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Destination, beta-lactam use influences MRE acquisition in travelers
Factors associated with the acquisition of multidrug-resistant Enterobacteriaceae during travel to tropical areas included the type of travel, the location, the use of beta-lactams during the trip and diarrhea, according to researchers from France.
Etienne Ruppé , PharmD , PhD, from the Laboratoire de Bactériologie at Bichat-Claude Bernard Hospital in Paris, and colleagues reviewed the fecal samples of 574 travelers across six vaccination centers in the Paris area for multidrug-resistant Enterobacteriaceae (MRE) between February 2012 and April 2013. The travelers were asked to provide fecal samples before and after trips to Asia, sub-Saharan Africa or Asia. If a positive sample was identified after travel, the travelers were asked to provide additional fecal samples 1 month, 2 months, 3 months, 6 months and 12 months after they returned home, or until there was no trace of MRE identified in the sample.
The researchers found 50.9% of travelers acquired at least one MRE during travel. In multivariate analysis, acquisition was significantly associated with diarrhea during travel (OR = 1.9; 95% CI, 1.31–2.75) beta-lactam use (OR = 4.08; 95% CI, 1.39–11.97), and the type of travel, with higher risk activities including backpacking, family visits and organized tours.
Travelers to Asia had a higher MRE acquisition rate at 72.4% compared to sub-Saharan Africa at 47.7% and Latin America at 31.1%. At 3-month follow-up 4.7% of travelers still carried MRE, with travelers to Asia and travelers with a high amount of MRE upon return indicating continued MRE infection.
“MRE acquisition during travel to tropical regions is very frequent but relatively short-lived,” they wrote. “The possible presence of MRE should thus be taken into account when prescribing empiric antibiotic therapy for infections that occur in travelers having returned from the tropics [less than] 3 months previously.”
Disclosure: The researchers report no relevant financial disclosures.