Assessment of the Microbiological Acceptability of Akkawi Cheese in Beirut and the Antimicrobial Resistance Profiles of Associated Escherichia coli

Abstract

Lebanon, like many other developing countries, suffers from the toll of emerging foodborne pathogens and antibiotic resistance within its food systems. Very little data is collected on the presence of foodborne pathogens in different types of food. Furthermore, research on the emergence and dissemination of antibiotic resistance within different food systems remain limited. For that purpose, this study focused on Akkawi cheese a popular local food item. The objective of the study was to evaluate the microbiological acceptability of Akkawi cheese from different retail stores in Beirut. This was done by assessing the densities of Escherichia coli and fecal coliforms, which are indicators of fecal pollution, as well as Staphylococcus aureus, which is an indicator of hygiene. The objective of the study was also to assess the antibiotic resistance phenotypes of the isolated E. coli. 50 Akkawi cheese samples and 13 brine samples were collected from different retail stores from 9 different districts of Beirut. A total of 135 E. coli strains were isolated: 118 (87.4%) were isolated from the cheese samples and 17 (12.6%) were isolated from the brine samples. Antimicrobial susceptibility testing, using the disk diffusion assay, revealed overall resistance of E. coli to penicillin (100%), ampicillin (68.1%), amoxicillin-clavulanate (88.1%), cefepime (21.5%), cefotaxime (43.0%), cephalexin (63.0%), cefixime (18.5%), doripenem (34.8%), meropenem (34.8%), imipenem (17.0%), gentamicin (40.0%), kanamycin (35.6%), streptomycin (57.8%), tetracycline (40.7%), ciprofloxacin (4.4%), norfloxacin (4.4%), trimethoprim-sulfamethoxazole (46.7%), and chloramphenicol (28.2%). But also, of the 135 E. coli isolates, 102 isolates (75.6%) were multidrug resistant (MDR). Furthermore, 2 mecA methicillin-resistant Staphylococcus aureus (MRSA) strains were detected in one of the cheese samples. These findings revealed critically high levels of multidrug resistance in Lebanese food systems. Multidrug resistant infections are on the rise, and they are difficult to treat using conventional antibiotics. And the fact that high levels of multidrug resistant E. coli were detected, means that other multidrug pathogens are likely to be present in dairy food systems as well as other food systems. The presence of high levels of multidrug resistance within Lebanese food systems contributes to an effective dissemination and circulation of antibiotic resistance within the community. Failure to act fast will result in a major public health crisis.