Probabilistic model for the estimation of the consumer exposure to methicillin-resistant Staphylococcus aureus due to cross-contamination and recontamination

The presence of multidrug-resistant bacteria like methicillin-resistant Staphylococcus aureus (MRSA) in retail meat is one of the current concerns of the public health authorities. Bacterial cross-contamination and recontamination during household food preparation could play an important role in the dissemination of such bacteria, and therefore could contribute to a serious health problem, more specifically for immunocompromised people. In order to evaluate the importance of such events, a probabilistic model was developed to estimate the likelihood and extent of cross-contamination and recontamination and the burden of MRSA from contaminated raw chicken meat via hands and kitchen utensils in a serving (consisting on a slice of bread and a piece of grilled chicken meat) during a household barbecue in Germany. A modular design was used, taking into account the chronological order of the routines during the barbecue event, and Monte Carlo simulations were applied. Available data on the prevalence and burden of MRSA in chicken meat at retail in Germany were used as starting point and were incorporated in the model as probability distributions. The probabilities and extent of bacterial transfer between food items and kitchen utensils (referred to as "Objects") and the routines performed during food preparation (referred to as "Actions") specified by their probabilities of occurrence were incorporated as the main input parameters. The model was set up in R 3.5.0 and converted to a standardized format (FSKX file). Therefore, the code can be easily accessed, evaluated, modified, and reused for different purposes. The present study contributes to the quantification of consumer exposure to MRSA through food consumption once contaminated food has entered the household kitchen. Even when the MRSA prevalence and bacterial load in retail chicken meat in Germany are low, resistant bacteria can reach the consumer due to cross-contamination and recontamination events. The results show that the probability of one CFU to be transferred from the contaminated raw chicken meat to the final serving and the number of MRSA bacteria transferred due to cross-contamination and recontamination events are in general low, being the contamination of the final serving more likely to occur via bread, rather than via grilled chicken. The results show that the prevalence of MRSA at retail highly influences the probability of the final serving to be contaminated. However, this study also highlights the importance of keeping good hygiene practices during the household food manipulation for reducing the spread of MRSA. The provision of the model in a standardized data format will allow an easy incorporation of the developed model into a complete quantitative microbial risk assessment model that will greatly help to estimate the risk of consumer exposure to MRSA through the consumption of contaminated food.