Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
Antimicrob Resist Infect Control. 2020 May 20;9(1):71. doi: 10.1186/s13756-020-00733-6.
International tourism increased from 25 million tourist arrivals in 1950 to over 1.3 billion in 2017. These travelers can be exposed to (multi) resistant microorganisms, may become colonized, and bring them back home. This systematic review aims to identify the carriage rates of multidrug-resistant Enterobacterales (MDR-E) among returning travelers, to identify microbiological methods used, and to identify the leading risk factors for acquiring MDR-E during international travel.
Articles related to our research question were identified through a literature search in multiple databases (until June 18, 2019) - Embase, Medline Ovid, Cochrane, Scopus, Cinahl, Web of Science, and Google Scholar.
Out of 3211 potentially relevant articles, we included 22 studies in the systematic review, and 12 studies in 7 random-effects meta-analyses. Highest carriage rates of MDR-E were observed after travel to Southern Asia (median 71%), followed by travel to Northern Africa (median 42%). Carbapenemase-producing Enterobacterales (CPE) were identified in 5 out of 22 studies, from a few patients. However, in only eight out of 22 studies (36.4%) the initial laboratory method targeted detection of the presence of CPE in the original samples. The risk factor with the highest pooled odds ratio (OR) for MDR-E was travel to Southern Asia (pooled OR = 14.16, 95% confidence interval [CI] = 5.50 to 36.45), followed by antibiotic use during travel (pooled OR = 2.78, 95% CI = 1.76 to 4.39).
Risk of acquiring MDR-E while travelling increases depending on travel destination and if antibiotics are used during travel. This information is useful for the development of guidelines for healthcare facilities with low MDR-E prevalence rates to prevent admission of carriers without appropriate measures. The impact of such guidelines should be assessed.
国际旅游业从 1950 年的 2500 万游客增长到 2017 年的超过 13 亿。这些旅行者可能会接触到（多重）耐药微生物，可能会定植，然后将其带回国内。本系统评价旨在确定返回旅行者中携带多重耐药肠杆菌科（MDR-E）的比例，确定用于检测的微生物学方法，并确定国际旅行中获得 MDR-E 的主要危险因素。
通过在多个数据库（截至 2019 年 6 月 18 日）中进行文献检索，确定与我们的研究问题相关的文章 - Embase、Medline Ovid、Cochrane、Scopus、Cinahl、Web of Science 和 Google Scholar。
在 3211 篇潜在相关文章中，我们将 22 项研究纳入系统评价，12 项研究纳入 7 项随机效应荟萃分析。从少数患者中发现，旅行至南亚（中位数 71%）后观察到 MDR-E 的携带率最高，其次是前往北非（中位数 42%）。在 22 项研究中的 5 项研究中鉴定出产碳青霉烯酶肠杆菌科（CPE），然而，在 22 项研究中仅有 8 项（36.4%）最初的实验室方法旨在检测原始样本中 CPE 的存在。MDR-E 的最高汇总优势比（OR）的危险因素是前往南亚旅行（汇总 OR=14.16，95%置信区间[CI]=5.50 至 36.45），其次是旅行期间使用抗生素（汇总 OR=2.78，95%CI=1.76 至 4.39）。
旅行时感染 MDR-E 的风险会随着旅行目的地的不同而增加，如果在旅行期间使用抗生素则会增加。这些信息对于制定针对 MDR-E 发病率低的医疗机构的指南非常有用，这些指南旨在防止未采取适当措施的携带者入院。应评估此类指南的影响。
