Institute of Medical Microbiology, University Hospital Münster, Münster, Germany.
Institute of Medical Microbiology, University Hospital Münster, Münster, Germany.
Clin Microbiol Infect. 2019 Oct;25(10):1287.e1-1287.e7. doi: 10.1016/j.cmi.2019.03.002. Epub 2019 Mar 19.
Travellers may be colonized with antimicrobial-resistant bacteria on return, but little is known about colonization during travel. Our objectives were to assess the acquisition and colonization dynamics during the stay abroad for a broad range of antimicrobial-resistant bacteria and resistance phenotypes and to identify risk factors for faecal carriage of antimicrobial-resistant bacteria.
German and Dutch participants (n = 132) of this prospective cohort study (2016-2018) completed a questionnaire on risk factors and provided daily stool samples before, during, and after travel. Samples were screened for extended-spectrum β-lactamase producing Enterobacterales (ESBL-E), carbapenem-resistant (CarbR-GN), and non-intrinsically colistin-resistant Gram-negative rods (ColR-GN), vancomycin-resistant Enterococcus faecium/faecalis (VRE), and Clostridioides difficile.
Colonization rates reached a plateau within a week after departure fluctuating around 48.5% (63/130) and 58.4% (45/77, ESBL-E), 10.4% (11/106) and 23.4% (18/77, ColR-GN), or 3.0% (4/132) and 6.8% (8/118, CarbR-GN). Colonization rates after the travel were 46.2% (61/132, ESBL-E), 9.0% (12/132, ColR-GN), and 3.4% (5/132, CarbR-GN). Travellers carried mcr-1- (15/132; 11.4%) or bla-positive (4/132; 3.0%) Enterobacterales. A vegetarian diet was associated with a lower risk for the acquisition of ESBL-E (OR = 0.4, p 0.04) and ColR-GN (OR = 0.1, p 0.01) during travel in a multivariable model. Similarly, travellers visiting friends and relatives had a lower risk for the acquisition of ESBL-E (OR = 0.3, p 0.009) and CarbR-GN (OR = 0.3, p 0.01). VRE and C. difficile were not detected.
The number of travellers with a temporary colonization during the journey exceeded the number of travellers still colonized after return.
旅行者在返回后可能会定植具有抗微生物药物耐药性的细菌，但关于旅行期间定植的情况知之甚少。我们的目的是评估广泛的抗微生物药物耐药菌和耐药表型在国外逗留期间的获得和定植动态，并确定粪便携带抗微生物药物耐药菌的危险因素。
本前瞻性队列研究（2016-2018 年）纳入了 132 名德国和荷兰参与者，他们填写了一份关于危险因素的调查问卷，并在旅行前、旅行中和旅行后每天提供粪便样本。对产超广谱β-内酰胺酶的肠杆菌科（ESBL-E）、耐碳青霉烯的革兰氏阴性杆菌（CarbR-GN）、非固有黏菌素耐药的革兰氏阴性杆菌（ColR-GN）、万古霉素耐药屎肠球菌/粪肠球菌（VRE）和艰难梭菌进行了筛选。
定植率在离开后的一周内达到了一个平台期，波动在 48.5%（130 人中有 63 人）和 58.4%（77 人中有 45 人，ESBL-E）、10.4%（106 人中有 11 人）和 23.4%（77 人中有 18 人，ColR-GN），或 3.0%（132 人中有 4 人）和 6.8%（118 人中有 8 人，CarbR-GN）。旅行后的定植率为 46.2%（132 人中有 61 人，ESBL-E）、9.0%（132 人中有 12 人，ColR-GN）和 3.4%（132 人中有 5 人，CarbR-GN）。旅行者携带 mcr-1-（132 人中有 15 人；11.4%）或 bla 阳性（132 人中有 4 人；3.0%）肠杆菌科。在多变量模型中，素食饮食与 ESBL-E（OR=0.4，p=0.04）和 ColR-GN（OR=0.1，p=0.01）在旅行期间的获得风险降低相关。同样，探亲访友的旅行者获得 ESBL-E（OR=0.3，p=0.009）和 CarbR-GN（OR=0.3，p=0.01）的风险降低。未检测到 VRE 和艰难梭菌。
旅行期间暂时定植的旅行者数量超过了返回后仍定植的旅行者数量。
