Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) among travellers to Africa : destination-specific data pooled from three European prospective studies

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Lääveri , T , Vlot , J A , van Dam , A P , Häkkinen , H K , Sonder , G J B , Visser , L G & Kantele , A 2018 , ' Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) among travellers to Africa : destination-specific data pooled from three European prospective studies ' , BMC Infectious Diseases , vol. 18 , 341 . https://doi.org/10.1186/s12879-018-3245-z

Title: Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) among travellers to Africa : destination-specific data pooled from three European prospective studies
Author: Lääveri, Tinja; Vlot, Jessica A.; van Dam, Alje P.; Häkkinen, Hanni K.; Sonder, Gerard J. B.; Visser, Leo G.; Kantele, Anu
Contributor organization: Clinicum
Department of Medicine
Infektiosairauksien yksikkö
University of Helsinki
Department of Bacteriology and Immunology
Anu Kantele-Häkkinen Research Group
HUS Inflammation Center
Date: 2018-07-23
Language: eng
Number of pages: 12
Belongs to series: BMC Infectious Diseases
ISSN: 1471-2334
DOI: https://doi.org/10.1186/s12879-018-3245-z
URI: http://hdl.handle.net/10138/238500
Abstract: Background: One third of travellers to low- and middle-income regions of the tropics and subtropics become colonized by extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE). The risk varies by destination and, for each traveller, may be substantially further increased by travellers' diarrhoea (TD) and antibiotic use. Despite the risk of TD in Africa, ESBL-PE acquisition rates in all studies are lower there than in Asia. Africa has become increasingly popular as a destination for international travellers, yet minimal data are available from the continent's subregions and countries. Methods: We analysed subregion- and country-specific data on carriage and risk factors for ESBL-PE colonization pooled from three prospective studies conducted between 2009 and 2013 among Finnish and Dutch travellers. The data were subjected to multivariable analysis of risk factors. In addition, we compared our data to two recent large investigations reporting data by subregion and country. Results: Our joint analysis comprised data on 396 travellers. The ESBL-PE colonization rate was highest in Northern Africa, followed by Middle and Eastern Africa, and lowest in Southern and Western Africa. Of individual countries with more than 15 visitors, the highest rates were seen for Egypt (12/17; 70.6%), Ghana (6/23; 26.1%), and Tanzania (14/81; 17.3%); the rates among travellers to Egypt were comparable to those reported in South and Southeast Asia. In a pooled multivariable analysis, travel destination, age, overnight hospitalisation abroad, TD, and use of fluoroquinolones were independently associated with increased ESBL-PE colonization rates. Conlusions: Even in areas with relatively low risk of colonization, antimicrobials clearly predispose to colonization with ESBL-PE. Travellers to Africa should be cautioned against unnecessary use of antibiotics.
Subject: ESBL
MDR
Extended-spectrum beta-lactamase
Enterobacteriaceae
Africa
Antimicrobials
Travel
ESCHERICHIA-COLI
RISK-FACTORS
MULTICENTER COHORT
FECAL CARRIAGE
COLONIZATION
ABROAD
ACQUISITION
PREVALENCE
VOLUNTEERS
DURATION
3121 General medicine, internal medicine and other clinical medicine
Peer reviewed: Yes
Rights: cc_by
Usage restriction: openAccess
Self-archived version: publishedVersion


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