Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Haartmaninkatu 3, FI-00014 Helsinki, Finland.
Inflammation Center, Infectious Diseases, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 3, FI-00029 HUS, Helsinki, Finland.
J Travel Med. 2021 Apr 14;28(3). doi: 10.1093/jtm/taaa237.
As antimicrobials increase the risk of acquiring multidrug-resistant (MDR) bacteria, unnecessary antibiotics should be avoided for travellers' diarrhoea (TD). Antibiotics are recommended in TD accompanied by fever or incapacitation (TD justifying use of antibiotics, TDjuAB). Seeking tools for reducing antibiotic use, we explored factors predisposing to TDjuAB and scrutinized antibiotic treatment among those with TDjuAB [TDjuAB(+) subgroup] and those with diarrhoea not justifying antibiotics [TDjuAB(-) subgroup].
We conducted a study among 370 prospectively recruited visitors to the tropics. Stool samples and questionnaires were collected before and after travel. Enteric pathogens were analysed by qPCR for enteropathogenic (EPEC), enteroaggregative (EAEC), enterotoxigenic (ETEC), enterohaemorrhagic (EHEC) and enteroinvasive (EIEC) E. coli/Shigella, Campylobacter, Salmonella, Yersinia and Vibrio cholerae, and for ETEC's toxins LT (heat-labile), STh (human heat-stable) and STp (porcine heat-stable). TD was defined by the WHO criteria and TDjuAB as diarrhoea accompanied by fever, and/or disrupting or preventing daily activities. Multivariable analysis was applied-separately for travel-related factors and pathogens-to identify risk factors for TDjuAB(+).
Among the 370 travellers, TD was contracted by 253 (68%), categorized as TDjuAB(+) in 93/253 (37%) and TDjuAB(-) in 160/253 (63%) of the cases. Antibiotics were used for TD by 41% in TDjuAB(+) and by 7% in the TDjuAB(-) group. Relative risk ratios (RRR)s are presented for both the TDjuAB(+) and the TDjuAB(-) groups. TDjuAB(+) was associated with long travel duration and young age. Among the 298 subjects not having taken antibiotics, increased RRRs were found e.g. for findings of Campylobacter coli/jejuni and ETEC's STh toxin.
The first to analyse risk factors for TDjuAB, our study presents RRRs for demographic and behavioural factors and for various pathogens. Only less than half of those in the TDjuAB(+) group took antibiotics, which demonstrates that most cases meeting the current criteria recover without antimicrobial treatment.
由于抗生素会增加获得多重耐药（MDR）细菌的风险，因此旅行者腹泻（TD）不应使用不必要的抗生素。伴有发热或乏力的 TD 推荐使用抗生素（需要使用抗生素的 TD，TDjuAB）。为了寻找减少抗生素使用的方法，我们研究了导致 TDjuAB 的相关因素，并仔细研究了 TDjuAB（+）亚组中伴有 TDjuAB 的患者和 TDjuAB（-）亚组中没有使用抗生素指征的腹泻患者的抗生素治疗情况。
我们对 370 名前瞻性招募的热带旅行者进行了一项研究。在旅行前后采集粪便样本和问卷调查。通过 qPCR 分析肠致病性（EPEC）、肠聚集性（EAEC）、肠毒性（ETEC）、肠出血性（EHEC）和肠侵袭性（EIEC）大肠杆菌/志贺菌、弯曲菌、沙门氏菌、耶尔森菌和霍乱弧菌，以及肠毒素 LT（不耐热）、STh（人热稳定）和 STp（猪热稳定）。根据世界卫生组织的标准定义 TD，伴有发热、且/或扰乱或妨碍日常活动的腹泻定义为 TDjuAB。我们分别对旅行相关因素和病原体进行多变量分析，以确定 TDjuAB（+）的危险因素。
在 370 名旅行者中，253 名（68%）患有 TD，其中 93 名（37%）为 TDjuAB（+），160 名（63%）为 TDjuAB（-）。在 TDjuAB（+）组中，41%的患者使用了抗生素治疗 TD，而在 TDjuAB（-）组中，7%的患者使用了抗生素。我们为 TDjuAB（+）和 TDjuAB（-）两组分别呈现了相对风险比（RRR）。TDjuAB（+）与旅行时间长和年龄小有关。在 298 名未使用抗生素的受试者中，发现了一些风险因素的 RRR 增加，例如弯曲菌 coli/jejuni 和 ETEC 的 STh 毒素。
本研究首次分析了 TDjuAB 的危险因素，为人口统计学和行为因素以及各种病原体提供了 RRR。只有不到一半的 TDjuAB（+）组患者使用了抗生素，这表明大多数符合当前标准的病例无需抗菌治疗即可康复。
