International travel may help spread drug-resistant bacteria in UK

People in England who were born in or recently traveled to areas of Asia have an increased risk for extended-spectrum beta-lactamase producing Enterobacteriaceae, or ESBLPE, according to researchers.

Those who have recently visited Africa or Latin America also have an increased risk for the bacteria, which are known to be resistant to antibiotics, they wrote in the Journal of Antimicrobial Chemotherapy. The most prevalent genotypes documented in the study included CTX-M ESBLPE.

“We believe that this study, showing CTX-M ESBLPE to be established in the general population of England and the prevalence of colonization to be considerably higher among some sections of the general population, has implications for empirical prescribing for all infections typically caused by Enterobacteriaceae, and that antimicrobial guidance should reflect our findings,” researcher Cliodna A.M. McNulty, head of Public Health England’s Primary Care Unit, and colleagues wrote.

To determine the prevalence of ESBLPE colonization in general and among different demographics, the researchers recruited patients who had been treated at 16 general practice facilities in England. Participants received incentives of 5 British pounds; filled out questionnaires about demographics, antibiotic use, travel and other factors; and submitted stool samples.

According to the researchers, 2,430 participants returned stool samples. The researchers estimated that the overall prevalence of ESBLPE colonization in England in 2014 was 7.3%. Among study participants, six of 10 who were born in Afghanistan had colonization with ESBLPE. Of the 259 born on the Indian subcontinent — India, Pakistan, Bangladesh or Sri Lanka — 25% had colonization (95% CI, 18.5%-32.9%).

Of the 140 who had traveled in the previous year to South Asia — any of the four Indian subcontinent countries or Nepal — 38.5% had colonization (95% CI, 27.8%-50.5%).

Those born on the Indian subcontinent were more likely to have ESBLPE colonization (adjusted OR = 5.4; 95% CI, 3-9.7). The same was true for those who had traveled to South Asia in the previous year (aOR = 2.9; 95% CI, 1.8-4.8) and those who had traveled in the previous year to Africa, China, South or Central America, Southeast Asia, Pacific Asia or Afghanistan (aOR = 2.6; 95% CI, 1.7-4.1).

“To improve our understanding of evolving risk groups for ESBLPE infections, we suggest enhanced or periodic antimicrobial resistance surveillance should be extended to patients with uncomplicated infections to reduce spectrum bias,” they said, “and data collection should include ethnic group, age and sex of the patient. If feasible to do so, we also suggest collecting country of birth, recent travel history, ethnic origins, occupation and use of antibiotics and antacids in the last year.” – by Joe Green

Disclosures: The authors report no relevant financial disclosures.