, which could be explained by the differences in the manufacturer practices, handling processes from producers to consumers, and the success of the hygienic measures employed during production. Furthermore, variation in the socioeconomic and political factors and differences in bacterial strains, geographical area, time, climatic factors, etc. could be responsible for the discrepancy in the level of antibiotic resistance between the provinces. Bacteria identified in meat including Escherichia coli, Listeria monocytogenes, Staphylococcus aureus, Campylobacter spp., Salmonella spp., etc. are incriminated as pathogenic agents causing serious infections in human and their drug-resistant counterparts can cause prolonged infection plus long hospital stays, increased mortality and morbidity as well as huge socioeconomic burden and even death. Therefore, uncooked meat or improperly cooked meat consumed by the population serves as a risk to human health.

Differences in Bacterial Communities of Retail Raw Pork in Different Market Types in Hangzhou, China

Pork is widely consumed globally, and pigs' microbiota can potentially harbor foodborne pathogens. Contaminated pork in retail markets poses significant implications for food quality and safety. However, limited studies have compared pork microbiomes in various marketing environments. In this study, we utilized traditional microbial culture methods and high-throughput 16S rRNA sequencing to assess pathogen contamination and bacterial diversity in raw pork samples purchased from farmers' markets and two types of supermarkets (upscale and ordinary) in Hangzhou, China. Traditional microbial plate cultures identified E. coli and Salmonella spp. in 32.1% (27/84) and 15.5% (13/84) of the collected pork samples, respectively. Moreover, 12 out of 13 Salmonella strains were found in farmers' markets. The MIC results indicated a high prevalence of MDR strains, accounting for 51.9% in E. coli and 53.8% in Salmonella. The prevalence of NaClO tolerant strains was 33.3% and 92.3% for E. coli and Salmonella, respectively. Sequencing results indicated significantly higher microbial diversity in farmers' market samples compared to supermarket samples. Farmers' market pork samples exhibited a greater abundance of Acinetobacter, while Pseudomonas and Brochothrix were predominant in supermarket samples. The total abundance of pathogenic and spoilage bacteria was also higher for the farmers' market samples. Cross-contamination during market trading was evident through a high correlation between bacterial abundance in pork from different stalls within the same farmers' market. PICRUSt2 analysis identified significant differences in the average proportions of genes for carbohydrate, energy, and lipid metabolism from the farmers' markets, suggesting an exacerbation of microbial metabolic activity and increased perishability of pork in this environment. In conclusion, this study revealed variations in the characteristics of raw pork bacterial contamination across different types of retail stores, as well as differences in the composition and diversity of their respective bacterial communities.

Essential Oils and Their Combination with Lactic Acid Bacteria and Bacteriocins to Improve the Safety and Shelf Life of Foods: A Review

The use of plant extracts (e.g., essential oils and their active compounds) represents an interesting alternative to chemical additives and preservatives applied to delay the alteration and oxidation of foods during their storage. Essential oils (EO) are nowadays considered valuable sources of food preservatives as they provide a healthier alternative to synthetic chemicals while serving the same purpose without affecting food quality parameters. The natural antimicrobial molecules found in medicinal plants represent a possible solution against drug-resistant bacteria, which represent a global health problem, especially for foodborne infections. Several solutions related to their application on food have been described, such as incorporation in active packaging or edible film and direct encapsulation. However, the use of bioactive concentrations of plant derivatives may negatively impact the sensorial characteristics of the final product, and to solve this problem, their application has been proposed in combination with other hurdles, including biocontrol agents. Biocontrol agents are microbial cultures capable of producing natural antimicrobials, including bacteriocins, organic acids, volatile organic compounds, and hydrolytic enzymes. The major effect of bacteriocins or bacteriocin-producing LAB (lactic acid bacteria) on food is obtained when their use is combined with other preservation methods. The combined use of EOs and biocontrol agents in fruit and vegetables, meat, and dairy products is becoming more and more important due to growing concerns about potentially dangerous and toxic synthetic additives. The combination of these two hurdles can improve the safety and shelf life (inactivation of spoilage or pathogenic microorganisms) of the final products while maintaining or stabilizing their sensory and nutritional quality. This review critically describes and collects the most updated works regarding the application of EOs in different food sectors and their combination with biocontrol agents and bacteriocins.

