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

Peirano, Gisele; Gregson, Daniel B.; Kuhn, Susan; Vanderkooi, Otto G; Nobrega, Diego; Pitout, Johann

doi:10.9778/cmajo.20170041

Cited by 16 publications

(18 citation statements)

References 13 publications

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“…In our study, overall antibiotic use during travel (excluding prophylactic use of doxycycline against malaria) was associated with a higher risk of acquisition of ESBL-E. This finding is in line with the results of other studies [7,29,43,47] but contrasts with the results of others [8,9,42]. Arcilla et al showed that quinolone use during travel was the strongest predictor of ESBL-E acquisition [7].…”

Section: Discussionsupporting

confidence: 88%

“…In our study, students with a primary destination in Vietnam or north India were 2-2.4 times more at risk of ESBL-E acquisition, reflecting results of other studies [7,8,42,45,46]. In the medical literature, traveling to South Asia [7,8] and in particular to India [9,43,47] is associated with a significant risk of acquiring ESBL-E, while travelling to Africa, the Middle East, and South and Central America were associated with lower risk. The acquisition of ESBL-E after a trip to Europe in general appears to be rare and could be explained by most studies not including travellers to Southern Europe.…”

Section: Discussionsupporting

confidence: 85%

“…Similar data were obtained among travellers from Sweden, with 73% of acquired ESBL-E resulting positive for blaCTX-M gene detection [42]. Also, in a cohort of Canadian travellers returning from South Asia, 88% of acquired ESBL E. coli resulted positive for blaCTX-M gene amplification [43].…”

Section: Discussionsupporting

confidence: 70%

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Acquisition of Multidrug-Resistant Bacteria and Colistin Resistance Genes in French Medical Students on Internships Abroad

Dao

Hoang

Magmoun

et al. 2020

Preprint

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Background: In France, no previous studies had addressed the acquisition of multidrug resistant (MDR) bacteria and colistin resistance genes by medical students when undertaking internships abroad. Methods: Nasopharyngeal, rectal, and vaginal swabs samples were collected from 382 French medical students before and after travel to investigate the acquisition of MDR bacteria. The bacterial diversity in the samples was assessed by culture on selective media. We also genetically characterised the isolates of MDR bacteria including Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E), methicillin-resistant Staphylococcus aureus (MRSA), and Carbapenemase-producing Enterobacteriacae (CPE) using the real-time polymerase chain reaction method. The samples were collected from 293 students and were investigated for mcr colistin-resistance genes using RT-PCR directly on the samples, followed by conventional PCR and sequencing. Results: A proportion of 29.3% of the participants had acquired ESBL-E and 2.6% had acquired CPE. The most common species and ESBL-E encoding gene were Escherichia coli (98.4%) and blaCTX-M-A (95.3%), respectively. A proportion of 6.8% of the participants had acquired mcr-1 genes, followed by mcr-3 (0.3%) and mcr-8 (0.3%). We found that taking part in humanitarian missions to orphanages, being in contact with children during travel, the primary destination of travel being Vietnam and north India, using antibiotics during travel, and studying in 2017 were associated with the acquisition of ESBL-E. When the primary destination of travel was Vietnam and the year of study was 2018, this was associated with acquisition of colistin resistance genes. Conclusion: Medical students are at a potential risk of acquiring ESBL-E, CPE and colistin resistance genes. A number of risk factors have been identified, which may be used to develop targeted preventive measures.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 85%

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Acquisition of Multidrug-Resistant Bacteria and Colistin Resistance Genes in French Medical Students on Internships Abroad

Dao

Hoang

Magmoun

et al. 2020

Preprint

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“…coli (6). Other traveler studies have also shown high acquisition rates of ESBL-producing Enterobacteriaceae in those who visit India: prospective studies report acquisition rates of 73% (66/90 participants) (10), 85% (53/62 participants) (11), and 87% (59/68 participants) (12). After WGS and bioinformatic screening of contigs, none of our post-travel isolates carried carbapenemase genes.…”

