Pathologenic multi-drug resitant escherichia coli from foodhandlers workiing in selected tourist hotels in Nairobi, Kenya

Abstract

Tourism, an important resource for socio-economic development in Kenya faces great challenges, by among other factors travelers diarrhoea. Contagious diarrheal diseases contribute significantly in the morbidity and mortality to people of all age groups, race and diverse locations especially in developing countries. Escherichia coli (E. coli) strains such as Enteroaggregative Escherichia coli (EAEC), Enterotoxigenic Escherichia coli (ETEC), Enterohemorrhagic Escherichia coli (EHEC) and Enteropathogenic Escherichia coli (EPEC) are aetiologically associated with traveler's diarrhea. Consumption of contaminated foods and water are implicated as the main route of transmission. Food handlers in tourist destination hotels could, therefore, play a significant role in the epidemiology of pathogenic Escherichia coli. The study sought to determine the prevalence of pathogenic Escherichia coli among the 885 consenting food handlers; including waiters, cooks, chefs, barmen, butchers and delivery personnel working in nine selected tourist hotels in Nairobi. In addition antibiotic resistant profiles, toxins and conjugation assays of the isolated Escherichia coli were determined. Thirty nine (4.4%) food handlers were infected with 1.8% EAEC, 1.2% ETEC, 1.1% EPEC and 0.2% EHEC. 61.5% and 38.5% of these pathotypes were isolated from diarrheal and nondiarrheal stool respectively. Food handlers (14.4%) from hotel-4 accounted for most of the pathogenic infection than any other hotel (P = 0.019). Sexes and ages of food handlers was not significantly associated with infection by pathogenic Escherichia coli (P = 0.256 and P = 0.126 respectively). All the EPEC had eaeA toxin genes, ETEC had STp and LT toxin genes, EAEC had aggR genes and LT toxin type while EHEC the stx2 toxin genes. Similarly 5.1% of the isolated serotypes were the virulent or more transmissible 0157:H7 strains. 15.4% Escherichia coli isolates were resistant to amoxicillin-Clavulanic acid, 8.7% to ampicillin, 53.8% sulphamethaxazol/trimethroprim and 56.4% tetracycline. While over 61.5% of these isolates were resistant to more than two different drug regimens. A total of 89.7% Escherichia coli isolates had plasmids ranging in size from 6-100 MDa of which 87.2% were able conjugate with recipient Escherichia coli K12F-NAr LA giving plasmids ranging in size from 4.5 to 58 MDa. This study illustrates that food handlers working in some tourist hotels in Nairobi are both symptomatic and asymptomatic carriers of multi-drug resistant and toxin expressing pathogenic Escherichia coli and are eminent danger in the transmission of traveler's diarrhea both to the local and foreign tourist. The government needs to review the Public Health Act and enhance surveillance systems for prompt detection of pathogenic E. coli. Further, there is the need to develop rapid kits for detection of these strains and genetically map the untypable isolates in Kenya