Muzembo Basilua Andre, Kitahara Kei, Ohno Ayumu, Okamoto Keinosuke, Miyoshi Shin-Ichi
Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 1-1-1 Tsushimanaka, Kita Ward, Okayama, 700-8530, Japan.
Collaborative Research Centre of Okayama University for Infectious Diseases in India, Kolkata 700010, India.
Trop Dis Travel Med Vaccines. 2022 Oct 1;8(1):22. doi: 10.1186/s40794-022-00179-1.
India is an attractive destination for travelers. Unfortunately, numerous reports exist on traveler's diarrhea (TD) and fecal colonization with extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-EC) among international travelers visiting India. Here, we systematically reviewed studies published on the acquisition of ESBL-EC and TD attack rates among international visitors to India.
Design: Systematic review and meta-analysis. A systematic search was performed using Google Scholar, PubMed, EMBASE, Web of Science, and gray literature from 2000 to December 2021, for studies containing data for ESBL-EC acquisition or TD experience related to a trip to India. Random effects models were used to compute the prevalence of ESBL-EC acquisition and TD attack.
The literature search yielded a total of 5023 records. Of these, 31 met our inclusion criteria for systematic review and only 17 could be meta-analyzed (9 for TD, and 8 for ESBL-EC). The overall pooled attack rate of TD was 39% (95% confidence interval, CI: 25-53%). In studies where travelers' memory was used to diagnose TD, the pooled attack rate of TD was slightly higher (42%, 95% CI: 21-64%) compared to those where TD was objectively documented (33%, 95% CI: 17-49%). There were significant risks to be colonized with ESBL-EC among the travelers who experienced TD. The pooled rate of ESBL-EC colonization was 72% (CI: 67-78%). Most ESBL-EC produced CTX-M-15 enzyme. Furthermore, most of the travelers who acquired ESBL-EC were from highly industrialized countries recruited from travel clinics: Canada (n = 80), Germany (n = 69), Netherlands (n = 20), Sweden (n = 18), Japan (n = 10), Finland (n = 8), USA (n = 7), Spain (n = 5), and Denmark (n = 3).
TD pooled attack rate and ESBL-EC acquisition among international travelers visiting India were high in this study. However, we cannot make generalizations based upon this TD pooled attack rate for the current situation, due to a lack of current data. Our study highlights that travelers should be advised on TD to ensure that they do not disregard the risk of contracting TD and be better prepared as a result. It also illustrates the importance of international travel in acquiring antibiotic-resistant Escherichia coli.
印度是吸引游客的目的地。不幸的是，有大量关于前往印度的国际旅行者发生旅行者腹泻（TD）以及产超广谱β-内酰胺酶大肠杆菌（ESBL-EC）粪便定植的报道。在此，我们系统回顾了关于前往印度的国际游客中ESBL-EC获得情况和TD发病率的已发表研究。
设计：系统回顾和荟萃分析。使用谷歌学术、PubMed、EMBASE、科学网以及2000年至2021年12月的灰色文献进行系统检索，以获取包含与前往印度旅行相关的ESBL-EC获得或TD经历数据的研究。采用随机效应模型计算ESBL-EC获得率和TD发病率。
文献检索共得到5023条记录。其中，31条符合我们系统回顾的纳入标准，仅有17条可进行荟萃分析（9条关于TD，8条关于ESBL-EC）。TD的总体合并发病率为39%（95%置信区间，CI：25 - 53%）。在使用旅行者记忆诊断TD的研究中，TD的合并发病率（42%，95%CI：21 - 64%）略高于客观记录TD的研究（33%，95%CI：17 - 49%）。发生TD的旅行者中有显著的ESBL-EC定植风险。ESBL-EC定植的合并率为72%（CI：67 - 78%）。大多数ESBL-EC产生CTX-M-15酶。此外，大多数获得ESBL-EC的旅行者来自从旅行诊所招募的高度工业化国家：加拿大（n = 80）、德国（n = 69）、荷兰（n = 20）、瑞典（n = 18）、日本（n = 10）、芬兰（n = 8）、美国（n = 7）、西班牙（n = 5）和丹麦（n = 3）。
本研究中前往印度的国际旅行者的TD合并发病率和ESBL-EC获得率较高。然而，由于缺乏当前数据，我们不能基于此TD合并发病率对当前情况进行概括。我们的研究强调，应就TD向旅行者提供建议，以确保他们不会忽视感染TD的风险并因此做好更好的准备。它还说明了国际旅行在获得耐抗生素大肠杆菌方面的重要性。
