Oundo Joseph O, Kariuki Samuel M, Boga Hamadi I, Muli Faith W, Iijima Yoshio
Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
J Travel Med. 2008 Jan-Feb;15(1):31-8. doi: 10.1111/j.1708-8305.2007.00174.x.
Contaminated food and water are acknowledged vehicles for the transmission of travelers' diarrhea (TD). Importance of food handlers as reservoirs of enteroaggregative Escherichia coli (EAEC), enteropathogenic E coli (EPEC), and Shiga toxin-producing E coli (STEC) causing TD has not been clearly demonstrated.
We undertook a 1-year prospective study to determine the presence and selected risk factors of carriage of EAEC, EPEC, and STEC by 1,399 food handlers working in tourist hotels in three popular tourist destinations of Kenya. Enterotoxigenic E coli (ETEC) was not sought in this study.
During the period April 2003 to May 2004, EAEC harboring the aggR gene were detected from 29 (2.1%) subjects and EPEC harboring the eaeA gene and STEC harboring the stx2 gene were detected from 11 (0.8%) and 2 (0.1%) of the study subjects, respectively. Mean age of subjects with EAEC was significantly lower (24.6 y) than the rest of the study population (28.2 y) (p < 0.05). Pit latrines usage was significantly associated with the isolation of EAEC (<0.001) but not with EPEC and STEC. Four of the 29 EAEC isolates were sensitive to all antibiotics tested, and 19 (65.5%) were multidrug resistant (MDR). Antibiotic resistance varied from 6.9% for cefuroxime to 72.4% for co-trimoxazole. Six EPEC isolates (6/13, 46.2%) showed multidrug resistance. Cluster analysis of the pulsed-field gel electrophoresis (PFGE) profiles showed that the EAEC isolates belonged to two clonally unrelated genotypes.
We conclude that food handlers working in tourist hotels are important carriers of EAEC that could cause TD and a high proportion of the EAEC are MDR. The isolation of MDR EAEC from food handlers working in tourist hotels is of potential public health importance. There is a need for a study employing molecular methods including PFGE to examine carriage of similar pathogens in food handlers, processed foods, and travelers consuming the food who develop diarrhea.
受污染的食物和水是公认的旅行者腹泻（TD）传播媒介。食物处理人员作为引起TD的肠聚集性大肠杆菌（EAEC）、肠致病性大肠杆菌（EPEC）和产志贺毒素大肠杆菌（STEC）储存宿主的重要性尚未得到明确证实。
我们进行了一项为期1年的前瞻性研究，以确定在肯尼亚三个热门旅游目的地的旅游酒店工作的1399名食物处理人员中EAEC、EPEC和STEC的携带情况及选定的风险因素。本研究未检测产肠毒素大肠杆菌（ETEC）。
在2003年4月至2004年5月期间，分别从29名（2.1%）受试者中检测到携带aggR基因的EAEC，从11名（0.8%）和2名（0.1%）受试者中检测到携带eaeA基因的EPEC和携带stx2基因的STEC。携带EAEC的受试者的平均年龄（24.6岁）显著低于其他研究人群（28.2岁）（p<0.05）。使用坑式厕所与EAEC的分离显著相关（<0.001），但与EPEC和STEC无关。29株EAEC分离株中有4株对所有测试抗生素敏感，19株（65.5%）为多重耐药（MDR）。抗生素耐药率从头孢呋辛的6.9%到复方新诺明的72.4%不等。6株EPEC分离株（6/13，46.2%）表现出多重耐药。脉冲场凝胶电泳（PFGE）图谱的聚类分析表明，EAEC分离株属于两种克隆无关的基因型。
我们得出结论，在旅游酒店工作的食物处理人员是可能导致TD的EAEC的重要携带者，且很大比例的EAEC为多重耐药。从在旅游酒店工作的食物处理人员中分离出多重耐药EAEC具有潜在的公共卫生重要性。有必要开展一项采用包括PFGE在内的分子方法的研究，以检查食物处理人员、加工食品以及食用这些食品后出现腹泻的旅行者中类似病原体的携带情况。
