Antimicrobial Resistant Staphylococcus spp., Escherichia coli, and Salmonella spp. in Food Handlers: A Global Review of Persistence, Transmission, and Mitigation Challenges

Abstract

Antimicrobial resistance in foodborne pathogens represents a critical global health challenge, with food handlers serving as key contributors in their transmission. This comprehensive review synthesizes evidence on the prevalence, transmission dynamics, and antimicrobial resistance patterns of three major pathogens, Staphylococcus spp., Escherichia coli, and Salmonella spp., among food handlers worldwide. Analysis of studies across diverse geographical regions reveals considerable variation in colonization rates, with Staphylococcus spp. prevalence ranging from 19.5% to 95.0%, Escherichia coli from 2.8% to 89.3%, and Salmonella spp. from 0.07% to 9.1%. Resistance profiles demonstrate alarming trends, including widespread β-lactam resistance and emerging resistance to last-resort antibiotics like carbapenems. Particularly concerning is the high occurrence of multidrug resistant (MDR) strains and extended spectrum β-lactamase (ESBL) producers in low- and middle-income countries. This review identified inadequate handwashing, poor hygiene infrastructure, and asymptomatic carriage as critical factors facilitating the transmission of antimicrobial resistant strains. These findings underscore the urgent need for enhanced surveillance systems, targeted decolonization strategies, improved hygiene protocols, and food handler education to mitigate the spread of resistant pathogens through the food chain.

Keywords: antibiotic resistance; food safety; foodborne pathogens; hygiene practices; one health.

Figure 1

The image illustrates the role of the food handlers within two distinct yet interconnected cycles. On the left, the food handler is depicted as a potential source of food contamination, alongside other contributors such as animals, raw ingredients, water, airborne and soil particles, utensils, and packaging materials. On the right, the diagram highlights the food handler’s involvement in the epidemiological cycle of antimicrobial-resistant bacteria dissemination. This cycle encompasses several interacting factors, including the use of antimicrobials in agricultural and healthcare settings, which contributes to the production of contaminated sewage originating from hospitals, slaughterhouses, households, and industrial facilities. Such waste leads to environmental contamination—affecting water sources, soil, animals and crops—which may, in turn, result in the consumption of contaminated food products. Critically, the food handler plays an active role in this dynamic when working in restaurants, street food stalls, or similar environments, where improper handling practices may lead to the contamination of various types of food. When such foods are consumed raw or are insufficiently cooked, the contamination can reach the consumer directly, thereby contributing to the transmission of pathogenic and antimicrobial-resistant bacteria.