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Travelers may harbor ESBL-E up to 1 year
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Travelers visiting areas with an elevated risk for extended-spectrum beta-lactamase-producing Enterobacteriaceae acquisition can carry the bacteria up to 12 months after return, according to a cohort study recently published in The Lancet Infectious Diseases.
“Identifying individuals at risk of [extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E)] carriage enables appropriate measures to be taken to prevent introduction and spread of ESBL-E or [carbapenemase-producing Enterobacteriaceae (CPE)] and for empirical adjustment of antibiotic treatment in individuals to optimize clinical care,” Maris S. Arcilla, MD, from the department of medical microbiology and infectious diseases at Erasmus University Medical Centre, and colleagues wrote.
The researchers investigated ESBL-E acquisition during international travel, with a focus on productive factors for acquisition, duration of colonization and probability of onward transmission. In this prospective, multicenter cohort study of 2,001 Dutch travelers and 215 non-travelling household members, researchers collected questionnaires on demographics, illness, and behavior, and fecal samples for ESBL-E screening before travel and 1, 3, 6 and 12 months after return.
In post-travel samples, researchers sequenced ESBL genes and performed PCR with specific primers for plasmid-encoded beta-lactamase enzymes TEM, SHV and CTX-M group 1, 2, 8, 9 and 25 to confirm the presence of ESBL genes in follow-up samples. They used multivariable regression analysis and mathematical modelling to identify predictors for acquisition and sustained carriage, and to determine household transmission rates.
Of 1,847 travelers who were ESBL negative before international travel, 633 (34.3%) developed ESBL-E (95%; CI 32.1-36.5). The highest number of acquisitions were among those who travelled to southern Asia (75%; 95% CI 68.4-80.9). Meanwhile, 40% to 50% of travelers visiting central and eastern Asia, western Asia, and northern Africa developed ESBL-E.
Predictors for acquisition included antibiotic use during travel (adjusted OR = 2.69; 95% CI, 1.79-4.05), traveler’s diarrhea (aOR = 2.31; 95% CI, 1.42–3.76), and pre-existing chronic bowel disease (aOR = 2.1; 95% CI, 1.13–3.9). Of the travellers who acquired ESBL-E, 11.3% remained colonized at 12 months after return, and an approximately 12% had probability of onward transmission within households.
“Our findings support the substantial contribution of international travel to the spread of ESBL-E and antimicrobial resistance worldwide,” Arcilla and colleagues concluded. “The degree of consequence of the emergence and spread of antimicrobial resistance by travellers, however, differs by region, and is highly dependent on local prevalence of antimicrobial resistance in the country of origin.”
The duration of colonization was “slightly more” than what researchers previously reported, Laurence Armand-Lefevre, MD, of Bichat-Claude Bernard Hospital in Paris, France, and colleagues wrote in an accompanying editorial. Although all travelers cannot be screened for ESBL-E, Armand-Lefevre and colleagues suggested that health care professionals should consider the risk for antibiotic-resistant bacteria in travelers with infections, especially those returning from high-risk areas.
“Given the growing evidence supporting high frequencies of ESBL-E acquisition during international travel, recommendations from infectious diseases and travel medicine organizations are needed,” they wrote. “Antimicrobial resistance because of transport between regions is now an important concept for community care. Primary care physicians will have important parts to play in the control of antimicrobial resistance among increasing numbers of travelers.” — by Savannah Demko
Disclosure: The researchers report no relevant financial disclosures.
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