Seek and ye shall find: Citrobacter in pre-cut veggies in a German hospital sickened 76

A foodborne outbreak of VIM carbapenemase-expressing Citrobacter freundii (CPC) occurred between February and June 2016 at a major university hospital in Germany.

An explosive increase of CPC isolated from rectal swabs of patients during weekly routine screening led to the declaration of an outbreak. A hospital-wide prevalence screening was initiated as well as screening of all patients on admission and before transfer to another ward, and canteen staff, patient rooms, medical and kitchen inventory and food. Swabs were streaked out on selective plates. All CPC isolates were analysed by mass spectrometry and selected isolates by whole-genome sequencing.

In total, 76 mostly unrelated cases in different wards were identified. The CPC was isolated from retained samples of prepared vegetable salads and puddings and from a mixing machine used to prepare them only after an overnight culture. The immediate ban on serving potential source food resulted in a sharp decline and finally disappearance of novel cases. Repeated testing of pre-sliced vegetables showed a high degree of contamination with C. freundii without a carbapenemase, indicating a possible source.

This report demonstrates that an explosive increase in carbapenemase-expressing Enterobacteriaceae contamination may be caused by a foodborne source, and suggests that pre-sliced vegetables have to be taken into account as a putative pathogen repository. It also underlines the importance of appropriate cooling, transport, re-heating and distribution of meals and indicates that probing of non-organic surfaces is limited by low sensitivity, which may be increased by additional overnight cultivation in appropriate media.

A nosocomial foodborne outbreak of a VIM carbapenemase-expressing Citrobacter freundii

15 January 2018

Clinical Infectious Diseases, https://doi.org/10.1093/cid/ciy034

Mathias Pletz, Antje Wollny, Ute-Heike Dobermann, Jurgen Rodel, Svetlana Neubauer, Claudia Stein, Christian Brandt, Anita Hartung, Alexander Mellmann, Sabine Edel, Vladimir Patchev, Oliwia Makarewicz, Jens Maschmann

https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciy034/4809943?redirectedFrom=PDF

Cilantro has a history of shits: Produce risk modelling in India

This study estimates illness (diarrhea) risks from fecal pathogens that can be transmitted via fecal-contaminated fresh produce. To do this, a quantitative microbial risk assessment (QMRA) framework was developed in National Capital Region, India based on bacterial indicator and pathogen data from fresh produce wash samples collected at local markets.

Produce wash samples were analyzed for fecal indicator bacteria (Escherichia coli, total Bacteroidales) and pathogens (Salmonella, Shiga-toxin producing E. coli (STEC), enterohemorrhagic E. coli (EHEC)). Based on the E. coli data and on literature values for Cryptosporidium and norovirus, the annual mean diarrhea risk posed by ingestion of fresh produce ranged from 18% in cucumbers to 59% in cilantro for E. coli O157:H7, and was <0.0001% for Cryptosporidium; for norovirus the risk was 11% for cucumbers and up to 46% for cilantro. The risks were drastically reduced, from 59% to 4% for E. coli O157:H7, and from 46% to 2% for norovirus for cilantro in post-harvest washing and disinfection scenario.

The present QMRA study revealed the potential hazards of eating raw produce and how post-harvest practices can reduce the risk of illness. The results may lead to better food safety surveillance systems and use of hygienic practices pre- and post-harvest.

Quantitative microbial risk assessment to estimate the risk of diarrheal diseases from fresh produce consumption in India

Food Microbiology, January 2018

Arti Kundu, Stefan Wuertz, Woutrina Smith

DOI: 10.1016/j.fm.2018.01.017 

http://www.x-mol.com/paper/530702

Confused consumers: Canadians say E. coli in romaine outbreak is over; U.S. says it’s leafy greens

Outbreaks of foodborne illness are fraught with uncertainties.

It’s OK to admit, to do the best with the info available, and get on with things.

On January 10, 2018, the Public Health Agency of Canada reported that an outbreak of Shiga toxin-producing E. coli O157:H7 infections (STEC O157:H7) they had identified was linked to romaine lettuce appears to be over.

As of January 10, 2018, there were 42 cases of E. coli O157 illness reported in five eastern provinces. Individuals became sick in November and early December 2017. Seventeen individuals were hospitalized. One individual died.