Microbiology of street food: understanding risks to improve safety

Street foods play important socioeconomic and cultural roles and are popular worldwide. In addition to providing convenient and low-cost meals for urban populations, street food offers an essential source of income for vendors, especially women, and it can reflect traditional local culture, which is an important attraction for tourists. Despite these benefits, the microbiological safety of street food has become a worldwide concern because it is often prepared and sold under inadequate safety conditions, without legal control and sanitary surveillance. Consequently, high counts of fecal indicator bacteria and several foodborne pathogens have been detected in street foods. This review provides insight into the microbiology of street food, focus on the associated microbiological safety aspects and main pathogens, and the global status of this important economic activity. Furthermore, the need to apply molecular detection rather than traditional culture-based methods is discussed to better understand the actual risks of microbial infection associated with street foods. Recognition is always the first step toward addressing a problem.

Assessment of food safety knowledge, attitude, practices of food handlers and microbial contamination in foods at the canteens of a University in Pakistan

Developing nations are striving to assure food safety that rely mainly upon handling procedures. The current study focused upon the understanding level and practices of food handlers working at various canteens of University of the Punjab, Quid-i-Azam campus, Lahore. Different canteens were selected where 300 different food handlers were judged for their approach towards food safety through a closed ended questionnaire. Samples of different food products were also taken randomly for their microbiological safety evaluation. The whole data was analyzed using chi-square to assess the proportion of correct and incorrect responses among various parameters. The non-significant variation was observed among the knowledge, attitude and practices scores of university and its hostels’ canteens food handlers. Overall, 60% of the responses were correct from the university and hostel canteens food handlers. Similarly, 50-60% of the responses regarding attitude and practices were correct from the university and hostel canteen food handlers. With many technical flaws, these food handlers showed moderate level of knowledge. Not only apprentices but the supervisors too, lacked the basic knowledge of temperature as major factor creating potential food safety threats. Lack of knowledge about personal hygiene and workplace sanitation were few contributing factors towards heedless behavior. Incidence of Salmonella and Staphylococcus aureus contamination in food samples was found 29% and 57%, respectively, while 35% food samples were found contaminated with E. coli. It further exposed the negligence, emphasizing proper training of employees as part and parcel of food safety procedures. It was concluded that more training programs along with periodic validation of food manufacturing standards are required to ensure food safety. Furthermore, strict surveillance and implementation of GMPs by the administrative authorities are needed to safeguard the consumers’ health.

Prevalence, Enterotoxigenic Potential and Antimicrobial Resistance of Staphylococcus aureus and Methicillin-Resistant Staphylococcus aureus (MRSA) Isolated from Algerian Ready to Eat Foods

Staphylococcus aureus causes a foodborne intoxication due to the production of enterotoxins and shows antimicrobial resistance, as in the case of methicillin-resistant strains (MRSA). Herein, we analyzed 207 ready-to-eat foods collected in Algeria, reporting a S. aureus prevalence of 23.2% (48/207) and respective loads of coagulase positive staphylococci (CPS) ranging from 1.00 ± 0.5 to 5.11 ± 0.24 Log CFU/g. The 48 S. aureus isolates were widely characterized by staphylococcal enterotoxin gene (SEg)-typing and 16S-23S rDNA intergenic spacer region (ISR)-PCR, as well as by detecting tst and mecA genes, genetic determinants of toxic shock syndrome toxin-1 and methicillin resistance, respectively. We found that the S. aureus isolates belonged to seven different SEg-types harboring the following combinations of genes: (1) selW, selX; (2) egc (seG, seI, seM, seN, seO), selW, selX; (3) seA, seH, seK, seQ, selW, selX; (4) seB, selW, selX; (5) seD, selJ, seR, selW, selX; (6) seH, selW, selX, selY; and (7) seA, egc, selW, selX, while among these, 2.1% and 4.2% were tst- and mecA- (staphylococcal chromosomal cassette mec-type IV) positive, respectively. Selected strains belonging to the 12 detected ISR-types were resistant towards antimicrobials including benzylpenicillin, ofloxacin, erythromycin, lincomycin, tetracyclin, kanamycin, oxacillin, and cefoxitin; 8.3% (1/12) were confirmed as MRSA and 16.7% (2/12) were multidrug resistant. The present study shows the heterogeneity of the S. aureus population in Algerian ready-to-eat foods as for their toxigenic potential and antimicrobial resistance, shedding the light on the quality and safety related to the consume of ready-to-eat foods in Algeria.

