Comparative Assessment of Carriage Rates and Risk Factors of Carbapenem-Resistant Enterobacterales among Community- and Hospital-Based Food Handlers in Urban Lagos, Nigeria

Abstract

Background: Carbapenem-resistant Enterobacteriaceae (CRE) are globally recognized as critical multidrug-resistant pathogens with limited treatment options, high transmission potential, and significant public health impact. Aims: The study aims to compare faecal carriage rates of CRE among community food handlers (CFHs) and hospital-based food handlers (HCFHs) in urban Lagos, Nigeria, and to identify socio-demographic and behavioral risk factors associated with colonisation. Study Design: This is a Cross-sectional study. Place and Duration of Study: The study was conducted at Ikeja Local Government Area of Lagos State, Nigeria and Lagos State University Teaching Hospital Nigeria, between April 2022 and March 2023. Methodology: Stool samples were collected from 240 healthy community food handlers (CFH) and 60 healthy hospital food handlers (HFH) among 300 food handlers in Ikeja, Lagos. Stool samples were cultured for Enterobacterales and screened for CRE using standard microbiological methods. Phenotypic confirmation of CRE was performed using EUCAST-recommended combination disk tests. Structured questionnaires captured data on demographics, medical history, occupational exposures, and hygiene practices. Associations between potential risk factors and CRE carriage were assessed using statistical analysis. Results: From 300 food handlers, 9 (3.0%) were CRE carriers. Colonization was detected in 6 of 240 CFHs (2.3%) and 3 of 60 HCFHs (4.4%), with no statistically significant difference (p > 0.05); however, resistance gene profiling revealed that K. pneumoniae harbored the full range of resistance genes (KPC, MBL, and OXA-48), whereas E. coli carried only MBL alone or MBL combined with OXA-48. Most carriers (67.7%) had ≤6 years of work experience, and the majority (55.6%) had completed high school education. No significant associations were observed with age, education, comorbidities, prior hospitalization, or travel history. However, significant associations were found between CRE carriage and inadequate hygiene practices, including inconsistent handwashing with soap and water (p = 0.0072), taking work uniforms home (p = 0.0002), and reusing gloves for both raw and cooked food (p = 0.011). Notably, 88.9% of CRE-positive handlers lacked formal food hygiene training. Hygiene-related practices were the only statistically significant predictors of CRE carriage. Conclusion: CRE carriage among food handlers in Lagos is relatively low but higher among hospital-based handlers. Inadequate hygiene practices rather than demographic or medical factors were key predictors of carriage. Strengthened food safety training, infection prevention strategies, and antimicrobial stewardship are urgently needed to mitigate the risk of CRE dissemination from food handlers to the wider community.