In the United States, the Centers for Disease Control, several states, and the U.S. Food and Drug Administration continue to investigate a multistate outbreak of 24 STEC O157:H7 infections in 15 states. Since CDC’s initial media statement on December 28, seven more illnesses have been added to this investigation. The last reported illness started on December 12, 2017.

The likely source of the outbreak in the United States appears to be leafy greens, but officials have not specifically identified a type of leafy greens eaten by people who became ill.  Leafy greens typically have a short shelf life, and since the last illness started a month ago, it is likely that contaminated leafy greens linked to this outbreak are no longer available for sale. Canada identified romaine lettuce as the source of illnesses there, but the source of the romaine lettuce or where it became contaminated is unknown.

Whole genome sequencing (WGS) showed that the STEC O157:H7 strain from ill people in the United States is closely related genetically to the STEC O157:H7 strain from ill people in Canada. WGS data alone are not sufficient to prove a link; health officials rely on other sources of data, such as interviews from ill people, to support the WGS link. This investigation is ongoing. Because CDC has not identified a specific type of leafy greens linked to the U.S. infections, and because of the short shelf life of leafy greens, CDC is not recommending that U.S. residents avoid any particular food at this time.

In the United States, a total of 24 STEC O157:H7 infections have been reported. Among the 18 ill people for whom CDC has information, nine were hospitalized, including one person in California who died. Two people developed hemolytic uremic syndrome, a type of kidney failure.

The Public Health Agency of Canada identified romaine lettuce as the source of the outbreak in Canada. In the United States, the likely source of the outbreak appears to be leafy greens, but health officials have not identified a specific type of leafy greens that sick people ate in common.

State and local public health officials continue to interview sick people in the United States to determine what they ate in the week before their illness started. Of 13 people interviewed, all 13 reported eating leafy greens. Five (56%) of nine ill people specifically reported eating romaine lettuce. This percentage was not significantly higher than results from a survey of healthy people in which 46% reported eating romaine lettuce in the week before they were interviewed.  Based on this information, U.S. health officials concluded that ill people in this outbreak were not more likely than healthy people to have eaten romaine lettuce.  Ill people also reported eating different types and brands of romaine lettuce. Currently, no common supplier, distributor, or retailer of leafy greens has been identified as a possible source of the outbreak. CDC continues to work with regulatory partners in several states, at the U.S. Food and Drug Administration, and the Canadian Food Inspection Agency to identify the source.

Although the most recent illness started on December 12, there is a delay between when someone gets sick and when the illness is reported to CDC. For STEC O157:H7 infections, this period can be two to three weeks. Holidays can increase this delay. Because of these reporting delays, more time is needed before CDC can say the outbreak in the United Stated is over. This investigation is ongoing.

Yup, they get into produce seeds, especially sprouts: Salmonella and E. coli internalization

Vegetable seeds contaminated with bacterial pathogens have been linked to fresh-produce-associated outbreaks of gastrointestinal infections. This study was undertaken to observe the physiological behavior of Salmonella enterica and enterohemorrhagic Escherichia coli (EHEC) cells artificially internalized into vegetable seeds during the germination process.

Surface-decontaminated seeds of alfalfa, fenugreek, lettuce, and tomato were vacuum-infiltrated with four individual strains of Salmonella or EHEC. Contaminated seeds were germinated at 25°C for 9 days, and different sprout/seedling tissues were microbiologically analyzed every other day. The internalization of Salmonella and EHEC cells into vegetable seeds was confirmed by the absence of pathogens in seed-rinsing water and the presence of pathogens in seed homogenates after post-internalization seed surface decontamination.

Results show that 317 (62%) and 343 (67%) of the 512 collected sprout/seedling tissue samples were positive for Salmonella and EHEC, respectively. The average Salmonella populations were significantly larger (P < 0.05) than the EHEC populations. Significantly larger Salmonella populations were recovered from the cotyledon and seed coat tissues, followed by the root tissues, but the mean EHEC populations from all sampled tissue sections were statistically similar, except in pre-germinated seeds. Three Salmonella and two EHEC strains had significantly larger cell populations on sprout/seedling tissues than other strains used in the study.

Salmonella and EHEC populations from fenugreek and alfalfa tissues were significantly larger than those from tomato and lettuce tissues. The study showed the fate of internalized human pathogens on germinating vegetable seeds and sprout/seedling tissues and emphasized the importance of using pathogen-free seeds for sprout production.

