McGuinness Sarah L, Muhi Stephen, Nadimpalli Maya L, Babiker Ahmed, Theunissen Caroline, Stroffolini Giacomo, Motta Leonardo, Gobbi Federico, Huits Ralph, Libman Michael, Leder Karin
Infectious Diseases Epidemiology Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Department of Infectious Diseases, Alfred Hospital, Melbourne, Victoria, Australia.
J Travel Med. 2025 Feb 3;32(1). doi: 10.1093/jtm/taae090.
Antimicrobial resistance (AMR) is a global health crisis, with Enterobacterales, including Escherichia coli and Klebsiella pneumoniae, playing significant roles. While international travel to low- and middle-income countries is linked to colonization with AMR Enterobacterales, the clinical implications, particularly the risk of subsequent infection, remain unclear due to limited data. We aimed to characterize E. coli and K. pneumoniae infections in travellers and the antimicrobial susceptibility profiles of their isolates.
We analysed data on E. coli and K. pneumoniae infections in travellers collected at GeoSentinel sites between 2015 and 2022, focusing on epidemiological, clinical and microbiological characteristics. We defined multi-drug resistance (MDR) as non-susceptibility to agents from at least three drug classes.
Over the 8-year period, we included 655 patients (median age 41 years; 74% female) from 57 sites in 27 countries, with 584 E. coli and 72 K. pneumoniae infections. Common travel regions included sub-Saharan Africa, Southeast Asia and South-Central Asia. Urinary tract infections predominated. Almost half (45%) were hospitalized. Among infections with antimicrobial susceptibility data across three or more drug classes, 203/544 (37%) E. coli and 19/67 (28%) K. pneumoniae demonstrated MDR. Over one-third of E. coli and K. pneumoniae isolates were non-susceptible to third-generation cephalosporins and cotrimoxazole, with 38% and 28% non-susceptible to fluoroquinolones, respectively. Travellers to South-Central Asia most frequently had isolates non-susceptible to third-generation cephalosporins, fluoroquinolones and carbapenems. We observed increasing frequencies of phenotypic extended spectrum beta-lactamase and carbapenem resistance over time.
E. coli and K. pneumoniae infections in travellers, particularly those to Asia, may be challenging to empirically treat. Our analysis highlights the significant health risks these infections pose to travellers and emphasizes the escalating global threat of AMR. Enhanced, systematic AMR surveillance in travellers is needed, along with prospective data on infection risk post travel-related AMR organism acquisition.
抗菌药物耐药性（AMR）是一场全球健康危机，包括大肠杆菌和肺炎克雷伯菌在内的肠杆菌科细菌在其中扮演着重要角色。虽然前往低收入和中等收入国家的国际旅行与AMR肠杆菌科细菌的定植有关，但由于数据有限，其临床影响，尤其是后续感染的风险仍不明确。我们旨在描述旅行者中大肠杆菌和肺炎克雷伯菌感染情况及其分离株的抗菌药物敏感性概况。
我们分析了2015年至2022年期间在全球监测点收集的旅行者中大肠杆菌和肺炎克雷伯菌感染的数据，重点关注流行病学、临床和微生物学特征。我们将多重耐药（MDR）定义为对至少三类药物不敏感。
在这8年期间，我们纳入了来自27个国家57个地点的655名患者（中位年龄41岁；74%为女性），其中有584例大肠杆菌感染和72例肺炎克雷伯菌感染。常见的旅行地区包括撒哈拉以南非洲、东南亚和南亚中部。尿路感染占主导。近一半（45%）的患者住院治疗。在对三类或更多类药物有抗菌药物敏感性数据的感染中，203/544（37%）的大肠杆菌和19/67（28%）的肺炎克雷伯菌表现出MDR。超过三分之一的大肠杆菌和肺炎克雷伯菌分离株对第三代头孢菌素和复方新诺明不敏感，分别有38%和28%对氟喹诺酮类不敏感。前往南亚中部的旅行者的分离株最常对第三代头孢菌素、氟喹诺酮类和碳青霉烯类不敏感。我们观察到随着时间的推移，表型产超广谱β-内酰胺酶和碳青霉烯类耐药的频率不断增加。
旅行者中的大肠杆菌和肺炎克雷伯菌感染，尤其是前往亚洲的旅行者中的感染，可能难以进行经验性治疗。我们的分析突出了这些感染给旅行者带来的重大健康风险，并强调了AMR在全球范围内不断升级的威胁。需要加强对旅行者的系统性AMR监测，以及有关旅行相关AMR病原体感染后感染风险的前瞻性数据。
