Travel-acquired ESBL-producing Enterobacteriaceae: impact of colonization at individual and community level

Abstract

Background: Antibiotic resistance is a rapidly increasing global emergency that calls for action from all of society. Intestinal multidrugresistant (MDR) bacteria have spread worldwide with extended-spectrum beta-lactamase (ESBL) -producing Enterobacteriaceae (ESBL-PE) as the most prevalent type. The millions of travelers annually visiting regions with poor hygiene contribute substantially to this spread. Our review explores the underlying data and discusses the consequences of the colonization. Methods: PubMed was searched for relevant literature between January 2010 and August 2016. We focused on articles reporting (1) the rate of ESBL-PE acquisition in a group of travelers recruited before/after international travel, (2) fecal carriage of ESBL-PE as explored by culture and, for part of the studies, (3) analysis of factors predisposing to colonization. Results: We reviewed a total of 16 studies focusing on travel-acquired ESBL-PE. The acquisition rates reveal that 2070% of visitors to (sub)tropical regions get colonized by ESBL-PE. The main risk factors predisposing to colonization during travel are destination, travelers diarrhea, and antibiotic use. Conclusions: While most of those colonized remain asymptomatic, acquisition of ESBL-PE may have consequences both at individual and community level. We discuss current efforts to restrict the spread.

Real-time sampling of travelers shows intestinal colonization by multidrug-resistant bacteria to be a dynamic process with multiple transient acquisitions

“…The impact of travel on the global spread of multidrug-resistant E. coli is well documented. Of travelers returning from the Indian subcontinent and Southeast Asia, Africa or South Asia, 20-80% are colonized by MDR-GN bacteria, most commonly ESBL-Ec [8][9][10][11][12][13][14][15]. This colonization can extend over a period of months or even over a year [8,12,13].…”

“…The literature shows international travel to be strongly associated with acquisition of MDR-GN strains, mostly ESBL-Ec [8][9][10][11][12][13][14][15]. The carriage rate of intestinal MDR-GN bacteria is highest among inhabitants of the Indian subcontinent and Southeast Asia, followed by Africa and South America [16].…”

“…Not surprisingly, travelers visiting these high-risk regions are at substantial risk of acquiring MDR-GN bacteria [15]. Colonization occurs even during short visits [8][9][10][11][12][13][14][15] and without antimicrobial use [17] and can last for months or even over a year [8,12,13] and lead to further spread after return home [8,13]. Genome-level analysis of MDR strains colonizing travelers shows that newly acquired MDR strains tend to displace resident intestinal commensal E. coli strains alongside new non-MDR strains, such that the pre-travel population remains as a minority [18].…”

Risk factors for fecal carriage of drug-resistant Escherichia coli: a systematic review and meta-analysis

“…Most of these studies have found previous antibiotic use to be associated with drug-resistant bacteria carriage in both primary care patients and healthy populations [18,19]. Also, traveling to developing countries has been identified as a risk factor for acquiring drug-resistant bacteria [20]. Risk factors related to healthcare-associated infections (HAI) have been reported as well, including admission to the intensive care unit (ICU), use of catheter, and dialysis [21][22][23].…”

Global commercial passenger airlines and travel health information regarding infection control and the prevention of infectious disease: What's in a website?

“…The Western Pacific, Southeast Asia and Eastern Mediterranean regions have the highest burden of resistance, with more than 60% of AMR carriage occurring via Thailand and India [16]. These popular destinations, as well as the Middle East, have high rates of extended spectrum beta-lactamase (ESBL) resistance, one of the most commonly acquired resistance mechanisms worldwide [17]. The rapid emergence of drug-resistant Candida auris has gained international attention with outbreaks in healthcare facilities around the world, including in patients within Victoria and New South Wales in Australia who acquired the infection from overseas hospitals [18].…”