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

Abstract

Antibiotic resistance (AR) is currently a major threat to global health, calling for a One Health approach to be properly understood, monitored, tackled, and managed. Potential risk factors for AR are often studied in specific high-risk populations, but are still poorly understood in the general population. Our aim was to explore, describe, and characterize potential risk factors for carriage of Extended-Spectrum Beta-Lactamase-resistant Escherichia coli (ESBL-EC) in a large sample of European individuals aged between 16 and 67 years recruited from the general population in Southern Germany, the Netherlands, and Romania. Questionnaire and stool sample collection for this cross-sectional study took place from September 2018 to March 2020. Selected cultures of participants’ stool samples were analyzed for detection of ESBL-EC. A total of 1183 participants were included in the analyses: 333 from Germany, 689 from the Netherlands, and 161 from Romania. Travels to Northern Africa (adjusted Odds Ratio, aOR 4.03, 95% Confidence Interval, CI 1.67–9.68), Sub-Saharan Africa (aOR 4.60, 95% CI 1.60–13.26), and Asia (aOR 4.08, 95% CI 1.97–8.43) were identified as independent risk factors for carriage of ESBL-EC. Therefore, travel to these regions should continue to be routinely asked about by clinical practitioners as possible risk factors when considering antibiotic therapy.

Antimicrobial Resistance in Qatar: Prevalence and Trends before and Amidst the COVID-19 Pandemic

“…Additionally, ESBL-EBCs and MRSA infections were positively correlated with the number of international visitors (ρ = 0.71 and 0.67, respectively), which decreased significantly during the pandemic. Globally, international travel has been documented to be associated with ESBL carriage and infections [ 29 , 30 ]. Similarly, international travel and close contact are associated with MRSA infections [ 31 , 32 ].…”

Human carriage of ESBL/pAmpC-producing Escherichia coli and Klebsiella pneumoniae in relation to the consumption of raw or undercooked vegetables, fruits, and fresh herbs

“…At the time of the sample collection in 2021 strict containment measures were in place for over a year due to the COVID-19 pandemic, which included increased physical distancing, use of face masks in public spaces, and travel restrictions. We hypothesized that this would decrease the ESBL-E/K carriage rate in the general population, since human contact is regarded the main route of transmission, and travel to countries with a high risk of ESBL-E acquisition has been an established risk factor ( 5 , 31 , 32 ). Indeed, the percentage of participants traveling to Africa, Asia, and Latin America in the preceding 6 months decreased from 13.0% in 2015–2017 to 1.2% in 2021.…”

Pathogen distribution and antimicrobial resistance in infections in migrants and nonmigrants in Denmark, a cross‐sectional study

“…Another review from 2022 on poverty and social determinants for health as risk factors for AMR organisms in Canada found an increased prevalence among indigenous groups and found higher income to be associated with a lower prevalence of MRSA [31]. Previous studies have also pointed to international travel as a risk factor for increased resistance [3,32,33]. Moreover, one study found that among travellers, those visiting friends and relatives as well as migrants had the highest risk of acquiring multi-drug resistant Gram-negative bacteria [34].…”