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J Travel Med. 2016 Feb 8;23(2):tav024. doi: 10.1093/jtm/tav024. Print 2016 Feb.

High carriage rate of ESBL-producing Enterobacteriaceae at presentation and follow-up among travellers with gastrointestinal complaints returning from India and Southeast Asia.

Author information

1
Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany, Department of Infectious Diseases, Virology, University Hospital Heidelberg, Heidelberg, Germany.
2
Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany, Laboratory Enders and Partners, Stuttgart, Germany.
3
Medizinisch-Diagnostische Institute Laboratorien, Berlin, Germany.
4
Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany.
5
Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany, Division of Infectiology and Pneumonology, Medical Department, Charité-Universitätsmedizin Berlin, Berlin, Germany.
6
Centre for Infection Medicine, Institute of Microbiology and Epizootics, Freie Universität Berlin, Berlin, Germany and.
7
Centre for Infection Medicine, Institute of Microbiology and Epizootics, Freie Universität Berlin, Berlin, Germany and Robert Koch-Institute, Berlin, Germany.
8
Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany, frank.mockenhaupt@charite.de.

Abstract

BACKGROUND:

International travel contributes to the spread of multidrug-resistant microorganisms including extended spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE). We assessed the proportion of faecal carriers of ESBL-PE among 211 patients with gastrointestinal symptoms who returned to Berlin, Germany, after international travel.

METHODS:

ESBL-PE were screened for on chromogenic agar, antimicrobial susceptibility testing was performed, and ESBL-genes were genotyped. Travel-related data were assessed by questionnaire.

RESULTS:

Diarrhoea, abdominal pain and nausea were the main symptoms. Half of the travellers carried ESBL-PE (97% Escherichia coli); the proportion was highest for returnees from India (72%) and mainland Southeast Asia (59%), and comparatively lower for Africa (33%) and Central America (20%). Co-resistance to fluoroquinolones (particularly in isolates from India), gentamicin and cotrimoxazole was frequent but all isolates were carbapenem-susceptible. ESBL-PE carriage decreased with increasing timespan from return to presentation, and with age. At revisit of initially ESBL-PE positive patients half a year later, 28% (17/61) of the individuals were still carriers, CTX-M groups being congruent with the initial isolates. CTX-M groups 9 and 1/9, vegetarian diet and cat ownership tended to be associated with ESBL-PE carriage upon revisit.

CONCLUSIONS:

Travellers, particularly those returning from India and Southeast Asia, constitute a relevant source of potential spread of ESBL-PE. Carriage declines over time but ESBL-PE persist for at least 6 months in a substantial proportion of individuals. Both genetic characteristics of the bacteria and lifestyle factors seem to contribute to persistent carriage of ESBL-PE. A recent, extra-European travel history argues for ESBL-PE screening and contact precautions for patients admitted to hospital.

KEYWORDS:

CTX-M; ESBL; antimicrobial resistance; extended-spectrum beta-lactamase; traveller

PMID:
26858272
DOI:
10.1093/jtm/tav024
[Indexed for MEDLINE]

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