Unité de Recherche sur les Maladies Infectieuses et Tropicales Émergentes (URMITE) CNRS-IRD UMR 6236, Méditerranée Infection, Faculté de Médecine et de Pharmacie, Aix-Marseille-Université, Marseille, France.
Ministry of Health, Riyadh, Saudi Arabia; Alfaisal University, College of Medicine, Riyadh, Saudi Arabia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, USA.
Travel Med Infect Dis. 2017 Jul-Aug;18:3-17. doi: 10.1016/j.tmaid.2017.06.008. Epub 2017 Jun 24.
Hajj is the annual mass gathering of Muslims, and is a reservoir and potential source of bacterial transmission. The emergence of bacterial transmission, including multi-drug resistance (MDR) bacteria, during Hajj has not been systematically assessed.
Articles in Pubmed, Scopus, and Google scholar were identified using controlled words relating to antibiotic resistance (AR) at the Hajj from January 2002 to January 2017. Eligible studies were identified by two researchers. AR patterns of bacteria were obtained for each study.
We included 31 publications involving pilgrims, Hajj workers or local patients attending hospitals in Mecca, Mina, and the Medina area. Most of these publications provided antibiotic susceptibility results. Ten of them used the PCR approach to identify AR genes. MRSA carriage was reported in pilgrims and food handlers at a rate of 20%. Low rates of vancomycin-resistant gram-positive bacteria were reported in pilgrims and patients. The prevalence of third-generation cephalosporin-resistant bacteria was common in the Hajj region. Across all studies, carbapenem-resistant bacteria were detected in fewer than 10% of E.coli isolates tested but up to 100% in K. pneumoniae and A. baumannii. Colistin-resistant Salmonella enterica, including mcr-1 colistin-resistant E.coli and K.pneumoniae were only detected in the pilgrim cohorts.
This study provides an overview of the prevalence of MDR bacteria at the Hajj. Pilgrims are at high risk of AR bacterial transmission and may carry and transfer these bacteria when returning to their home countries. Thus, pilgrims should be instructed by health care practitioners about hygiene practices aiming at reducing traveler's diarrhea and limited use of antibiotics during travel in order to reduce the risk of MDR bacterial transmission.
朝觐是穆斯林的年度集会，是细菌传播的蓄水池和潜在来源。在朝觐期间，细菌传播（包括多药耐药菌）的出现尚未得到系统评估。
使用与 2002 年 1 月至 2017 年 1 月期间朝觐期间抗生素耐药性相关的受控词，在 Pubmed、Scopus 和 Google scholar 中确定文章。由两名研究人员确定符合条件的研究。从每项研究中获取细菌的抗生素耐药模式。
我们纳入了 31 篇涉及朝圣者、朝觐工人或麦加、米纳和麦地那地区医院就诊的当地患者的出版物。这些出版物大多提供了抗生素药敏结果。其中 10 项使用 PCR 方法鉴定 AR 基因。在朝圣者和食品处理人员中，MRSA 携带率为 20%。在朝圣者和患者中，万古霉素耐药革兰阳性菌的检出率较低。第三代头孢菌素耐药菌在朝觐地区普遍存在。在所有研究中，在测试的大肠杆菌分离株中，碳青霉烯类耐药菌的检出率不到 10%，但在肺炎克雷伯菌和鲍曼不动杆菌中高达 100%。仅在朝圣者队列中检测到对黏菌素耐药的沙门氏菌属，包括 mcr-1 黏菌素耐药大肠杆菌和肺炎克雷伯菌。
本研究提供了朝觐期间 MDR 细菌流行情况的概述。朝圣者感染 AR 细菌传播的风险很高，在返回自己的国家时可能会携带和传播这些细菌。因此，应告知卫生保健从业者有关卫生实践的指导，以减少旅行者腹泻和旅行期间抗生素的有限使用，从而降低 MDR 细菌传播的风险。