The pathogenic and spoilage bacteria associated with red meat and application of different approaches of high CO2 packaging to extend product shelf-life

With the fast-global development of packaging techniques, the potential antimicrobial effect of CO₂, as a safe, cheap and readily available gas, makes it the integral component for packaging of meat products. The associated spoilage and/or pathogenic bacteria on raw meat may respond in different ways to elevated CO₂ concentrations. The growth of some aerobic Gram-negative bacteria such as Pseudomonas spp. is significantly inhibited but some LAB bacteria may be allowed to grow faster and dominate the product. The antimicrobial efficacy of enriched CO₂ packaging is attributed to the rate of CO₂ solubility in the product which is itself affected by the level of headspace CO₂, product pH, temperature and the ratio of headspace gas to product (G:P). This review, first, explores the varied range of beef and sheep meat spoilage and pathogenic bacteria and the intrinsic and extrinsic parameters that may influence the pattern of microbial growth and meat spoilage rate during storage. Then, the antimicrobial mechanism of elevated CO₂ packaging will be discussed and the different approaches of achieving enriched CO₂ packaging i.e. the traditional technique of flushing a desired gas mixture and/or using the new commercially developed CO₂ emitters will then be compared in terms of their strengths, limitations and technical mode of action.

Chemical composition, extraction sources and action mechanisms of essential oils: Natural preservative and limitations of use in meat products

The antimicrobial activity of essential oils (EO) is associated with the presence of secondary metabolites synthesized by plants. Its mechanism of action involves the interaction of its hydrophobic components with the lipids present in the cell membrane of microorganism, resulting in metabolic damages and cell death. Spoilage and pathogenic microorganisms are contaminants in meat and meat products with considerable impacts on food quality and safety. Research shows the potential of applying essential oils in the preservation of meat food systems as compounds of low toxicity, extracted from a natural source, and as an alternative to consumer demand for healthy foods with a more natural appeal. In addition, there is a great diversity of plants from which essential oils can be extracted, whose antimicrobial activity in vitro and in meat and meat products has been proven.

Microbiological assessment of street foods at the point of sale in Maputo (Mozambique)

Objectives

The aim of this study was to assess the microbiological quality and safety of street food sold in the main streets and informal markets of Maputo, the capital of Mozambique.

Materials and Methods

From 83 different vendors selling different types of foods, 83 samples of ready-to-eat (RTE) street food were analyzed. Mesophiles, Escherichia coli and total coliforms were used as quality and hygiene indicators. Listeria monocytogenes (L. monocytogenes) Salmonella and coagulase-positive staphylococci were used as food safety indicators.

Results

High proportions of unsatisfactory food samples were found in both traditional hot (76.7%) and cold (75%) foods. L. monocytogenes and Salmonella were tested negative in this survey. However, when coagulase-positive staphylococci was used as a food safety indicator, approximately 25% (23/83) of the food samples analyzed were classified as unsatisfactory/potentially hazardous.

Conclusions

These results, showing that street food sold in Maputo clearly requires adequate sanitary conditions for its preparation and sale, contribute to the development of good manufacturing practices (GMP) for street food in Maputo, Mozambique. This is the first report on the microbiological quality and safety of street food in Mozambique.

Bacterial contaminants and their antibiotic susceptibility patterns in ready-to-eat foods vended in Ogun state, Nigeria

Contamination of ready-to-eat (RTE) foods by pathogenic bacteria may predispose consumers to foodborne diseases. This study investigated the presence of bacterial contaminants and their antibiotic susceptibility patterns in three locally processed RTE foods (eko, fufu and zobo) vended in urban markets in Ogun state, Nigeria. Bacteria isolated from a total of 120 RTE food samples were identified by 16S rRNA gene phylogeny while susceptibility patterns to eight classes of antibiotics were determined by the disc diffusion method. Species belonging to the genera Acinetobacter and Enterobacter were recovered from all RTE food types investigated, Klebsiella and Staphylococcus were recovered from eko and fufu samples, while those of Shigella were recovered from eko samples. Enterobacter hormaechei was the most prevalent species in all three RTE food types. Precisely 99% of 149 isolates were multidrug-resistant, suggesting a high risk for RTE food handlers and consumers. Co-resistance to ampicillin and cephalothin was the most frequently observed resistance phenotype. Results demonstrate that improved hygiene practices by food processors and vendors are urgently required during RTE processing and retail. Also, adequate food safety guidelines, regulation and enforcement by relevant government agencies are needed to improve the safety of RTE foods and ensure the protection of consumer health.