Section: Resultsmentioning

confidence: 97%

Acquisition and Loss of CTX-M-Producing and Non-Producing Escherichia coli in the Fecal Microbiome of Travelers to South Asia

Bevan

McNally

Thomas

et al. 2018

mBio

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Escherichia coli strains which produce CTX-M extended-spectrum beta-lactamases are endemic as colonizers of humans and in the environment in South Asia. This study demonstrates that acquisition of CTX-M-producing E. coli (CTX-M-EC) in travelers from the United Kingdom to South Asia is polyclonal, which is likely due to multiple acquisition events from contaminated food and drinking water during travel. CTX-M-EC frequently persists in the fecal microbiome for at least 1 year after acquisition, often alongside newly acquired non-CTX-M E. coli strains. In travelers who acquire CTX-M-EC, pre-travel non-CTX-M E. coli remains as a minority population in the gut until the CTX-M-EC strains are lost. The non-CTX-M strains are then reestablished as the predominant E. coli population. This study has shed light on the dynamics of CTX-M-EC acquisition, colonization, and loss after travel. Future work involving manipulation of nonvirulent resident E. coli could be used to prevent colonization with antibiotic-resistant E. coli.

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“…Overall, the studies scored between 9 and 26 out of 33 points, with a median of 18 points. Six studies had a low methodological quality [22,27,28,32,33,38,41], seven a moderate methodological quality [12,21,23,25,26,30,36], and six studies a high methodological quality [29,31,34,35,37,39,40,42].…”

Section: Study Qualitymentioning

confidence: 99%

Acquisition of multidrug-resistant Enterobacterales during international travel: a systematic review of clinical and microbiological characteristics and meta-analyses of risk factors

holt

Mourik

Beishuizen

et al. 2020

Antimicrob Resist Infect Control

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Background: International tourism increased from 25 million tourist arrivals in 1950 to over 1.3 billion in 2017. These travelers can be exposed to (multi) resistant microorganisms, may become colonized, and bring them back home. This systematic review aims to identify the carriage rates of multidrug-resistant Enterobacterales (MDR-E) among returning travelers, to identify microbiological methods used, and to identify the leading risk factors for acquiring MDR-E during international travel. Methods: Articles related to our research question were identified through a literature search in multiple databases (until June 18, 2019)-Embase, Medline Ovid, Cochrane, Scopus, Cinahl, Web of Science, and Google Scholar. Results: Out of 3211 potentially relevant articles, we included 22 studies in the systematic review, and 12 studies in 7 random-effects meta-analyses. Highest carriage rates of MDR-E were observed after travel to Southern Asia (median 71%), followed by travel to Northern Africa (median 42%). Carbapenemase-producing Enterobacterales (CPE) were identified in 5 out of 22 studies, from a few patients. However, in only eight out of 22 studies (36.4%) the initial laboratory method targeted detection of the presence of CPE in the original samples. The risk factor with the highest pooled odds ratio (OR) for MDR-E was travel to Southern Asia (pooled OR = 14.16, 95% confidence interval [CI] = 5.50 to 36.45), followed by antibiotic use during travel (pooled OR = 2.78, 95% CI = 1.76 to 4.39). Conclusions: Risk of acquiring MDR-E while travelling increases depending on travel destination and if antibiotics are used during travel. This information is useful for the development of guidelines for healthcare facilities with low MDR-E prevalence rates to prevent admission of carriers without appropriate measures. The impact of such guidelines should be assessed.

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

Cited by 16 publications

References 13 publications

<strong>Acquisition of Multidrug-Resistant Bacteria and Colistin Resistance Genes in French Medical Students on Internships Abroad</strong>

<strong>Acquisition of Multidrug-Resistant Bacteria and Colistin Resistance Genes in French Medical Students on Internships Abroad</strong>

Acquisition and Loss of CTX-M-Producing and Non-Producing Escherichia coli in the Fecal Microbiome of Travelers to South Asia

Acquisition of multidrug-resistant Enterobacterales during international travel: a systematic review of clinical and microbiological characteristics and meta-analyses of risk factors

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