Travel-Related Antimicrobial Resistance: A Systematic Review

Abstract

There is increasing evidence that human movement facilitates the global spread of resistant bacteria and antimicrobial resistance (AMR) genes. We systematically reviewed the literature on the impact of travel on the dissemination of AMR. We searched the databases Medline, EMBASE and SCOPUS from database inception until the end of June 2019. Of the 3052 titles identified, 2253 articles passed the initial screening, of which 238 met the inclusion criteria. The studies covered 30,060 drug-resistant isolates from 26 identified bacterial species. Most were enteric, accounting for 65% of the identified species and 92% of all documented isolates. High-income countries were more likely to be recipient nations for AMR originating from middle- and low-income countries. The most common origin of travellers with resistant bacteria was Asia, covering 36% of the total isolates. Beta-lactams and quinolones were the most documented drug-resistant organisms, accounting for 35% and 31% of the overall drug resistance, respectively. Medical tourism was twice as likely to be associated with multidrug-resistant organisms than general travel. International travel is a vehicle for the transmission of antimicrobial resistance globally. Health systems should identify recent travellers to ensure that adequate precautions are taken.

Gut Resistome of Preschool Children After Prolonged Mass Azithromycin Distribution: A Cluster-randomized Trial

“…Therefore, by 36 months, only the 15 communities in the present study remained azithromycin-naïve out of the enrollment area. In this setting, physical contact between participants of neighboring villages could have resulted in the exchange of microbes and any associated antimicrobial resistance (ie, contamination) [ 8 , 9 ]. Indeed, the pattern of macrolide resistance in this study mirrors the amount of antibiotic selection pressure in the surrounding communities of the larger trial, with the highest abundance of macrolide resistance seen at the month 36 study visit, which corresponds to the 1-year time period when virtually all surrounding communities were receiving azithromycin ( Supplementary Figure 2 ) [ 10 ].…”

The Case against Antibiotics and for Anti-Virulence Therapeutics

“…Bacteria can also become resistant to a broadspectrum of antibiotics by upregulating the production of efflux transporters (Figure 2G) and/or reducing permeability mechanisms (Figure 2H) [52][53][54]. Quinolones [55], tetracyclines [56,57], β-lactams [58], macrolides [59][60][61], and several other antibiotic classes are vulnerable to efflux by bacteria.…”

“…Bacteria can also become resistant to a broadspectrum of antibiotics by upregulating the production of efflux transporters (Figure 2G) and/or reducing permeability mechanisms (Figure 2H) [52][53][54]. Quinolones [55], tetracyclines [56,57], β-lactams [58], macrolides [59][60][61], and several other antibiotic classes are vulnerable to efflux by bacteria. Resistance mechanisms are often used in concert to achieve multidrug resistance, and dangerous multidrug-resistant (MDR) pathogens are increasingly becoming more prevalent.…”

Future developments in training

“…Despite warnings early in the pandemic [ 38 ], patients with COVID-19 continued to receive broad-spectrum antimicrobials regardless of the implications on antimicrobial resistance. This comes at an inopportune time, as increased travel and global trade have already broadened the reach of multidrug-resistant bacteria, fungi and parasites [ [39] , [40] , [41] , [42] ]. It is well known that resistance genes emerge as a result of selection pressure exerted by antimicrobials during treatment.…”