Prevalence of Microorganisms of Public Health Significance in Ready-to-Eat Foods Sold in Developing Countries: Systematic Review and Meta-Analysis

Background

The issue of microbial quality and safety of ready-to-eat foods has become a public health concern that needs to be addressed to protect the consumer's health. Contamination of ready-to-eat foods by enteric pathogens such as Escherichia coli, Salmonella, and Staphylococcus aureus bacteria is associated with potential health risks and can cause foodborne outbreaks. Thus, the systematic review and meta-analysis aimed at determining the overall evidence on the prevalence of microorganisms of public health significance in ready-to-eat foods based on previous studies.

Methods

The articles published from 2015 to 2020 were searched from multiple electronic databases such as PubMed, Google Scholar, MEDLINE, CINAHL, Science Direct, Web of Science, and the Directory of Open Access Journals. The JBI critical appraisal tool was applied to the included articles. To determine the heterogeneity among the included articles, I² statistics were used while publication bias was evaluated using the visual funnel plot. A Forest plot using the random effect model for meta-analysis was used to estimate the pooled prevalence of E. coli, Salmonella, and S. aureus in ready to eat foods.

Results

The pooled prevalence of E. coli, Salmonella, and S. aureus in ready to eat foods was 33.8% (95% CI: 19.9, 51.2; Q value = 67.080, I² = 89.56%), 26.0% (95% CI: 13.8, 43.6%; Q value = 83.67, I² = 91.63%), and 46.3% (95% CI: 24.8, 69.4%, I² = 94.9%), respectively.

Conclusion

The findings show that contamination of ready-to-eat foods with pathogenic microorganisms continues to be a public health risk. Thus, effective food hygiene and safety systems are necessary to protect the health of the consumers and the public as a whole.

Microbial Quality of Ready-to-Eat Foods Sold in School Cafeterias in Chongqing, China

ABSTRACT

The microbiological quality of ready-to-eat (RTE) foods from school cafeterias in Chongqing, People's Republic of China, was evaluated and compared with a guideline published by a provincial health commission. These RTE foods were divided into five types based on their preparation processes and potential risks: 1, general cooked and hot-held foods; 2, cooked meats; 3, heated aquatic products; 4, fresh fruits or vegetables; and 5, cooked foods with postcooking handling (e.g., cutting, cooling, or addition of ingredients or condiments). Food types 1 through 3 (subjected to thermal processes and hot-held) were microbiologically safer than types 4 and 5 (prepared by nonthermal process or with postcooking processes). None of the samples of types 1 through 3 were unsatisfactory based on their aerobic plate counts (APC) and total coliforms (TC), whereas 43.1% of type 4 and 8.3 and 71.7% of type 5 samples were unsatisfactory due to high counts of TC and high APC and TC, respectively. Two, 12, and 50 samples of types 2, 4, and 5, respectively, were unacceptable due to high levels of Staphylococcus aureus. Bacillus cereus and Vibrio parahaemolyticus were detected, but levels were below the unacceptable limits. None of the samples were positive for Salmonella, Listeria monocytogenes, or Escherichia coli O157. The bacterial profile can be used by policy makers and epidemiologists for microbiological risk assessments, which may be conducive to developing interventions to control hazards, improve food hygiene, and develop safety management systems for school cafeterias in China.

HIGHLIGHTS

A Study on Prevalence and Characterization of Bacillus cereus in Ready-to-Eat Foods in China

Bacillus cereus is widely distributed in different food products and can cause a variety of symptoms associated with food poisoning. Since ready-to-eat (RTE) foods are not commonly sterilized by heat treatment before consumption, B. cereus contamination may cause severe food safety problems. In this study, we investigated the prevalence of B. cereus in RTE food samples from different regions of China and evaluated the levels of bacterial contamination, antibiotic resistance, virulence gene distribution, and genetic polymorphisms of these isolates. Of the tested retail RTE foods, 35% were positive for B. cereus, with 39 and 83% of the isolated strains harboring the enterotoxin-encoding hblACD and nheABC gene clusters, respectively. The entFM gene was detected in all B. cereus strains. The cytK gene was present in 68% of isolates, but only 7% harbored the emetic toxin-encoding gene cesB. Antimicrobial susceptibility testing revealed that the majority of the isolates were resistant not only to most β-lactam antibiotics, but also to rifamycin. Multilocus sequence typing (MLST) revealed that the 368 isolates belonged to 192 different sequence types (STs) including 93 new STs, the most prevalent of which was ST26. Collectively, our study indicates the prevalence, bacterial contamination levels, and biological characteristics of B. cereus isolated from RTE foods in China and demonstrates the potential hazards of B. cereus in RTE foods.

