Real-life food-safety behavior and incidence of foodborne infections in solid organ transplant recipients

Abstract

Food‐safety measures are recommended in solid organ transplant (SOT) recipients. However, the actual adherence of patients in a real‐life setting and the impact on the incidence of foodborne infections remain largely unexplored. We performed a survey among SOT recipients followed at our institution, aiming to evaluate their food‐safety behavior. We assessed the incidence of microbiologically proven foodborne infections by chart review. One hundred ninety‐seven SOT recipients (kidney = 117, lung = 35, liver = 29, and heart = 16) participated in the survey. Overall, 17.7% of the participants observed all food‐safety recommendations (22.0% avoided food at risk of contamination while 67.9% applied hygiene recommendations). Patients within the first year after transplantation (odds ratio [OR] 5.42; P = .001) and females (OR 4.67; P = .001) followed food‐safety recommendations more closely. Although the majority of SOT recipients felt concerned and actively sought information on food safety (68%‐70%), only 27% were able to recognize all risks of foodborne infection in hypothetical scenarios. Incidence of proven foodborne infections was 17.9% (95% confidence interval 9.9%‐30.9%) 5 years after transplantation. Importantly, foodborne infections occurred exclusively among patients not following food‐safety recommendations. In summary, most SOT recipients eat foods that make them at risk of foodborne infections. Our results indicate that there is room for improvement in patient education, particularly later after transplantation, and reinforce current food‐safety recommendations.

Approaches to safe living and diet after solid organ transplantation

“…The effects of chronic immunosuppression can weaken the defenses of the gut‐associated lymphoid tissue, thereby allowing foodborne pathogens to penetrate the gastrointestinal tract and enter the body 52 . The incidence of foodborne illness among adult solid organ transplant recipients has been reported to be approximately 18% in the first 5 years post‐transplant and is likely to be even higher in children 53 . In addition to being more susceptible to contracting a foodborne illness, immunosuppressed children have reduced ability to fight the foodborne pathogen once infected and, therefore, are more likely to experience serious illness or death 54 .…”

“…Analysis of recent trends in foodborne illness by the CDC Foodborne Diseases Active Surveillance Network (FoodNet) indicates that infections from poultry contaminated by Camplyobacter or Salmonella and raw produce contaminated by Cyclospora are also on the rise 50 . A recent Swiss study discovered that the incidence of Campylobacter among solid organ transplant recipients was 8 to 40 times higher than in the general population 53 . Multi‐center studies focused on global foodborne illness trends among pediatric transplant recipients would be beneficial in order to identify the pathogens that pose the biggest threat to this population.…”

“…Studies show that the education provided at the time of transplantation is variable in quality and content, and the food safety knowledge and practices of the majority of transplant recipients may not be optimal. One study of 197 kidney, lung, liver, and heart transplant recipients reported that only a small minority (17.7%) consistently followed food safety guidelines, and microbiologically proven foodborne infections occurred only among the subset of patients who did not follow food safety guidelines 64 . Another study reported that while 67% of transplant recipients owned a food thermometer, only 44% of patients used it while cooking poultry and 0% used it while cooking hamburgers or reheating leftovers 54 .…”

“…52 The incidence of foodborne illness among adult solid organ transplant recipients has been reported to be approximately 18% in the first 5 years post-transplant and is likely to be even higher in children. 53 In addition to being more susceptible to contracting a foodborne illness, immunosuppressed children have reduced ability to fight the foodborne pathogen once infected and, therefore, are more likely to experience serious illness or death. 54 For example, children who contract Norovirus after solid organ transplant have extended periods of viral shedding and suffer from prolonged diarrhea and more severe outcomes in comparison with non-immunosuppressed children.…”

“…50 A recent Swiss study discovered that the incidence of Campylobacter among solid organ transplant recipients was 8 to 40 times higher than in the general population. 53 Multi-center studies focused on global foodborne illness trends among pediatric transplant recipients would be beneficial in order to identify the pathogens that pose the biggest threat to this population. guidelines, the AAP has issued a policy statement strongly recommending that all infants and children consume only pasteurized milk and milk products, and they also endorse a ban on the sale of raw milk products throughout the United States.…”