Frequent acquisition of low-virulence strains of ESBL-producing<i>Escherichia coli</i>in travellers

Vading, M.; Kabir, Muhammad Humaun; Kalin, Mats; Iversen, Aina; Wiklund, Susanne; Nauclér, Pontus; Giske, Christian G.

doi:10.1093/jac/dkw335

Cited by 58 publications

(56 citation statements)

References 32 publications

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“…Another study explored ESBL-PE prevalence rates among patients attending an Infectious Diseases ward and found an increased risk of ESBL-PE carriage and symptomatic ESBL-PE infection among patients with a history of international travel during the past 12 months: 23/191 (23%) patients with travel history were colonized and out of these, 4/23 (17%) had UTI and one had bacteremia (4%) with a culture-verified ESBL-PE 27 . The low risk among healthy travellers concurs with a recent study showing the vast majority of travel-acquired ESBL-PE to lack virulence factors of uropathogenic strains 44 . On the other hand, in other investigations, a pandemic spread of the uropathogenic ST131 ESBL E. coli has been reported 45 …”

Section: Consequences For Travellers Contacts and Communitysupporting

confidence: 81%

Travel-acquired ESBL-producing Enterobacteriaceae: impact of colonization at individual and community level

Woerther

Andremont

Kantele

2017

Journal of Travel Medicine

115

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Background: Antibiotic resistance is a rapidly increasing global emergency that calls for action from all of society. Intestinal multidrugresistant (MDR) bacteria have spread worldwide with extended-spectrum beta-lactamase (ESBL) -producing Enterobacteriaceae (ESBL-PE) as the most prevalent type. The millions of travelers annually visiting regions with poor hygiene contribute substantially to this spread. Our review explores the underlying data and discusses the consequences of the colonization. Methods: PubMed was searched for relevant literature between January 2010 and August 2016. We focused on articles reporting (1) the rate of ESBL-PE acquisition in a group of travelers recruited before/after international travel, (2) fecal carriage of ESBL-PE as explored by culture and, for part of the studies, (3) analysis of factors predisposing to colonization. Results: We reviewed a total of 16 studies focusing on travel-acquired ESBL-PE. The acquisition rates reveal that 2070% of visitors to (sub)tropical regions get colonized by ESBL-PE. The main risk factors predisposing to colonization during travel are destination, travelers diarrhea, and antibiotic use. Conclusions: While most of those colonized remain asymptomatic, acquisition of ESBL-PE may have consequences both at individual and community level. We discuss current efforts to restrict the spread.

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Section: Consequences For Travellers Contacts and Communitysupporting

confidence: 81%

Travel-acquired ESBL-producing Enterobacteriaceae: impact of colonization at individual and community level

Woerther

Andremont

Kantele

2017

Journal of Travel Medicine

115

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“…Of these, 58 studies were forwarded to full-text article screening. Of the 58 full-text articles, we identified 15 relevant articles that reported risk factors associated with drug-resistant Enterobacteriaceae (10) or E. coli (5) carriage [37][38][39][40][41][42][43][44][45][46][47][48][49][50][51].…”

Section: Study Selectionmentioning

confidence: 99%

Risk factors for fecal carriage of drug-resistant Escherichia coli: a systematic review and meta-analysis