Fate of Salmonella enterica and Enterohemorrhagic Escherichia coli cells artificially internalized into vegetable seeds during germination

Appl. Environ. Microbiol. January 2018 84:e01888-17; Accepted manuscript posted online 27 October 2017, doi:10.1128/AEM.01888-17

Da Liu, Yue Cui, Ronald Walcott and Jinru Chen

http://aem.asm.org/content/84/1/e01888-17.abstract?etoc

 

 

21 sick with E. coli O157 from Romaine lettuce in Canada: What says LGMA?

The Sponge-Bob leafy greens cone of silence has once again been deployed with 21 sick from E. coli O157 linked to Romaine lettuce.

The Public Health Agency of Canada made the announcement Monday night, so it’s time for another edition of spokesthingy fairytales. The statements in italics are from the Public Health Agency of Canada. The comments below are mine.

The Public Health Agency of Canada is collaborating with provincial public health partners, the Canadian Food Inspection Agency and Health Canada.

How do you know a Canadian is making a presentation at a scientific conference? They spend half the talk noting collaborations.

At this time, there are no product recalls associated with this outbreak. The outbreak investigation is ongoing, and this public health notice will be updated on a regular basis as the investigation evolves.

We’ll see.

The risk to Canadians is low.

If you have no product recalls, no real clues other than some lettuce, how can you say the risk is low?

However, Canadians are reminded to follow safe food handling practices for lettuce to avoid becoming ill.

Washing does almost nothing to improve the safety of leafy greens, other than to remove the snot from an appropriately heightened 5-year-old and make consumers feel better.

Most people with an E. coli infection will become ill for a few days and then recover fully.

Unless you’re part of the percentage that has life-long health issues from eating a salad.

Some E. coli infections can be life threatening, though this is rare.

But it really sucks when it happens.

Currently, there are 21 cases of E. coli O157 illness under investigation in three provinces: Quebec (3), New Brunswick (5), and Newfoundland and Labrador (13).

These are not prime lettuce growing areas in Canada, in November.

Individuals became sick in November 2017. Ten individuals have been hospitalized.

No deaths have been reported.

See, no biggie. But this was issued Dec. 11. 2017. So was it early November or late November. The difference is hugely significant when assessing the timeliness of the announcement.

The Canadian Food Inspection Agency is working with public health officials to determine the source of the romaine lettuce that ill individuals were exposed to.
Which will be buried and vaguely released in some journal article a couple of years from now.
The following food safety tips for lettuce will help you reduce your risk of getting an E. coli infection.

  • Wash your hands thoroughly with warm water and soap for at least 20 seconds, before and after handling lettuce.

Water temperature doesn’t matter.

  • Discard outer leaves of fresh lettuce.
  • Wash your unpackaged lettuce under fresh, cool running water. There is no need to use anything other than water to wash lettuce. Washing it gently with water is as effective as using produce cleansers.

And neither are effective at removing pathogens.

  • Keep rinsing your lettuce until all of the dirt has been washed away.
  • Don’t soak lettuce in a sink full of water. It can become contaminated by bacteria in the sink.
  • Ready-to-eat lettuce products sold in sealed packages and labelled as washed, pre-washed or triple washed do not need to be washed again.
  • Use warm water and soap to thoroughly wash all utensils, countertops and cutting boards before and after handling lettuce to avoid cross-contamination.
  • Store lettuce in the refrigerator for up to seven days. Discard when leaves become wilted or brown.
  • Bagged, ready-to-eat, pre-washed lettuce products should also be refrigerated and used before the expiration date.

The Government of Canada is committed to food safety.

The Government of Canada is committed to creating a perception of commitment to food safety.

The Public Health Agency of Canada leads the human health investigation into an outbreak and is in regular contact with its federal and provincial partners to monitor the situation and to collaborate on steps to address the outbreak.

Thanks for the org-chart update.

This is nothing but crass industry-government-academia politico ass-covering.

At some point, the people barfing would probably appreciate something just a tad more human.

Cut means increased risk: 18 sick in Salmonella outbreak in Oregon, Washington linked to pre-cut fruit

Brad Schmidt of The Oregonian reports that 18 people in Washington and Oregon have been diagnosed with Salmonella after eating pre-cut fruit purchased from local grocery stores, prompting a review by state and federal health authorities.

