Despite Predominance of Uropathogenic/Extraintestinal Pathotypes Among Travel-acquired Extended-spectrum β-Lactamase-producing Escherichia coli, the Most Commonly Associated Clinical Manifestation Is Travelers' Diarrhea

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Kantele , A , Lääveri , T , Mero , S , Häkkinen , I M K , Kirveskari , J , Johnston , B D & Johnson , J R 2020 , ' Despite Predominance of Uropathogenic/Extraintestinal Pathotypes Among Travel-acquired Extended-spectrum β-Lactamase-producing Escherichia coli, the Most Commonly Associated Clinical Manifestation Is Travelers' Diarrhea ' , Clinical Infectious Diseases , vol. 70 , no. 2 , pp. 210-218 . https://doi.org/10.1093/cid/ciz182

Title: Despite Predominance of Uropathogenic/Extraintestinal Pathotypes Among Travel-acquired Extended-spectrum β-Lactamase-producing Escherichia coli, the Most Commonly Associated Clinical Manifestation Is Travelers' Diarrhea
Author: Kantele, Anu; Lääveri, Tinja; Mero, Sointu; Häkkinen, Inka M. K.; Kirveskari, Juha; Johnston, Brian D.; Johnson, James R.
Contributor: University of Helsinki, Department of Medicine
University of Helsinki, HUS Inflammation Center
University of Helsinki, HUMI - Human Microbiome Research
University of Helsinki, Faculty of Medicine
University of Helsinki, Clinicum
Date: 2020-01-15
Language: eng
Number of pages: 9
Belongs to series: Clinical Infectious Diseases
ISSN: 1058-4838
URI: http://hdl.handle.net/10138/318136
Abstract: Background. One-third of the 100 million travelers to the tropics annually acquire extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-PE), with undefined clinical consequences. Methods. Symptoms suggesting Enterobacteriaceae infections were recorded prospectively among 430 Finnish travelers, 90 (21%) of whom acquired ESBL-PE abroad. ESBL-PE isolates underwent polymerase chain reaction-based detection of diarrheagenic Escherichia coli (DEC) pathotypes (enteroaggregative E. coli [EAEC], enteropathogenic E. coli [EPEC], enterotoxigenic E. coli [ETEC], enteroinvasive E. coli, and Shiga toxin-producing E. coli), and extraintestinal pathogenic/uropathogenic E. coli (ExPEC/UPEC). Laboratory-confirmed ESBL-PE infections were surveyed 5 years before and after travel. Results. Among the 90 ESBL-PE carriers, manifestations of Enterobacteriaceae infection included travelers' diarrhea (TD) (75/90 subjects) and urinary tract infection (UTI) (3/90). The carriers had 96 ESBL-producing E. coli isolates, 51% exhibiting a molecular pathotype: 13 (14%) were DEC (10 EAEC, 2 EPEC, 1 ETEC) (12 associated with TD) and 39 (41%) ExPEC/UPEC (none associated with UTI). Of ESBL-PE, 3 (3%) were ExPEC/UPEC-EAEC hybrids (2 associated with diarrhea, none with UTI). Potential ESBL-PE infections were detected in 15 of 90 subjects (17%). The 10-year medical record survey identified 4 laboratory-confirmed ESBL-PE infections among the 430 travelers, all in subjects who screened ESBL-PE negative after returning home from their index journeys but had traveled abroad before their infection episodes. Conclusions. Half of all travel-acquired ESBL-producing E. coli strains qualified molecularly as pathogens. Extraintestinal and uropathogenic pathotypes outnumbered enteric pathotypes (41% vs 14%), yet the latter correlated more closely with symptomatic infection (0% vs 92%). Despite more ESBL-PE strains qualifying as ExPEC/UPEC than DEC, travel-acquired ESBL-PE are more often associated with TD than UTI.
Subject: 3121 General medicine, internal medicine and other clinical medicine
extended-spectrum beta-lactamase
ESBL
travel
DEC
ExPEC
MULTIDRUG-RESISTANT ENTEROBACTERIACEAE
INTERNATIONAL TRAVELERS
FECAL CARRIAGE
RISK
COLONIZATION
EPIDEMIOLOGY
ACQUISITION
PATHOGENS
COMMUNITY
IMPACT
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