HKU-Pasteur Research Pole, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR 999077, China.
Faculty of Medicine, University of Clermont Auvergne, Clermont-Ferrand 63100, France.
J Travel Med. 2021 Apr 14;28(3). doi: 10.1093/jtm/taab022.
International travel could facilitate the spread of antimicrobial-resistant bacteria including extended spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E). Previous studies, which attempted to understand the role of gut microbiota in the acquisition of antimicrobial resistant bacteria during international travels, are limited to western travellers.
We established a prospective cohort of 90 Hong Kong travellers to investigate gut microbiota determinants and associated risk factors for the acquisition of ESBL-E. Baseline characteristics and travel-associated risk factors were gathered through questionnaires. Faecal samples were collected in 3-4 days before and after travel. Antimicrobial susceptibility of ESBL-E isolates was tested, and gut microbiota were profiled by 16S rDNA amplicon sequencing. Non-parametric tests were used to detect potential associations, and logistic regression models were used to quantify the associations. Random forest models were constructed to identify microbial predictors for ESBL-E acquisition.
In total, 49 (54.4%) participants were tested negative for ESBL-E colonization before travel and were followed up after travel. A total of 60 ESBL-E isolates were cultured from 20 (40.8%) participants. Having low Actinobacteria richness and low abundance of short-chain fatty acid-producing bacteria in the gut microbiota before travel increased the risk of acquiring ESBL-E and the risk can be further exacerbated by eating raw seafood during travel. Besides, post-travel ESBL-E positive participants had increased abundances of several opportunistic pathogens such as Staphylococcus, Enterococcus, Escherichia/Shigella and Klebsiella. The random forest model integrating pre-travel microbiota and the identified travel-related risk factor could predict ESBL-E acquisition with an area under the curve of 75.4% (95% confidence interval: 57.9-93.0%).
In this study, we identified both travel-related risk factors and microbiota predictors for the risk of ESBL-E acquisition. Our results provide foundational knowledge for future developments of microbiota-based interventions to prevent ESBL-E acquisition during international travels.
国际旅行可能会促进包括产超广谱β-内酰胺酶肠杆菌科（ESBL-E）在内的抗微生物耐药菌的传播。之前的研究试图了解肠道微生物群在国际旅行期间获得抗微生物耐药菌中的作用，但这些研究仅限于西方旅行者。
我们建立了一个前瞻性队列，包括 90 名香港旅行者，以调查肠道微生物群决定因素以及与 ESBL-E 获得相关的风险因素。通过问卷调查收集基线特征和旅行相关风险因素。在旅行前 3-4 天和旅行后采集粪便样本。测试 ESBL-E 分离株的抗微生物敏感性，并通过 16S rDNA 扩增子测序对肠道微生物群进行分析。使用非参数检验检测潜在关联，使用逻辑回归模型量化关联。构建随机森林模型以识别 ESBL-E 获得的微生物预测因子。
总共有 49 名（54.4%）参与者在旅行前未检测到 ESBL-E 定植，并在旅行后进行了随访。共有 20 名（40.8%）参与者的 60 株 ESBL-E 分离株被培养出来。旅行前肠道微生物群中放线菌丰富度低和短链脂肪酸产生菌数量低会增加获得 ESBL-E 的风险，而旅行期间食用生海鲜会进一步加剧这种风险。此外，旅行后 ESBL-E 阳性参与者的几种机会性病原体如葡萄球菌、肠球菌、大肠杆菌/志贺氏菌和克雷伯氏菌的丰度增加。整合旅行前微生物群和确定的旅行相关风险因素的随机森林模型可以预测 ESBL-E 获得的曲线下面积为 75.4%（95%置信区间：57.9-93.0%）。
在这项研究中，我们确定了与 ESBL-E 获得相关的旅行相关风险因素和微生物群预测因子。我们的结果为未来开发基于微生物群的干预措施提供了基础，以防止国际旅行期间获得 ESBL-E。