Matsui

Riley

2020

Antimicrob Resist Infect Control

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Background: Antimicrobial resistance is a serious public health problem. Fecal carriage of drug-resistant bacteria has been suggested as an important source of antimicrobial resistant genes (ARGs). We aimed to identify risk factors associated with fecal carriage of drug-resistant commensal Escherichia coli among healthy adult population. Methods: We conducted a systematic review and meta-analysis following the PRISMA guideline. We identified observational studies published from 2014 to 2019 through PubMed, Embase, and Web of Science. Studies were eligible if they investigated and reported risk factors and accompanying measure of associations for fecal carriage of drug-resistant E. coli for healthy population aged 18-65. Data on risk factors assessed in three or more studies were extracted. Results: Fifteen of 395 studies involving 11480 healthy individuals were included. The pooled prevalence of drug-resistant Enterobacteriaceae was 14% (95% confidence interval [CI] 8-23%). Antimicrobial use within the 12 months prior to stool culture (odds ratio [OR] 1.84 [95%CI 1.35-2.51]), diarrhea symptoms (OR 1.56 [95%CI 1.09-2.25]), travel to India (OR 4.15 [95%CI 2.54-6.78]), and vegetarian diet (OR 1.60 [95%CI 1.00(1.0043)-2.56(2.5587)]) were associated with increased risk of fecal carriage of drug-resistant E. coli. Among travellers, antimicrobial use (OR 2.81 [95%CI 1.47-5.36]), diarrhea symptoms (OR 1.65 [95%CI 1.02-2.68]), travel to India (OR 3.80 [95%CI 2.23-6.47]), and vegetarian diet (OR 1.92 [95%CI 1.13-3.26]) were associated with increased risk. Among general adult population, antimicrobial use (OR 1.51 [95%CI 1.17-1.94]), diarrhea symptoms (OR 1.53 [95%CI 1.27-1.84]), and travel to Southeast Asia (OR 1.67 [95%CI 1.02-2.73]) were associated with the increased risk of drug-resistant E. coli carriage. Conclusions:The findings indicate that dietary habit as well as past antimicrobial use and travel to high-risk country are associated with the risk of fecal carriage of drug-resistant commensal E. coli.

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“…Notably, the gene has been identified in isolates from animal sources at a much higher frequency than that for human isolates, and along with other lines of evidence, these data suggest that the reservoir for mcr-1 is in animals (5). While animals and animal products are key vectors in the spread of mcr-1 , colonization of humans with bacterial strains carrying this gene has been reported among travelers to the Caribbean, China, Southeast Asia, and southern Africa (6–9). However, other reported cases of humans colonized with mcr-1 -containing bacteria have no obvious route of transmission and lack any exposure to colistin (10, 11).…”

Section: Introductionmentioning

confidence: 99%

Analysis of Serial Isolates of mcr-1 -Positive Escherichia coli Reveals a Highly Active IS Apl1 Transposon

Snesrud

Ong

Corey

et al. 2017

Antimicrob Agents Chemother

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The emergence of a transferable colistin resistance gene (mcr-1) is of global concern. The insertion sequence ISApl1 is a key component in the mobilization of this gene, but its role remains poorly understood. Six Escherichia coli isolates were cultured from the same patient over the course of 1 month in Germany and the United States after a brief hospitalization in Bahrain for an unconnected illness. Four carried mcr-1 as determined by real-time PCR, but two were negative. Two additional mcr-1-negative E. coli isolates were collected during follow-up surveillance 9 months later. All isolates were analyzed by whole-genome sequencing (WGS). WGS revealed that the six initial isolates were composed of two distinct strains: an initial ST-617 E. coli strain harboring mcr-1 and a second, unrelated, mcr-1-negative ST-32 E. coli strain that emerged 2 weeks after hospitalization. Follow-up swabs taken 9 months later were negative for the ST-617 strain, but the mcr-1-negative ST-32 strain was still present. mcr-1 was associated with a single copy of ISApl1, located on a 64.5-kb IncI2 plasmid that shared >95% homology with other mcr-1 IncI2 plasmids. ISApl1 copy numbers ranged from 2 for the first isolate to 6 for the final isolate, but ISApl1 movement was independent of mcr-1. Some movement was accompanied by gene disruption, including the loss of genes encoding proteins involved in stress responses, arginine catabolism, and l-arabinose utilization. These data represent the first comprehensive analysis of ISApl1 movement in serial clinical isolates and reveal that, under certain conditions, ISApl1 is a highly active IS element whose movement may be detrimental to the host cell.

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Frequent acquisition of low-virulence strains of ESBL-producingEscherichia coliin travellers

Abstract: EPE acquired during travel have seemingly low pathogenicity, possibly indicating a low risk of clinical infection. Pre-travel advice should emphasize avoiding unnecessary antibiotic treatment during travel.

Cited by 58 publications

References 32 publications

Travel-acquired ESBL-producing Enterobacteriaceae: impact of colonization at individual and community level

Travel-acquired ESBL-producing Enterobacteriaceae: impact of colonization at individual and community level

Risk factors for fecal carriage of drug-resistant Escherichia coli: a systematic review and meta-analysis

Analysis of Serial Isolates of mcr-1 -Positive Escherichia coli Reveals a Highly Active IS Apl1 Transposon

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