Antimicrobials Increase Travelers' Risk of Colonization by Extended-Spectrum Betalactamase-Producing Enterobacteriaceae

Kantele, Anu; Lääveri, Tinja; Mero, Sointu; Vilkman, Katri; Pakkanen, Sari H.; Ollgren, Jukka; Antikainen, Jenni; Kirveskari, Juha

doi:10.1093/cid/ciu957

Cited by 263 publications

(264 citation statements)

References 32 publications

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“…The most prominent increases were observed in less abundant genes encoding resistance to sulfonamide (2.6-fold), trimethoprim (7.7-fold), and beta-lactams (2.6-fold). The metagenomic results offer a new and broadened perspective on the changes of the antibiotic resistance potential of the human gut microbiome after travel, providing an independent complement to previous studies targeting a limited number of bacterial species or antibiotic resistance genes (11,(13)(14)(15)(16)(17)21).…”

Section: Discussionmentioning

confidence: 94%

“…In recent years, acquisition of Enterobacteriaceae strains resistant to cephalosporin antibiotics by production of extendedspectrum beta-lactamases (ESBLs) have been quantified in travelers from the Netherlands (9, 10), France (11), Australia (12), Sweden (13)(14)(15), Germany (16), and Finland (17). Certain risk factors, such as intake of antibiotics and a travel destination on the Indian peninsula, appear to increase the risk of acquisition (9,10,(12)(13)(14)(15)17). Consequently, there is general concern over the contribution of travel to the global dispersal of antibiotic-resistant bacteria.…”

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confidence: 99%

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The Human Gut Microbiome as a Transporter of Antibiotic Resistance Genes between Continents

Bengtsson‐Palme

Angelin

Huss

et al. 2015

Antimicrob Agents Chemother

179

109

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e Previous studies of antibiotic resistance dissemination by travel have, by targeting only a select number of cultivable bacterial species, omitted most of the human microbiome. Here, we used explorative shotgun metagenomic sequencing to address the abundance of >300 antibiotic resistance genes in fecal specimens from 35 Swedish students taken before and after exchange programs on the Indian peninsula or in Central Africa. All specimens were additionally cultured for extended-spectrum beta-lactamase (ESBL)-producing enterobacteria, and the isolates obtained were genome sequenced. The overall taxonomic diversity and composition of the gut microbiome remained stable before and after travel, but there was an increasing abundance of Proteobacteria in 25/35 students. The relative abundance of antibiotic resistance genes increased, most prominently for genes encoding resistance to sulfonamide (2.6-fold increase), trimethoprim (7.7-fold), and beta-lactams (2.6-fold). Importantly, the increase observed occurred without any antibiotic intake. Of 18 students visiting the Indian peninsula, 12 acquired ESBL-producing Escherichia coli, while none returning from Africa were positive. Despite deep sequencing efforts, the sensitivity of metagenomics was not sufficient to detect acquisition of the low-abundant genes responsible for the observed ESBL phenotype. In conclusion, metagenomic sequencing of the intestinal microbiome of Swedish students returning from exchange programs in Central Africa or the Indian peninsula showed increased abundance of genes encoding resistance to widely used antibiotics.

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Section: Discussionmentioning

confidence: 94%

mentioning

confidence: 99%

The Human Gut Microbiome as a Transporter of Antibiotic Resistance Genes between Continents

Bengtsson‐Palme

Angelin

Huss

et al. 2015

Antimicrob Agents Chemother

179

109

View full text Add to dashboard Cite

show abstract

“…[13][14][15] In a study from Finland, traveller's diarrhea (adjusted OR 31.0, 95% CI 2.7-358.1) and antibiotic therapy for traveller's diarrhea (adjusted OR 3.0, 95% CI 1.4-6.7) were the most important risk factors for acquiring ESBLproducing E. coli. 16 The same author group showed that use of loperamide alone to treat mild traveller's diarrhea was not associated with an increased risk of colonization with ESBLproducing E. coli. 17 The largest and most comprehensive travel study investigating multidrug-resistant E. coli colonization among returning travellers was performed in the Netherlands.…”

Section: Discussionmentioning

confidence: 99%

Rates of colonization with extended-spectrum β-lactamase-producing Escherichia coli in Canadian travellers returning from South Asia: a cross-sectional assessment

Peirano¹,

Gregson²,

Kuhn³

et al. 2017

CMAJ Open

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“…Overcrowded conditions, especially during the Hajj, are a major risk for dissemination of antibiotic resistance (AR) bacteria. Moreover, taking antibiotics during travel may play a major role in selecting AR bacteria (8). However, without colistin selection in pilgrims during the Hajj, mcr-1-resistant strains can disseminate among pilgrims, demonstrating a low transmission fitness cost.…”

mentioning

confidence: 99%

Acquisition of mcr-1 Plasmid-Mediated Colistin Resistance in Escherichia coli and Klebsiella pneumoniae during Hajj 2013 and 2014

Leangapichart

Gautret

Brouqui

et al. 2016

Antimicrob Agents Chemother

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bA plasmid-mediated transferable colistin resistance gene, mcr-1, was recently described in China (1) and was rapidly reported in several other countries (2). The spread of the mcr-1 gene was not only reported in Escherichia coli but also associated with other Enterobacteriaceae species isolated from human clinical samples, farm animals, and travelers (2, 3). However, whether or not the mcr-1 gene is acquired during the Hajj (the Muslim pilgrimage to Mecca) remains unknown.We conducted two cohort studies of pilgrims traveling to Mecca in 2013 (22 September to 23 October) (4, 5) and in 2014 (19 September to 12 October) (6). A total of 440 rectal swab samples were collected from pilgrims (in 2013, 129 pilgrims [before and after their pilgrimage]; in 2014, 92 pilgrims before and 90 pilgrims after their pilgrimage) and were then screened for the presence of the mcr-1 gene by real-time PCR and results confirmed by standard PCR and sequencing as described previously (7). All PCR-positive samples were then tested in an attempt to isolate mcr-1-resistant strains by culture on Cepacia agar (bioMérieux, Marcy-l'Étoile, France). Different colonies were tested by matrixassisted laser desorption ionization-time of flight (MALDI-TOF), antibiotic susceptibility testing (EUCAST), Etest (MIC susceptibility, Յ2 mg/liter), PCR, sequencing of the mcr-1 and extendedspectrum-beta-lactamase (ESBL) genes (bla CTX-M , bla TEM , and bla SHV ) (5), and multilocus sequence typing (MLST) analysis (http://mlst.warwick.ac.uk/mlst/dbs/Ecoli/ and http://bigsdb.web .pasteur.fr/klebsiella/klebsiella.html). All mcr-1 and ESBL gene sequencing results were then analyzed with NCBI database.

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Antimicrobials Increase Travelers' Risk of Colonization by Extended-Spectrum Betalactamase-Producing Enterobacteriaceae

Cited by 263 publications

References 32 publications

The Human Gut Microbiome as a Transporter of Antibiotic Resistance Genes between Continents

The Human Gut Microbiome as a Transporter of Antibiotic Resistance Genes between Continents

Rates of colonization with extended-spectrum β-lactamase-producing Escherichia coli in Canadian travellers returning from South Asia: a cross-sectional assessment

Acquisition of mcr-1 Plasmid-Mediated Colistin Resistance in Escherichia coli and Klebsiella pneumoniae during Hajj 2013 and 2014

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