Colonisation with multi-resistant Enterobacteriaceae in hospitalised Danish patients with a history of recent travel: A cross-sectional study☆
Section snippets
Background
A fast global spread of multi-resistant Enterobacteriaceae has been seen within the last decade. Especially the global spread of carbapenemase-producing gram negative bacteria presents a serious threat to health care systems around the world [1], [2], [3], [4]. The multi-drug resistant bacteria have been reported as a gut colonist suggesting possible transmission by faecal-oral route, hence complicating prevention of the transmission.
Early identification of infected patients and carriers may
Methods
From 6 July to 6 October 2011 all patients admitted to the Department of Infectious Diseases and Internal Medicine, Aarhus University Hospital, Denmark were systematically asked to inform about their travel history; this was independent of the reason for hospitalisation. To be included in the study patients should have travelled outside Denmark within the previous three months. Included patients were questioned about travel destination, length of travel, and illness during travel including
Results
During the study period, 425 patients were hospitalised and 88 patients (38 men and 50 women) had a history of travel within the previous three months and were thus included. Median age was 37 years (range 15–74).
Descriptive data on the 88 travellers according to ESBL-EC carrier status are presented in Table 1 and travel destinations are described in Table 2.
None of the travellers carried carbapenem-resistant Gram-negative Bacilli including the New Delhi Metallo-beta-lactamase (NDM-1).
Eleven of
Discussion
There is an increasing concern for environmental dissemination of multi-drug resistant bacteria. A number of reports have shown multi-drug resistant bacteria colonising the gut of returning travellers [5], [7], [9].
This study analysed the rate of colonisation by multi-resistant Enterobacteriaceae in patients with a recent travel history admitted to our hospital.
In this study of hospitalized returned travellers in Denmark we did not find any patients colonised with carbapenem-resistant
Conclusion
In this study we found 12.5% out of 88 hospitalised patients with a history of recent travel to be colonialised with ESBL-EC. None were colonised with carbapenem-resistant Gram-negative Bacilli. Similar to other studies we found that colonisation was associated with diarrhoea during travelling abroad and a duration of travel of more than two weeks.
Funding
No financial support or grant was received for this study.
Conflict of interest
The authors state that they have no conflicts of interest.
References (13)
- et al.
Dissemination of NDM-1 positive bacteria in the New Delhi environment and its implications for human health: an environmental point prevalence study
Lancet Infectious Diseases
(2011) Environmental dissemination of NDM-1: time to act sensibly
Lancet Infectious Diseases
(2011)- et al.
International travel with acquisition of multi-drug resistant gram negative bacteria containing the New Delhi metallo-beta-lactamase gene, Bla(NDM-1)
Travel Medicine and Infectious Disease
(2011) - et al.
Community-onset extended-spectrum beta-lactamase (ESBL) producing Escherichia coli: importance of international travel
Journal of Infection
(2008) - et al.
Faecal carriage of extended-spectrum beta-lactamase-producing and AmpC beta-lactamase-producing bacteria among Danish army recruits
Clinical Microbiology and Infection
(2011) Prevalence and clonality of extended-spectrum beta-lactamases in Asia
Clinical Microbiology and Infection
(2008 Jan)
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Bacterial travellers’ diarrhoea: A narrative review of literature published over the past 10 years
2022, Travel Medicine and Infectious DiseaseCitation Excerpt :Although most travellers who become colonised remain asymptomatic [123], travellers may spread the bacteria within the community and facilitate further dissemination of MDR bacteria on their return [130]. TD has been identified as a significant risk factor for colonisation with MDR bacteria such as ESBL-PE in several studies [125,127,128,132,135–138]. The occurrence of diarrhoea or gastrointestinal disorders during travel may increase the risk of acquiring MDR Enterobactericeae by a factor of 2–3 [135].
Screening for antimicrobial-resistant Gram-negative bacteria in hospitalised patients, and risk of progression from colonisation to infection: Systematic review
2022, Journal of InfectionCitation Excerpt :Screening in high risk setting (n = 53 studies, 63.9%)14, 16, 20, 22, 25, 26, 28, 30, 32–36, 38–41, 43, 45, 47, 50, 52–60, 64, 65, 67, 69–72, 75–77, 80, 81, 83, 90, 91, 100–104 was performed largely in ICU or ICU and other wards (n = 40; 75.5%)14, 16, 20, 26, 30, 32–34, 38–41, 43, 45, 47, 50, 52–56, 59, 60, 64, 69–71, 73, 75–77, 80, 81, 100–104; the remaining studies were conducted in haematology (n = 6),22, 35, 65, 83, 90, 91 transplant units (n = 5)25, 28, 36, 58, 67 and rehabilitation wards (n = 2).57, 72 One study27 has not been categorised neither as high-risk nor low-intermediate risk ward. Combining target patient groups and setting type, we identified six screening approaches: all admitted patients (AA) to hospital (8 studies, 9.6%),19, 44, 63, 74, 78, 82, 98, 99 AA patients to high risk ward/s (41, 49.4%),14, 16, 20, 25, 26, 28, 32–34, 36, 38–40, 43, 45, 47, 52, 53, 55, 57–60, 64, 67, 69–73, 75–77, 80, 81, 90, 100–104 AA patients to low/intermediate risk wards (LIRW) (10, 12.0%),13, 17, 21, 23, 24, 46, 51, 62, 86, 105 high-risk (HR) patients admitted to hospital (9, 10.8%),18, 48, 49, 61, 66, 79, 81, 82, 85 HR patients admitted to high risk ward/s (12, 14.4%),22, 30, 33, 35, 41, 50, 54, 56, 65, 83, 91 HR patients admitted to low/intermediate risk wards (LIRW) (2; 2.4%).62, 68
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2017, Biomedical and Environmental SciencesColonization with extended-spectrum beta-lactamase-producing and carbapenemase-producing Enterobacteriaceae in international travelers returning to Germany
2015, International Journal of Medical MicrobiologyCitation Excerpt :Thus, the options for empirical antibiotic therapy in cases of clinical infections are limited (Woerther et al., 2013). Several authors from Scandinavia associated gastroenteritis during travel with the risk for ESBL-PE acquisition (Lausch et al., 2013; Östholm-Balkhed et al., 2013; Tängdén et al., 2010). This association was confirmed by the results of our study (p = 0.011).
Nosocomial infections and their control strategies
2015, Asian Pacific Journal of Tropical BiomedicineDo probiotics prevent colonization with multi-resistant Enterobacteriaceae during travel? A randomized controlled trial
2019, Travel Medicine and Infectious DiseaseCitation Excerpt :In Swedish studies pre-travel colonization rates was 2.4% in 2013 [9] and 7.1% in 2015 [10], and a Finnish study found a colonization rate of 1.2% in 2015 [11]. A Danish hospital-based study found an equal rate of 12.5% colonization among hospitalized patients and showed a tendency to more extensive travel activity among the colonized cases [8]. The post-travel incidence in this study was slightly higher than previous studies from 2014 to 2017 that found ESBL-E colonization rates after travel to India ranging from 62.5 to 90.6% [5,6,10,21–23].
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This paper was presented at the 4th Northern European Conference on Travel Medicine, June 6–8, 2012, Dublin as an oral presentation.