Travel Medicine and Infectious Disease ( IF 6.3 ) Pub Date : 2019-11-23 , DOI: 10.1016/j.tmaid.2019.101521 Lynn Meurs , Felix S. Lempp , Norman Lippmann , Henning Trawinski , Arne C. Rodloff , Matthias Eckardt , Anja Klingeberg , Tim Eckmanns , Jan Walter , Christoph Lübbert , Muna Abu Sin , Esther-Maria Antão , Michael Behnke , Jutta Bleidorn , Evgeniya Boklage , Tim Eckmanns , Christina Forstner , Petra Gastmeier , Jochen Gensichen , Alexander Gropmann , Stefan Hagel , Regina Hanke , Wolfgang Hanke , Anja Klingeberg , Lukas Klimmek , Ulrich Kraft , Tobias Kramer , Markus Lehmkuhl , Norman Ludwig , Antina Lübke-Becker , Oliwia Makarewicz , Anne Moeser , Inga Petruschke , Mathias W. Pletz , Cornelius Remschmidt , Florian Salm , Katja Schmücker , Sandra Schneider , Christin Schröder , Frank Schwab , Joachim Trebbe , Szilvia Vincze , Horst C. Vollmar , Jan Walter , Sebastian Weis , Wibke Wetzker , Lothar H. Wieler
Background
Intercontinental travel contributes to the spread of extended-spectrum beta-lactamase producing Enterobacterales (ESBL-PE). We assessed risk factors for intestinal ESBL-PE colonization in people travelling to low and middle income countries in the tropics and subtropics to better understand how travel affects ESBL-PE spread.
Method
This prospective cohort study in travellers attending a travel clinic in Leipzig, Germany was conducted in 2016–2017. Information on risk factors related to travel, symptoms, antibiotic use, health care usage, accommodation, destination, diet and hygiene was collected by questionnaire after travel. Stools were phenotypically tested for ESBL-PE before and after travel. Risk factors for ESBL-PE colonization were identified using logistic regression.
Results
Of the 230 travellers that were ESBL-PE negative before travelling, 23% (n = 53) travellers returned positive. Multivariable analyses showed that age, type of accommodation and travelling to Asia were associated with ESBL-PE colonization.
Conclusions
Given that a considerable amount of travellers returned with ESBL-PE, we recommend raising awareness in returning high-risk travellers, e.g. those returning from high-risk areas. They should be aware that they may carry antimicrobial-resistant bacteria after travel, and how they can prevent its spread. The role of the type of accommodation as a factor favouring intestinal colonization with ESBL-PE requires further investigation.
中文翻译：
长距离旅行期间产生广谱β-内酰胺酶的肠杆菌（ESBL-PE）的肠道菌落：在德国旅行诊所进行的一项队列研究（2016–2017）
背景
洲际旅行有助于扩大产生广谱β-内酰胺酶的肠杆菌（ESBL-PE）的传播。我们评估了前往热带和亚热带的中低收入国家旅行的人肠道ESBL-PE定植的危险因素，以更好地了解旅行如何影响ESBL-PE的传播。
方法
这项针对前瞻性队列研究的对象是2016年至2017年在德国莱比锡的一家旅行诊所就诊的旅行者。旅行后通过问卷收集与旅行，症状，抗生素使用，医疗保健使用，住宿，目的地，饮食和卫生有关的危险因素的信息。在旅行之前和之后，对凳子进行表型测试以进行ESBL-PE测试。使用logistic回归确定ESBL-PE定植的危险因素。
结果
在旅行前ESBL-PE阴性的230位旅行者中，有23％（n = 53）的旅行者返回正。多变量分析显示，年龄，住所类型和前往亚洲旅行与ESBL-PE定植有关。
结论
鉴于有大量的旅行者使用ESBL-PE返回，我们建议提高对返回高风险旅行者（例如，从高风险地区返回的旅行者）的认识。他们应该意识到，旅行后可能携带抗药性细菌，以及如何防止其传播。适应性作为促进ESBL-PE肠道菌落形成的因素的作用需要进一步研究。
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