Antibiotic resistance strains in ready to eat foods from hospital and community in Rome, Italy: where are more widespread and what implications?

Background The surveillance data on antimicrobial resistance, collected by the European Antimicrobial Resistance Surveillance Network, show the rise and spread of antibiotic resistance in Europe as an important public health concern. Currently, one of the main routes of transmission of resistant pathogens is represented by ready to eat foods, animal and vegetable, whose raw materials are occasionally treated with antibiotics in order to preserve their characteristics. The aim of this study was comparing the differences in antibiotic resistance in Enterobacteriaceae from community and hospital canteens in Rome, Italy and analyzing the potential implications. Methods All food samples were analyzed according to the ISO 21528-1. The genus, species and the corresponding susceptibility testing were performed using ID32ETM Automated System and ATBTM strips read by mini API . Univariate analysis was performed to assess the associations between antibiotic resistance and the two kind of environment. Results A total of 325 food samples (238 from community and 87 from hospital) were analyzed, 94 (29%) of those were positive for Enterobacteriaceae. The prevalence of positivity in community canteens was 33.2% (N = 79) while the prevalence of positivity in hospital canteens was 17.2% (N = 15). Resistance to cephalothin was observed in 80.9% of cases, followed by ticarcillin in 64.9%, cefotaxime in 56.4% and cefuroxime in 53.2%. Concerning the differences between the two scenarios, the prevalence of strains resistant to piperacillin (p = 0.01), ticarcillin (p = 0.01), cefotaxime (p = 0.03) and cefuroxime (p = 0.03) in the community samples was higher than in the hospital ones. Although the differences were not significant, even for the other antibiotics, the prevalence of resistance in the community samples was greater than in the hospital ones. Conclusions This significant higher prevalence of strains resistant to several antibiotics in the community samples allows deducing that the hospital environment is much safer than the community one, as regards the spread of antibiotic resistance through food. Monitoring this public health issue in the community food production enables to protect those who need antibiotic treatment, especially hospitalized patients who often contract opportunistic infections.