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

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Kantele , A , Laaveri , T , Mero , S , Vilkman , K , Pakkanen , S H , Ollgren , J , Antikainen , J & Kirveskari , J 2015 , ' Antimicrobials Increase Travelers' Risk of Colonization by Extended-Spectrum Betalactamase-Producing Enterobacteriaceae ' Clinical Infectious Diseases , vol. 60 , no. 6 , pp. 837-846 . DOI: 10.1093/cid/ciu957

Title: Antimicrobials Increase Travelers' Risk of Colonization by Extended-Spectrum Betalactamase-Producing Enterobacteriaceae
Author: Kantele, Anu; Laaveri, Tinja; Mero, Sointu; Vilkman, Katri; Pakkanen, Sari H.; Ollgren, Jukka; Antikainen, Jenni; Kirveskari, Juha
Contributor: University of Helsinki, Department of Medicine
University of Helsinki, Clinicum
University of Helsinki, Department of Diagnostics and Therapeutics
University of Helsinki, Department of Medicine
University of Helsinki, Department of Bacteriology and Immunology
University of Helsinki, Department of Biological and Environmental Sciences (-2009)
University of Helsinki, Clinicum
Date: 2015-03-15
Language: eng
Number of pages: 10
Belongs to series: Clinical Infectious Diseases
ISSN: 1058-4838
URI: http://hdl.handle.net/10138/225117
Abstract: Background. More than 300 million travelers visit regions with poor hygiene annually. A significant percentage of them become colonized by resistant intestinal bacteria such as extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) and may transmit the strains to others and to medical care settings when they return home. Despite the threats to global healthcare caused by an upsurge in antimicrobial resistance, no effort has been centered on prevention of colonization while traveling. Methods. Stool samples were collected from 430 Finns before and after traveling outside Scandinavia. All specimens were analyzed for ESBL-and carbapenemase-producing Enterobacteriaceae (CPE). Questionnaires were used to survey volunteers about use of antimicrobials as well as other potential risk factors. The results were subjected to multivariable analysis. Results. Twenty-one percent (90/430) of the travelers became colonized by ESBL-PE and none by CPE. Geographic region, occurrence of travelers' diarrhea (TD), age, and use of antimicrobial (AB) for TD were identified as independent risk factors predisposing to contracting ESBL-PE. Eleven percent of those in subgroup TD-AB-, 21% in TD+AB-, and 37% in TD+AB+ acquired ESBL-PE. The risk proved to be highest in South Asia (46%); 23% became colonized in subgroup TD-AB-, 47% in TD+AB-, and 80% in TD+AB+. In Southeast Asia, the rates were 14%, 37%, and 69%, respectively. Conclusions. TDand antimicrobials for TD proved to be independent risk factors, with up to 80% of TD+AB+ travelers contracting ESBL-PE. Inmodernpre-travel counseling for those visiting high-risk regions, travelers should be advised against taking antibiotics for mild or moderate TD.
Subject: ESBL
colonization
travel
antimicrobials
travelers' diarrhea
ESCHERICHIA-COLI
MULTIRESISTANT ENTEROBACTERIACEAE
INTERNATIONAL TRAVEL
DIARRHEA
INFECTION
SPREAD
3121 Internal medicine
3111 Biomedicine
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