Acquisition and colonization dynamics of antimicrobial-resistant bacteria during international travel: a prospective cohort study

Schaumburg, Frieder; Sertic, S.M.; Correa-Martínez, Carlos L.; Mellmann, Alexander; Köck, Robin; Becker, Karsten

doi:10.1016/j.cmi.2019.03.002

Cited by 46 publications

(38 citation statements)

References 27 publications

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“…It remains an open question, how likely is it that the transmission of mcr -positive Enterobacterales to humans via the food chain occurs? Despite the high detection rates of mcr genes in water or livestock, a study consecutively testing 132 German travelers recently found that 11.4% of all persons carried mcr - 1 -positive Enterobacterales during and after travel, but none of them were colonized before leaving Germany [ 21 ]. In other European countries, the prevalence of mcr - 1 in the community or among patients in hospitals was also low (0–0.4%) [ 22 , 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Epidemiology of Multidrug-Resistant Pathogens in the Food Chain and the Urban Environment in Northwestern Germany

et al. 2020

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The surveillance of antimicrobial resistance among humans and food-producing animals is important to monitor the zoonotic transmission of multidrug-resistant bacteria (MDRB). We assessed the prevalence of four MDRB within the meat production chain, including extended-spectrum β-lactamase (ESBL)-producing, carbapenemase-producing Enterobacterales (CPE) and colistin-resistant Enterobacterales (Col-E), as well as vancomycin-resistant enterococci (VRE). In total, 505 samples from four stages of meat production, i.e., slaughterhouses, meat-processing plants, fresh food products and the urban environment, were collected in northwestern Germany in 2018/2019 and screened for the presence of MDRB using both culture-based and PCR-based techniques. We detected genes encoding for carbapenemases in 9–56% (blaOXA-48, blaKPC, blaNDM, blaVIM) and colistin resistance-encoding mcr genes in 9–26% of the samples from all stages. Culture-based analysis found CPE and VRE only in environmental samples (11% and 7%, respectively), but Col-E and ESBL-producers in 1–7% and 12–46% of samples from all stages, respectively. Overall, our results showed that ESBL-producers and mcr-carrying Col-E were common in food-producing animals at slaughterhouses, in meat-processing plants and in food items at retail, while CPE and VRE were only found in the environment. The discrepancy between detected carbapenemase genes and isolated CPE emphasizes the need for more sensitive detection methods for CPE monitoring.

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Section: Discussionmentioning

confidence: 99%

Prevalence and Epidemiology of Multidrug-Resistant Pathogens in the Food Chain and the Urban Environment in Northwestern Germany

et al. 2020

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“…It could be that the potential acquisition of ESBL-E in connection with diarrhoea was partially cleared at the time of sampling. A cohort study among 132 German and Dutch travellers who provided daily stool samples before, during, and after travel showed that the number of travellers with a temporary colonisation during the journey exceeded the number of travellers still colonised after return [18].…”

Section: Discussionmentioning

confidence: 99%

<strong>Acquisition of Multidrug-Resistant Bacteria and Colistin Resistance Genes in French Medical Students on Internships Abroad</strong>

Dao

Hoang

Magmoun

et al. 2020

Preprint

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Background: In France, no previous studies had addressed the acquisition of multidrug resistant (MDR) bacteria and colistin resistance genes by medical students when undertaking internships abroad. Methods: Nasopharyngeal, rectal, and vaginal swabs samples were collected from 382 French medical students before and after travel to investigate the acquisition of MDR bacteria. The bacterial diversity in the samples was assessed by culture on selective media. We also genetically characterised the isolates of MDR bacteria including Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E), methicillin-resistant Staphylococcus aureus (MRSA), and Carbapenemase-producing Enterobacteriacae (CPE) using the real-time polymerase chain reaction method. The samples were collected from 293 students and were investigated for mcr colistin-resistance genes using RT-PCR directly on the samples, followed by conventional PCR and sequencing. Results: A proportion of 29.3% of the participants had acquired ESBL-E and 2.6% had acquired CPE. The most common species and ESBL-E encoding gene were Escherichia coli (98.4%) and blaCTX-M-A (95.3%), respectively. A proportion of 6.8% of the participants had acquired mcr-1 genes, followed by mcr-3 (0.3%) and mcr-8 (0.3%). We found that taking part in humanitarian missions to orphanages, being in contact with children during travel, the primary destination of travel being Vietnam and north India, using antibiotics during travel, and studying in 2017 were associated with the acquisition of ESBL-E. When the primary destination of travel was Vietnam and the year of study was 2018, this was associated with acquisition of colistin resistance genes. Conclusion: Medical students are at a potential risk of acquiring ESBL-E, CPE and colistin resistance genes. A number of risk factors have been identified, which may be used to develop targeted preventive measures.

