High Rate of Acquisition but Short Duration of Carriage of Multidrug-Resistant Enterobacteriaceae After Travel to the Tropics.

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Abstract

Multidrug-resistant Enterobacteriaceae (MRE) are widespread in the community, especially in tropical regions. Travelers are at risk of acquiring MRE in these regions, but the precise extent of the problem is not known.

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Most cited references 14

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Extended-spectrum beta-lactamase-producing Enterobacteriaceae: an emerging public-health concern.

Johann Pitout, Kevin B Laupland (2008)

The medical community relies on clinical expertise and published guidelines to assist physicians with choices in empirical therapy for system-based infectious syndromes, such as community-acquired pneumonia and urinary-tract infections (UTIs). From the late 1990s, multidrug-resistant Enterobacteriaceae (mostly Escherichia coli) that produce extended-spectrum beta lactamases (ESBLs), such as the CTX-M enzymes, have emerged within the community setting as an important cause of UTIs. Recent reports have also described ESBL-producing E coli as a cause of bloodstream infections associated with these community-onset UTIs. The carbapenems are widely regarded as the drugs of choice for the treatment of severe infections caused by ESBL-producing Enterobacteriaceae, although comparative clinical trials are scarce. Thus, more rapid diagnostic testing of ESBL-producing bacteria and the possible modification of guidelines for community-onset bacteraemia associated with UTIs are required.

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Foreign travel is a major risk factor for colonization with Escherichia coli producing CTX-M-type extended-spectrum beta-lactamases: a prospective study with Swedish volunteers.

Thomas Tängdén, Otto Cars, Åsa Melhus … (2010)

Foreign travel has been suggested to be a risk factor for the acquisition of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. To our knowledge, this has not previously been demonstrated in a prospective study. Healthy volunteers traveling outside Northern Europe were enrolled. Rectal swabs and data on potential travel-associated risk factors were collected before and after traveling. A total of 105 volunteers were enrolled. Four of them did not complete the study, and one participant carried ESBL-producing Escherichia coli before travel. Twenty-four of 100 participants with negative pretravel samples were colonized with ESBL-producing Escherichia coli after the trip. All strains produced CTX-M enzymes, mostly CTX-M-15, and some coproduced TEM or SHV enzymes. Coresistance to several antibiotic subclasses was common. Travel to India was associated with the highest risk for the acquisition of ESBLs (88%; n = 7). Gastroenteritis during the trip was an additional risk factor (P = 0.003). Five of 21 volunteers who completed the follow-up after 6 months had persistent colonization with ESBLs. This is the first prospective study demonstrating that international travel is a major risk factor for colonization with ESBL-producing Enterobacteriaceae. Considering the high acquisition rate of 24%, it is obvious that global efforts are needed to meet the emergence and spread of CTX-M enzymes and other antimicrobial resistances.

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Colonisation with Escherichia coli resistant to "critically important" antibiotics: a high risk for international travellers.

K. Kennedy, P. Collignon (2010)

Antimicrobial resistance among community-acquired isolates of Escherichia coli is increasing globally, with international travel emerging as a risk for colonisation and infection. The aim was to determine the rate and duration of colonisation with resistant E. coli following international travel. One hundred and two adult hospital staff and contacts from Canberra, Australia, submitted perianal/rectal swabs before and following international travel. Swabs were cultured selectively to identify E. coli resistant to gentamicin, ciprofloxacin and/or third-generation cephalosporins. Those with resistant E. coli post-travel were tested monthly for persistent colonisation. Colonisation with antibiotic-resistant E. coli increased significantly from 7.8% (95% confidence interval [CI] 3.8-14.9) pre-travel to 49% (95% CI 39.5-58.6) post-travel. Those colonised were more likely to have taken antibiotics whilst travelling; however, travel remained a risk independent of antibiotic use. Colonisation with resistant E. coli occurred most frequently following travel to Asia. While over half of those carrying resistant E. coli post-travel had no detectable resistant strains two months after their return, at least 18% remained colonised at six months. Colonisation with antibiotic-resistant E. coli occurs commonly after international travel, and can be persistent. Medical practitioners should be aware of this risk, particularly when managing patients with suspected Gram-negative sepsis.

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Author and article information

Journal

Journal ID (iso-abbrev): Clin. Infect. Dis.

Title: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

ISSN (Electronic): 1537-6591

ISSN (Print): 1058-4838

Publication date (Electronic): Aug 15 2015

Volume: 61

Issue: 4

Affiliations

[1 ] Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat, Laboratoire de Bactériologie Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137 Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité

[2 ] Département d'Epidémiologie et Recherche Clinique, AP-HP, Hôpital Bichat, URC Paris-Nord INSERM, CIC 1425-EC, UMR 1123 Université Paris Diderot, UMR 1123, Sorbonne Paris Cité

[3 ] Institut Pasteur, Centre Médical, Centre d'Infectiologie Necker-Pasteur.

[4 ] Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat, Laboratoire de Bactériologie.

[5 ] Département d'Epidémiologie et Recherche Clinique, AP-HP, Hôpital Bichat, URC Paris-Nord INSERM, CIC 1425-EC, UMR 1123.

[6 ] AP-HP, Hôpital Bichat.

[7 ] AP-HP, Hôpital Saint-Antoine, Maladies Infectieuses et Tropicales, Paris.

[8 ] AP-HP, Hôpital de Bicêtre, Maladies Infectieuses et Tropicales, Le Kremlin-Bicêtre.

[9 ] AP-HP, Hôpital Avicenne, Maladies Infectieuses et Tropicales, Bobigny.

[10 ] AP-HP, Hôpital Tenon, Maladies Infectieuses et Tropicales, Paris.

[11 ] Département d'Epidémiologie et Recherche Clinique, AP-HP, Hôpital Bichat, URC Paris-Nord.

[12 ] Institut de Veille Sanitaire, Saint Maurice.

[13 ] Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137 Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité AP-HP, Hôpital Bichat, Unité d'Hygiène et de Lutte contre les Infections Nosocomiales, Paris, France.

[14 ] Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137 Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité AP-HP, Hôpital Bichat.

Article

Publisher Item ID: civ333

DOI: 10.1093/cid/civ333

PubMed ID: 25904368

SO-VID: 3dc53aac-e31d-4cc6-bb05-8eebafc6b1c9

Copyright © © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.