前往热带地区旅行后，耐多药肠杆菌科的获得率高，但携带时间短。

High Rate of Acquisition but Short Duration of Carriage of Multidrug-Resistant Enterobacteriaceae After Travel to the Tropics.

机构信息

Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat, Laboratoire de Bactériologie Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137 Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité

Département d'Epidémiologie et Recherche Clinique, AP-HP, Hôpital Bichat, URC Paris-Nord INSERM, CIC 1425-EC, UMR 1123 Université Paris Diderot, UMR 1123, Sorbonne Paris Cité

出版信息

Clin Infect Dis. 2015 Aug 15;61(4):593-600. doi: 10.1093/cid/civ333. Epub 2015 Apr 22.

DOI:10.1093/cid/civ333

PMID:25904368

Abstract

BACKGROUND

Multidrug-resistant Enterobacteriaceae (MRE) are widespread in the community, especially in tropical regions. Travelers are at risk of acquiring MRE in these regions, but the precise extent of the problem is not known.

METHODS

From February 2012 to April 2013, travelers attending 6 international vaccination centers in the Paris area prior to traveling to tropical regions were asked to provide a fecal sample before and after their trip. Those found to have acquired MRE were asked to send fecal samples 1, 2, 3, 6, and 12 months after their return, or until MRE was no longer detected. The fecal relative abundance of MRE among all Enterobacteriaceae was determined in each carrier.

RESULTS

Among 824 participating travelers, 574 provided fecal samples before and after travel and were not MRE carriers before departure. Of these, 292 (50.9%) acquired an average of 1.8 MRE. Three travelers (0.5%) acquired carbapenemase-producing Enterobacteriaceae. The acquisition rate was higher in Asia (142/196 [72.4%]) than in sub-Saharan Africa (93/195 [47.7%]) or Latin America (57/183 [31.1%]). MRE acquisition was associated with the type of travel, diarrhea, and exposure to β-lactams during the travel. Three months after return, 4.7% of the travelers carried MRE. Carriage lasted longer in travelers returning from Asia and in travelers with a high relative abundance of MRE at return.

CONCLUSIONS

MRE acquisition is very frequent among travelers to tropical regions. Travel to these regions should be considered a risk factor of MRE carriage during the first 3 months after return, but not beyond.

CLINICAL TRIALS REGISTRATION

NCT01526187.

摘要

背景

多药耐药肠杆菌科（MRE）在社区中广泛存在，尤其是在热带地区。旅行者在这些地区有感染 MRE 的风险，但具体情况尚不清楚。

方法

2012 年 2 月至 2013 年 4 月，在前往热带地区旅行前，前往巴黎地区 6 个国际疫苗接种中心的旅行者被要求在旅行前后提供粪便样本。发现携带 MRE 的旅行者被要求在返回后 1、2、3、6 和 12 个月，或直至 MRE 不再检出时，再次提供粪便样本。在每位携带 MRE 的旅行者中，均确定了 MRE 在所有肠杆菌科中的粪便相对丰度。

结果

在 824 名参与旅行者中，有 574 名旅行者在旅行前后提供了粪便样本，且在出发前未携带 MRE。其中 292 名（50.9%）平均携带 1.8 株 MRE。3 名旅行者（0.5%）携带产碳青霉烯酶肠杆菌科细菌。在亚洲（196 人中有 142 人[72.4%]）旅行者中的感染率高于撒哈拉以南非洲（195 人中有 93 人[47.7%]）或拉丁美洲（183 人中有 57 人[31.1%]）。MRE 的感染与旅行类型、腹泻和旅行期间接触β-内酰胺类药物有关。旅行者在返回后 3 个月时，有 4.7%携带 MRE。从亚洲返回的旅行者和携带 MRE 相对丰度较高的旅行者，其携带 MRE 的时间较长。