Extended-spectrum beta-lactamase-producing strains among diarrhoeagenicEscherichia coli—prospective traveller study with literature review

Abstract

Background: Antibiotics are no longer the primary approach for treating all travelers’ diarrhea (TD): most cases resolve without antibiotics and using them predisposes to colonization by multidrug-resistant bacteria. Data are accumulating on increasing resistance among TD pathogens, yet research into the most common agents, diarrheagenic Escherhichia coli (DEC), remains limited. Methods: A total of 413 travelers to the (sub)tropics were analyzed for travel-acquired diarrheal pathogens and ESBL-PE. To identify ESBL-producing DEC, ESBL-producing E. coli (ESBL-EC) isolates were subjected to multiplex qPCR for various DEC pathotypes: enteroaggregative (EAEC), enteropathogenic (EPEC), enterotoxigenic (ETEC), enteroinvasive (EIEC), and enterohemorrhagic (EHEC) E. coli. For a literature review, we screened studies among travelers and locals in low- and middle-income countries (LMIC) on the frequency of ESBL-producing DEC, and among travelers, also DEC with resistance to ciprofloxacin, azithromycin, and rifamycin derivatives. Results: Our rate of ESBL-EC among all DEC findings was 2.7% (13/475); among EAEC 5.7% (10/175), EPEC 1.1% (2/180), ETEC 1.3% (1/80), and EHEC (0/35) or EIEC 0% (0/5). The literature search yielded three studies reporting ESBL-EC frequency and thirteen exploring resistance to TD antibiotics among travel-acquired DEC. For EAEC and ETEC, the ESBL-EC rates were 10–13% and 14–15%, resistance to fluoroquinolones 0–42% and 0–40%, azithromycin 0–29% and 0–61%, and rifaximin 0% and 0–20%. The highest rates were from the most recent collections. Proportions of ESBL-producing DEC also appear to be increasing among locals in LMICs and even carbapenemase-producing DEC were reported. Conclusions: ESBL producers are no longer rare among DEC and the overall resistance to various antibiotics is increasing. The data predict decreasing efficacy of antibiotic treatment, threatening its benefits, for disadvantages still prevail when efficacy is lost.

Prevalence of Multidrug-Resistant Diarrheagenic Escherichia coli in Asia: A Systematic Review and Meta-Analysis

“…MDR and ESBL-producing DEC strains are superbugs that have the ability to resist to at least three different classes of antibiotics and to hydrolyze the third-generation cephalosporins—such as cefotaxime, ceftazidime, ceftriaxone, cefuroxime, and cefepime—or monobactams such as aztreonam [ 14 ]. The most common beta-lactamase ( bla ) genes reported in the ESBL-producing DEC isolates include bla TEM , bla SHV , and bla CTX-M , with the highest frequency of ESBL producers found in the EAEC pathotype [ 15 , 16 , 17 ]. The fact that these resistance genes are easily transferable among bacterial species via mobile genetic elements (e.g., plasmids, integrons, insertion sequences, and transposons) has made disease management for MDR and ESBL-producing DEC more challenging [ 18 ].…”

Antimicrobial-resistant bacteria in international travelers

“…Twenty-one percent of travelers acquired ESBL-PE, the majority of which were E. coli [27 ▪ ]. No carbapenemase-producing Enterobacterales were found [21 ▪ ,26]. Of the travelers who acquired ESBL-PE, none had longitudinal carriage after one year.…”

“…Clinicians providing pretravel health consultation should also consider antimicrobial stewardship principles and be cautious about the prescription of broad-spectrum antimicrobials for empiric use by travelers. Recent analyses have shown that although the occurrence of travelers’ diarrhea cannot be controlled for, reducing the use of empiric antimicrobial treatment for travelers’ diarrhea may be useful for lowering the acquisition of travel-associated AMR bacteria [21 ▪ ,55 ▪▪ ,82].…”

“…International travel has been identified as playing a role in the spread of resistance genes and organisms [12,20,21 ▪ ,22 ▪ ]. The ongoing COVID-19 global pandemic has highlighted the ease with which infectious diseases can be disseminated by international travel.…”

International Travel as a Risk Factor for Carriage of Extended-Spectrum β-Lactamase-Producing Escherichia coli in a Large Sample of European Individuals—The AWARE Study

“…Antibiotic therapy is also a risk factor for carriage of AR by individuals. Other potential risk factors include: travels to high-risk areas for AR [2,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28], consumption of food contaminated with AR bacteria [29,30], a poorer health status that leads individuals into being treated with antibiotics or at healthcare facilities increasing their exposure to AR bacteria [23,26], and occupation where the workplace might potentially increase exposure to antibiotics or AR bacteria, such as working at animal markets, dairy facilities, farms, slaughterhouses, wastewater treatment plants, and healthcare facilities [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46]. However, most of the studies examining potential risk factors focus on high-risk populations, such as travelers [10,12,16,…”