Department of Infectious Diseases, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Meilahti Infectious Diseases and Vaccine Research Center, MeiVac, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
J Travel Med. 2022 Jul 14;29(4). doi: 10.1093/jtm/taac022.
As hospitals have a high prevalence of multidrug-resistant organisms (MDRO), hospitalization abroad indicates for travellers an increased risk of acquiring MDRO-and carrying the strains home. Antimicrobial resistance (AMR) rates are highest in the (sub)tropics, whereas Europe is considered a lower risk region. Since AMR prevalences vary within Europe, we aimed to gather country-specific data on the risks for hospitalized travellers.
At hospitals of the Helsinki and Uusimaa district in Finland, patients hospitalized abroad over the past 12 months are systematically screened for methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales (ESBL-PE), carbapenemase-producing bacteria and vancomycin-resistant Enterococcus spp. (VRE). Among patients screened 2010-19, we selected those hospitalized in Europe, recorded their MDRO findings, infections and mortality, and analysed MDRO-associated risk factors.
Of the 1772 patients treated in 41 European countries, 16.6% (295) carried MDRO, 12.5% (221) ESBL-PE, 7.8% (138) solely ESBL-E. coli, 2.6% (46) MRSA, 2.2% (30) of those screened VRE and 2.2% (39) carbapenem-resistant Gram-negatives. Among those colonized, 9.8% (29) had symptomatic MDRO infections and 0.3% (one) died. Colonization was most frequently recorded for those treated in eastern and southern Europe, with Bulgaria, Cyprus and the Russian Federation scoring highest. MDRO colonization was associated with antibiotic treatment and showed a negative correlation with time from discharge to screening.
After hospitalization in European countries, ESBL-PE carriage was relatively common (12.5%), while other MDROs proved less frequent (<5%). Antibiotic treatment and short time since hospitalization abroad increased the risk of MDRO colonization. Clear differences between countries and regions were revealed, with highest rates in the east and the south.
由于医院普遍存在多重耐药菌（MDRO），因此出国就医的旅行者面临更高的感染 MDRO 并将耐药菌携带回家的风险。抗生素耐药性（AMR）率在（亚热带）热带地区最高，而欧洲被认为是低风险地区。由于欧洲内部的 AMR 流行率存在差异，我们旨在收集有关住院旅行者风险的特定国家数据。
在芬兰赫尔辛基和乌西玛地区的医院，系统地对过去 12 个月内在国外住院的患者进行筛查，以检测耐甲氧西林金黄色葡萄球菌（MRSA）、产超广谱β-内酰胺酶（ESBL）的肠杆菌科（ESBL-PE）、产碳青霉烯酶细菌和万古霉素耐药肠球菌（VRE）。在筛查的 2010-19 年期间，我们选择了在欧洲住院的患者，记录了他们的 MDRO 检测结果、感染和死亡率，并分析了 MDRO 相关的危险因素。
在来自 41 个欧洲国家的 1772 名患者中，16.6%（295 人）携带 MDRO，12.5%（221 人）携带 ESBL-PE，7.8%（138 人）仅携带产 ESBL 的大肠埃希菌，2.6%（46 人）携带 MRSA，2.2%（30 人）筛查出 VRE，2.2%（39 人）携带耐碳青霉烯类的革兰氏阴性菌。在定植的患者中，9.8%（29 人）有症状性 MDRO 感染，0.3%（1 人）死亡。在东欧和南欧国家，定植的情况最为常见，保加利亚、塞浦路斯和俄罗斯联邦的得分最高。MDRO 定植与抗生素治疗有关，与从出院到筛查的时间呈负相关。
在欧洲国家住院后，ESBL-PE 携带较为常见（12.5%），而其他 MDRO 则相对较少（<5%）。抗生素治疗和短时间的国外住院增加了 MDRO 定植的风险。结果显示，各国和各地区之间存在明显差异，东欧和南欧的比率最高。
