Lübbert Christoph, Straube Laurentia, Stein Claudia, Makarewicz Oliwia, Schubert Stefan, Mössner Joachim, Pletz Mathias W, Rodloff Arne C
Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Liebigstr. 20, D-04103 Leipzig, Germany.
Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Liebigstr. 20, D-04103 Leipzig, Germany.
Int J Med Microbiol. 2015 Jan;305(1):148-56. doi: 10.1016/j.ijmm.2014.12.001. Epub 2014 Dec 9.
Two hundred and twenty-five healthy German volunteers traveling to 53 different countries (mostly in Asia, Africa and South America) were enrolled in a prospective cohort study. Stool samples and data on potential travel-associated risk factors (such as type of travel, nutritional habits, occurrence of gastroenteritis) were collected before and after traveling. Screening for extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) and carbapenemase-producing Enterobacteriaceae (CPE) was performed using selective media (CHROMagar™ ESBL/CPE plates). Isolates with confirmed ESBL-phenotype were examined for the presence of blaCTX-M, blaTEM, blaSHV, and blaVIM, blaIMP, blaNDM, blaKPC, blaOXA-48 genes by PCR amplification and sequencing. Antimicrobial susceptibility testing was performed using conventional microbroth dilution. Pre-travel analysis of 205 fully evaluable participants revealed an ESBL-PE prevalence rate of 6.8% (14/205). Among 191 participants that were ESBL-negative before travel, 58 (30.4%) were colonized by ESBL-producing Escherichia coli, and 5 (8.6%) additionally carried ESBL-producing Klebsiella pneumoniae upon return. However, no carbapenem-resistant Enterobacteriaceae were detected. ESBL-genotyping revealed that 52/54 (96.6%) E. coli and 4/4 (100%) K. pneumoniae strains available for sequencing produced CTX-M enzymes, mostly CTX-M-15 (33/56, 58.9%), and 2/54 (3.7%) E. coli strains produced SHV-12 enzymes. Travel to India was associated with the highest ESBL-PE acquisition rate (11/15, 73.3%; p=0.015), followed by South East Asia (22/46, 47.8%; p=0.038). Evaluation of travel-associated risk factors demonstrated significance for the occurrence of gastroenteritis (p=0.011). Strictly practiced hand hygiene and exclusive consumption of packaged beverages showed no protective effect. The ESBL-PE persistence rate after 6 months was 8.6% (3/35). We conclude that global efforts are needed to address the further spread of ESBL-PE in the community. Active surveillance and contact isolation precautions may be recommended at admission to medical facilities especially for patients who traveled to India and South East Asia in the previous 6 months.
225名前往53个不同国家（主要是亚洲、非洲和南美洲）的健康德国志愿者参与了一项前瞻性队列研究。在旅行前后收集粪便样本以及与旅行相关的潜在风险因素数据（如旅行类型、营养习惯、肠胃炎的发生情况）。使用选择性培养基（CHROMagar™ ESBL/CPE平板）对产超广谱β-内酰胺酶肠杆菌科细菌（ESBL-PE）和产碳青霉烯酶肠杆菌科细菌（CPE）进行筛查。对确认具有ESBL表型的分离株，通过PCR扩增和测序检测blaCTX-M、blaTEM、blaSHV以及blaVIM、blaIMP、blaNDM、blaKPC、blaOXA-48基因的存在情况。采用常规微量肉汤稀释法进行药敏试验。对205名可进行全面评估的参与者进行旅行前分析，结果显示ESBL-PE患病率为6.8%（14/205）。在旅行前ESBL阴性的191名参与者中，58名（30.4%）被产ESBL的大肠埃希菌定植，5名（8.6%）在返回时还携带产ESBL的肺炎克雷伯菌。然而，未检测到耐碳青霉烯类肠杆菌科细菌。ESBL基因分型显示，54株可用于测序的大肠埃希菌中有52株（96.6%）和4株肺炎克雷伯菌（100%）产生CTX-M酶，其中大多为CTX-M-15（33/56，58.9%），2株（3.7%）大肠埃希菌产生SHV-12酶。前往印度旅行与ESBL-PE获得率最高相关（11/15，73.3%；p=0.015），其次是东南亚（22/46，47.8%；p=0.038）。对旅行相关风险因素的评估表明肠胃炎的发生具有显著性（p=0.011）。严格执行手部卫生和只饮用包装饮料未显示出保护作用。6个月后ESBL-PE持续携带率为8.6%（3/35）。我们得出结论，需要全球共同努力应对ESBL-PE在社区中的进一步传播。建议在医疗机构入院时进行主动监测并采取接触隔离预防措施，尤其是对于过去6个月内前往印度和东南亚的患者。