Diversity of Serotype, Genotype, and Antibiotic Susceptibility of Salmonella Prevalent in Pickled Ready-to-Eat Meat

Pickled ready-to-eat meat (PRTEM) is a meat product that is treated with various seasonings and then cooked. PRTEM is a popular food consumed mostly in China and some Asian countries. Since this food is considered 'ready to eat', once it is contaminated by foodborne pathogens such as Salmonella, the prospect for significant morbidity, mortality, and immeasurable economic losses can occur. Here we investigated the prevalence and concentration of Salmonella in 107 PRTEM samples collected from Shaanxi, China during 2015-2016. Furthermore, we analyzed the serotype, antibiotic susceptibility, and presence of antibiotic resistance genes and amino acid mutations in 219 Salmonella isolates, followed by subtyping of 115 representative isolates. The average detection rate of Salmonella-positive PRTEM was 58.9%, and the average most probable number (MPN) of Salmonella in positive samples was 2.27 logMPN per gram of sample (range: 2.10-2.43). Ten serotypes were identified from the 219 Salmonella isolates, with S. Thompson (37.9%) and S. Indiana (20.5%) being predominant. The remaining serotypes were S. Typhi (7.8%), S. Typhimurium (7.3%), S. Mbandaka (6.9%), S. Albany (6.4%), S. Blockley (5.5%), S. Infantis (4.1%), S. Escanaba (3.2%), and S. Dusseldorf (0.5%). All isolates were resistant to ceftiofur (100%), while most of them were resistant to ciprofloxacin (99.1%), amoxicillin-clavulanic acid (97.7%), trimethoprim-sulfamethoxazole (96.4%), ampicillin (92.3%), sulfisoxazole (92.2%), tetracyclines (90.4%), and nalidixic acid (90.4%), respectively. A single mutation of Ser83Phe (27.1%) and double mutations of Ser83Phe-Asp87Gly (25.9%) in GyrA were detected in 85 isolates, whereas mutations of Thr57Ser (63.9%) and Ser80Arg (36.1%) in ParC were detected in 122 isolates. qnrB, oqxAB, aac(6')-Ib, and qnrA were present in 50 (22.8%), 48 (21.9%), 26 (11.9%), and 1 (0.5%) isolate(s), respectively. Pulse field gel electrophoresis results revealed that those isolates recovered from the same type of PRTEM or the same sampling place shared identical or similar DNA profiles, antibiotic resistance phenotypes, and even plasmid-mediated quinolone resistance encoding genes. The findings indicate that Salmonella is commonly prevalent in PRTEMs at high concentrations in Shaanxi, China. More attention should be paid to the processing and storage of this ready-to-eat food to prevent bacterial contamination and foodborne outbreaks.

Impact of alcohol-based hand-gel sanitizer and hand hygiene advice on travellers' diarrhoea and colonization with extended-spectrum beta-lactamase-producing Enterobacteriaceae: A randomised, controlled trial

BACKGROUND

Travellers' diarrhoea (TD) is the most common health problem in international travellers. Besides being bothersome for the individual and a considerable economic burden for the public, TD is also known to be associated with becoming colonized with extended-spectrum β-lactamase (ESBL)-producing Enterobacteriacea. Despite the high frequency of TD cases, easy and effective preventive measures are lacking. The aim of this study was to assess the impact of using hand gel sanitizer on the incidence of TD and colonization with ESBL-producing Enterobacteriaceae.

METHOD

A multicentre randomized intervention trial studying the effect of hand gel sanitizer on the incidence of TD and colonization with ESBL-producing Enterobacteriaceae in travellers to Southeast Asia was performed.

RESULTS

The intention to treat analysis showed a reduction in the incidence of WHO TD in the intervention group (OR 0.54 (95% CI 0.30-0.97), p = 0.04). No effect was seen or the incidence of becoming colonized with ESBL-producing Enterobacteriaceae.

CONCLUSION

Using hand gel sanitizer might have a protective effect on the occurrence of TD. Based on the current data, education on the proper use appears to play a key role for its effectiveness.