Instituto de Microbiologia Professor Paulo de Góes, Universidade Federal Do Rio de Janeiro, Rio de Janeiro, Brazil.
Departamento de Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade Federal Do Rio de Janeiro, Rio de Janeiro, Brazil.
Travel Med Infect Dis. 2021 May-Jun;41:102028. doi: 10.1016/j.tmaid.2021.102028. Epub 2021 Mar 16.
Antimicrobial resistance is increased by international mobility. We present data about intestinal colonization of travelers departing from a middle-income country.
Travelers were recruited from 2015 to 2019, collected an anal stool specimen and answered a questionnaire before and after travel. Enterobacterales isolates were investigated for antimicrobial resistance; extended-spectrum beta-lactamase (ESBL) and carbapenemase production; plasmid-encoded cephalosporinases (pAmpC), plasmid-mediated quinolone resistance (PMQR) and mcr genes by PCR and sequencing; and association with travel related variables.
Among 210 travelers, 26 (12%) carried multidrug-resistant Enterobacterales (MDR-E) and 18 (9%) ESBL-producing Enterobacterales (ESBL-E) before travel, with an increased prevalence from 1% to 11% over the study years. Acquisition of MDR-E and ESBL-E occurred in 59 (32%) and 43 (22%) travelers, respectively, mostly bla carrying Escherichia coli. One traveler acquired one isolate carrying bla gene, and two others, isolates carrying mcr-1. PMQR were detected in 14 isolates of returning travelers. The risk of MDR-E acquisition was higher in Southeast Asia and the Indian subcontinent, and after using antimicrobial agents.
We describe an increasing pre-travel prevalence of ESBL-E colonization in subjects departing from this middle-income country over time. Travel to known risk areas and use of antimicrobial agents during travel were associated with acquisition of MDR-E. Travel advice is critical to mitigating this risk, as colonization by MDR-E may raise the chances of antimicrobial-resistant infections.
国际间的人员流动会增加抗生素耐药性。本研究呈现了从中等收入国家出发旅行者的肠道定植情况的数据。
2015 年至 2019 年期间，招募旅行者并在旅行前后采集肛拭子标本和问卷调查。对肠杆菌科分离株进行抗生素耐药性、超广谱β-内酰胺酶（ESBL）和碳青霉烯酶产生、质粒编码头孢菌素酶（pAmpC）、质粒介导的喹诺酮耐药（PMQR）和 mcr 基因的 PCR 和测序分析，并与旅行相关变量进行关联分析。
在 210 名旅行者中，26 名（12%）旅行者在旅行前携带多重耐药肠杆菌科（MDR-E），18 名（9%）旅行者携带产 ESBL 肠杆菌科（ESBL-E），研究期间，这两种情况的发生率从 1%增加到 11%。59 名（32%）和 43 名（22%）旅行者分别发生了 MDR-E 和 ESBL-E 定植，主要为携带 bla 基因的大肠埃希菌。1 名旅行者定植携带 bla 基因的 1 株分离株，另外 2 名旅行者定植携带 mcr-1 的分离株。14 株返回旅行者的分离株中检测到 PMQR。去东南亚和印度次大陆旅行以及旅行期间使用抗生素与 MDR-E 定植的风险增加相关。
我们描述了从中等收入国家出发旅行者的 ESBL-E 定植率随着时间的推移逐渐增加。前往已知的高风险地区旅行和旅行期间使用抗生素与 MDR-E 的定植有关。旅行建议对减轻这种风险至关重要，因为 MDR-E 的定植可能会增加抗生素耐药性感染的机会。
