Foreign Travel Is a Major Risk Factor for Colonization with
            <i>Escherichia coli</i>
            Producing CTX-M-Type Extended-Spectrum β-Lactamases: a Prospective Study with Swedish Volunteers

Tängdén, Thomas; Cars, Otto; Melhus, Åsa; Löwdin, Elisabeth

doi:10.1128/aac.00220-10

Cited by 326 publications

(230 citation statements)

References 32 publications

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“…Multiple logistic regression analysis showed that travel in the previous 12 months to Africa, Asia or Latin America is a risk factor for carriage of ESBL/pAmpC-E, which is in agreement with findings of others [7,28,29]. The findings of Reuland et al showing that the use of PPIs is a risk factor were confirmed [7].…”

Section: Discussionsupporting

confidence: 87%

Extended-spectrum β-lactamase- and pAmpC-producing Enterobacteriaceae among the general population in a livestock-dense area

Wielders

Hoek

Hengeveld

et al. 2017

Clinical Microbiology and Infection

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Extended-spectrum b-lactamases b-lactam resistance Livestock farming Prevalence Risk factors a b s t r a c tObjectives: In the Netherlands there is an ongoing debate regarding environmental health risks of livestock farming for neighbouring residents. This explorative study aims to determine the prevalence of carriage of extended-spectrum b-lactamase and/or plasmid-mediated AmpC-producing Enterobacteriaceae (ESBL/pAmpC-E) in the general population living in a livestock-dense area, and to study associations between determinants, including exposure through contact with animals and the environment, and human carriage of ESBL/pAmpC-E. Methods: A cross-sectional study was performed among 2432 adults (aged 20e72 years) in 12 temporary research centres in the south of the Netherlands, consisting of a questionnaire and analysis of a faecal sample to assess carriage of ESBL/pAmpC-E. Risk factors were analysed using logistic regression. Results: The prevalence for carriage of ESBL/pAmpC-E was 4.5% (109/2432; 95% CI 3.7e5.4) ranging from 1.4% to 10.9% among the research centres. ESBL/pAmpC resistance genes were detected in Escherichia coli and Klebsiella pneumoniae isolates obtained from these 109 persons and the most common ESBLresistance genes were bla CTX-M-15 , bla CTX-M-14/17 and bla CTX-M-1 , originating from 76 participants. Travel in the previous 12 months to Africa, Asia or Latin America (OR 2.82; 95% CI 1.71e4.63), having kept cows for a hobby in the previous 5 years (OR 3.77; 95% CI 1.22e11.64), usage of proton-pump inhibitors (OR 1.84; 95% CI 1.05e3.23), and living within 1000 m of a mink farm (OR 2.26; 95% CI 1.28e3.98) were identified as risk factors. Exposure to poultry was not identified as a risk factor. Conclusions: Overall, living in close proximity to livestock animals and farms does not seem to be a risk factor for carriage of ESBL/pAmpC-E. C.C.H. Wielders, CMI 2017;23:120.e1e120.e8

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Section: Discussionsupporting

confidence: 87%

Extended-spectrum β-lactamase- and pAmpC-producing Enterobacteriaceae among the general population in a livestock-dense area

Wielders

Hoek

Hengeveld

et al. 2017

Clinical Microbiology and Infection

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“…Tangden et al associated gastroenteritis during travel with the risk for ESBL-E acquisition among travelers from Sweden ( 3 ). That association was not found in this study, which may reflect less fecal–oral contamination while traveling.…”

Section: Discussionmentioning

confidence: 99%

Extended-Spectrum β-Lactamase–producingEnterobacteriaceaeamong Travelers from the Netherlands

Paltansing¹,

Vlot²,

Kraakman³

et al. 2013

Emerg. Infect. Dis.

112

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A prospective cohort study was performed among travelers from the Netherlands to investigate the acquisition of carbapenemase-producing Enterobacteriaceae (CP-E) and extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBL-E) and associated risk factors. Questionnaires were administered and rectal swab samples were collected and tested before and after traveler return. Of 370 travelers, 32 (8.6%) were colonized with ESBL-E before trave,; 113 (30.5%) acquired an ESBL-E during travel, and 26 were still colonized 6 months after return. No CP-E were found. Independent risk factors for ESBL-E acquisition were travel to South and East Asia. Multilocus sequence typing showed extensive genetic diversity among Escherichia coli. Predominant ESBLs were CTX-M enzymes. The acquisition rate, 30.5%, of ESBL-E in travelers from the Netherlands to all destinations studied was high. Active surveillance for ESBL-E and CP-E and contact isolation precautions may be recommended at admission to medical facilities for patients who traveled to Asia during the previous 6 months.

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“…Studies in Australia ( 13 ), Sweden ( 14 , 15 ), and the Netherlands ( 16 ) have shown that international travel is a major risk factor for colonization with ESBL-producing Enterobacteriaceae . Likely, these resistant strains are acquired from the environment during travel, e.g., through food consumption ( 17 ).…”

mentioning

confidence: 99%

High Rates of Antimicrobial Drug Resistance Gene Acquisition after International Travel, the Netherlands

Wintersdorff¹,

Penders²,

Stobberingh³

et al. 2014

Emerg. Infect. Dis.

117

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We investigated the effect of international travel on the gut resistome of 122 healthy travelers from the Netherlands by using a targeted metagenomic approach. Our results confirm high acquisition rates of the extended-spectrum β-lactamase encoding gene blaCTX-M, documenting a rise in prevalence from 9.0% before travel to 33.6% after travel (p<0.001). The prevalence of quinolone resistance encoding genes qnrB and qnrS increased from 6.6% and 8.2% before travel to 36.9% and 55.7% after travel, respectively (both p<0.001). Travel to Southeast Asia and the Indian subcontinent was associated with the highest acquisition rates of qnrS and both blaCTX-M and qnrS, respectively. Investigation of the associations between the acquisitions of the blaCTX-M and qnr genes showed that acquisition of a blaCTX-M gene was not associated with that of a qnrB (p = 0.305) or qnrS (p = 0.080) gene. These findings support the increasing evidence that travelers contribute to the spread of antimicrobial drug resistance.

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Foreign Travel Is a Major Risk Factor for Colonization with Escherichia coli Producing CTX-M-Type Extended-Spectrum β-Lactamases: a Prospective Study with Swedish Volunteers

Cited by 326 publications

References 32 publications

Extended-spectrum β-lactamase- and pAmpC-producing Enterobacteriaceae among the general population in a livestock-dense area

Extended-spectrum β-lactamase- and pAmpC-producing Enterobacteriaceae among the general population in a livestock-dense area

Extended-Spectrum β-Lactamase–producingEnterobacteriaceaeamong Travelers from the Netherlands

High Rates of Antimicrobial Drug Resistance Gene Acquisition after International Travel, the Netherlands

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