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“…a selective agar plate method without a pre-enrichment with a broth containing second or third generation cephalosporins (Table 2) [26, 29-31, 35, 36, 39, 42]. In only 4 of these eight studies, a CPE was found [26,31,36,42]. In 13 out of the 22 studies (59.1%), screening for CPE was carried out in isolates or directly on the specimen by a variety of phenotypic and genotypic methods (Table 2).…”

Section: Microbiological Methodsmentioning

confidence: 99%

“…Only one study clearly defined TD as more than 3 loose/liquid stools per 24 h or more frequently than normal for an individual [29] and one study referred to the World Health Organization (WHO) definition [42]. The other included studies just asked in questionnaires if the participant had experienced TD yes or no.…”

Section: Study Characteristicsmentioning

confidence: 99%

Acquisition of multidrug-resistant Enterobacterales during international travel: a systematic review of clinical and microbiological characteristics and meta-analyses of risk factors

holt

Mourik

Beishuizen

et al. 2020

Antimicrob Resist Infect Control

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Background: International tourism increased from 25 million tourist arrivals in 1950 to over 1.3 billion in 2017. These travelers can be exposed to (multi) resistant microorganisms, may become colonized, and bring them back home. This systematic review aims to identify the carriage rates of multidrug-resistant Enterobacterales (MDR-E) among returning travelers, to identify microbiological methods used, and to identify the leading risk factors for acquiring MDR-E during international travel. Methods: Articles related to our research question were identified through a literature search in multiple databases (until June 18, 2019)-Embase, Medline Ovid, Cochrane, Scopus, Cinahl, Web of Science, and Google Scholar. Results: Out of 3211 potentially relevant articles, we included 22 studies in the systematic review, and 12 studies in 7 random-effects meta-analyses. Highest carriage rates of MDR-E were observed after travel to Southern Asia (median 71%), followed by travel to Northern Africa (median 42%). Carbapenemase-producing Enterobacterales (CPE) were identified in 5 out of 22 studies, from a few patients. However, in only eight out of 22 studies (36.4%) the initial laboratory method targeted detection of the presence of CPE in the original samples. The risk factor with the highest pooled odds ratio (OR) for MDR-E was travel to Southern Asia (pooled OR = 14.16, 95% confidence interval [CI] = 5.50 to 36.45), followed by antibiotic use during travel (pooled OR = 2.78, 95% CI = 1.76 to 4.39). Conclusions: Risk of acquiring MDR-E while travelling increases depending on travel destination and if antibiotics are used during travel. This information is useful for the development of guidelines for healthcare facilities with low MDR-E prevalence rates to prevent admission of carriers without appropriate measures. The impact of such guidelines should be assessed.

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Acquisition and colonization dynamics of antimicrobial-resistant bacteria during international travel: a prospective cohort study

Cited by 46 publications

References 27 publications

Prevalence and Epidemiology of Multidrug-Resistant Pathogens in the Food Chain and the Urban Environment in Northwestern Germany

Prevalence and Epidemiology of Multidrug-Resistant Pathogens in the Food Chain and the Urban Environment in Northwestern Germany

<strong>Acquisition of Multidrug-Resistant Bacteria and Colistin Resistance Genes in French Medical Students on Internships Abroad</strong>

Acquisition of multidrug-resistant Enterobacterales during international travel: a systematic review of clinical and microbiological characteristics and meta-analyses of risk factors

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