Prevalence of multidrug-resistant Salmonella on ready-to-eat betel leaves (Paan) and in water used for soaking betel leaves in North Indian cities.

The purpose of this study was to determine the prevalence of Salmonella in the water used by Paan vendors in 11 North Indian cities. The analysis of 776 water samples and 120 samples each of preprocessed Paan (from vendor stock) and ready-to-eat Paan collected from Bareilly revealed that four of the ready-to-eat Paan and 34 of the water samples contained multidrug-resistant Salmonella strains. The isolates belonged to five different serovars, i.e., Salmonella Newport (1), Salmonella Paratyphi B (1), Salmonella Teko (1), Salmonella Virchow (3), and Salmonella Saintpaul (32), and could also be classified into 18 different resistotypes. All of the isolates were sensitive to cotrimoxazole, and 97.27% of the isolates were sensitive to chloramphenicol, imipenem, ciprofloxacin, ceftriaxone, and neomycin. Multidrug resistance (against 5 to 18 antibiotics) was common, particularly for nalidixic acid (65.79%), cephalothin (68.42%), cefoperazone (57.89%), sulfamethizole (52.63%), furazolidone (65.79%), kanamycin (68.42%), doxycycline (50.00%), and cefotaxime (44.74%). Bacteriological analysis of 16 Salmonella-positive and 23 Salmonella-negative samples revealed that the presence of Salmonella in water samples had a negative correlation (r = -0.35) with coliform counts and a positive correlation (r = 0.55) with nonlactose fermenter counts. We determined that centrifugation was a rapid and cheap method for concentrating large samples of Salmonella. The presence of multidrug-resistant strains of zoonotic Salmonella on ready-to-eat Paan is a public health concern and may be one of the factors responsible for the hyperendemic status of salmonellosis in India.