Officials in both states have traced the outbreak to pre-cut watermelon, cantaloupe and fruit mixes containing those fruits. The products were purchased from Fred Meyer, QFC, Rosauers and Central Market.

Anyone who bought those products from those stores between Oct. 25 and Dec. 1 is urged to throw out the fruit.

“They should not eat it,” said Jonathan Modie, a spokesman for the Oregon Health Authority.

Just two of the 18 confirmed cases happened in Oregon, Modie said, with one in Multnomah County and one in Wasco County. Both people ate fruit purchased from Fred Meyer, he said, and the products carried Fred Meyer labels.

A spokesman for Fred Meyer, Jeffrey Temple, said the grocer pulled pre-cut watermelon and cantaloupe from store shelves in response to Friday’s advisory by the state of Washington.

Customers can return items to local stores for a full refund.

“Our highest priority is our customer’s safety and the safety of our food,” Temple said in a statement. “We will continue to work closely with state and federal health officials on their investigation to determine the source of this outbreak.” 

Uh-huh.

 

Hospitals should watch their litigation backside if growing their own produce with no safety talk

I’m not Debbie Downer, but I am Dougie Downer and never get invited to dinner.

This idea has risk written all over it.

Sarah Toy of USA Today writes that high atop the roof of a Boston hospital power plant in the middle of the city, you’ll find something unexpected: A 7,000-square-foot oasis with a lush carpet of green, rows upon rows of mesclun, kale, rainbow chard and a sea of plump green and red tomatoes.

Sounds good, has all the buzzwords except the one that I and anyone serving meals to immunocompromised people in hospitals should care about: microbiologically safe.

“There is an increasing trend in hospital farms,” said Stacia Clinton, the national program director for Health Care Without Harm’s Healthy Food in Health Care program, which advises hospitals on ways to provide sustainable and nutritious food. “There’s a greater demand now for people to know where their food is coming from, and hospitals are looking for ways to connect people to their food more directly.”

No mention of produce food safety.

If it’s growing on roofs, birds –Salmonella and Campylobacter factories – are crapping on the stuff, and washing does almost nothing.

Disgruntled contractor allegedly sprays poop on produce in S. Carolina

WYFF 4 reports a disgruntled contractor sprayed what investigators told employees was apparently feces on produce at a West Ashley Harris Teeter, officials with the supermarket said.

Charleston police said 41-year-old Pau S. Hang has been arrested and charged with damage to personal property. Police say Hang has been on trespass notice for the store.

“The suspect is accused of spraying a brown liquid from a spray bottle onto some of the produce in the store,” CPD officials said. “Police don’t know the type of liquid that was used.”

According to Harris Teeter officials, the suspect attempted to contaminate food in the produce department and the fresh foods department inside the store in the St. Andrews Shopping Center in Charleston.

Lunar module to control that E. coli

Escherichia coli O157:H7 is an important foodborne pathogen that causes severe bloody diarrhea, hemorrhagic colitis, and hemolytic uremic syndrome.

Ruminant manure is a primary source of E. coli O157:H7 contaminating the environment and food sources. Therefore, effective interventions targeted at reducing the prevalence of fecal excretion of E. coli O157:H7 by cattle and sheep and the elimination of E. coli O157:H7 contamination of meat products as well as fruits and vegetables are required.

Bacteriophages offer the prospect of sustainable alternative approaches against bacterial pathogens with the flexibility of being applied therapeutically or for biological control purposes.

This article reviews the use of phages administered orally or rectally to ruminants and by spraying or immersion of fruits and vegetables as an antimicrobial strategy for controlling E. coli O157:H7. The few reports available demonstrate the potential of phage therapy to reduce E. coli O157:H7 carriage in cattle and sheep, and preparation of commercial phage products was recently launched into commercial markets.

However, a better ecological understanding of the phage E. coli O157:H7 will improve antimicrobial effectiveness of phages for elimination of E. coli O157:H7 in vivo.

Use of bacteriophages to control Escherichia coli O157:H7 in domestic ruminants, meat products, and fruit and vegetables

Foodborne Pathogens and Disease, June 2017, ahead of print, Wang Lili, Qu Kunli, Li Xiaoyu, Cao Zhenhui, Wang Xitao, Li Zhen, Song Yaxiong, and Xu Yongping, https://doi.org/10.1089/fpd.2016.2266

http://online.liebertpub.com/doi/abs/10.1089/fpd.2016.2266