title: High Rate of Acquisition but Short Duration of Carriage of Multidrug-Resistant Enterobacteriaceae After Travel to the Tropics.
abstract: BACKGROUND
  Multidrug-resistant Enterobacteriaceae (MRE) are widespread in the community, especially in tropical regions. Travelers are at risk of acquiring MRE in these regions, but the precise extent of the problem is not known.
  
  
  METHODS
  From February 2012 to April 2013, travelers attending 6 international vaccination centers in the Paris area prior to traveling to tropical regions were asked to provide a fecal sample before and after their trip. Those found to have acquired MRE were asked to send fecal samples 1, 2, 3, 6, and 12 months after their return, or until MRE was no longer detected. The fecal relative abundance of MRE among all Enterobacteriaceae was determined in each carrier.
  
  
  RESULTS
  Among 824 participating travelers, 574 provided fecal samples before and after travel and were not MRE carriers before departure. Of these, 292 (50.9%) acquired an average of 1.8 MRE. Three travelers (0.5%) acquired carbapenemase-producing Enterobacteriaceae. The acquisition rate was higher in Asia (142/196 [72.4%]) than in sub-Saharan Africa (93/195 [47.7%]) or Latin America (57/183 [31.1%]). MRE acquisition was associated with the type of travel, diarrhea, and exposure to β-lactams during the travel. Three months after return, 4.7% of the travelers carried MRE. Carriage lasted longer in travelers returning from Asia and in travelers with a high relative abundance of MRE at return.
  
  
  CONCLUSIONS
  MRE acquisition is very frequent among travelers to tropical regions. Travel to these regions should be considered a risk factor of MRE carriage during the first 3 months after return, but not beyond.
  
  
  BACKGROUND
  NCT01526187.
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat, Laboratoire de Bactériologie Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137 Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité
authors.forename: Etienne
authors.initials: E
authors.lastname: Ruppé
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat, Laboratoire de Bactériologie Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137 Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité
authors.forename: Laurence
authors.initials: L
authors.lastname: Armand-Lefèvre
authors.affiliation: Département d'Epidémiologie et Recherche Clinique, AP-HP, Hôpital Bichat, URC Paris-Nord INSERM, CIC 1425-EC, UMR 1123 Université Paris Diderot, UMR 1123, Sorbonne Paris Cité
authors.forename: Candice
authors.initials: C
authors.lastname: Estellat
authors.affiliation: Institut Pasteur, Centre Médical, Centre d'Infectiologie Necker-Pasteur.
authors.forename: Paul-Henri
authors.initials: PH
authors.lastname: Consigny
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat, Laboratoire de Bactériologie.
authors.forename: Assiya
authors.initials: A
authors.lastname: El Mniai
authors.affiliation: Département d'Epidémiologie et Recherche Clinique, AP-HP, Hôpital Bichat, URC Paris-Nord INSERM, CIC 1425-EC, UMR 1123.
authors.forename: Yacine
authors.initials: Y
authors.lastname: Boussadia
authors.affiliation: Institut Pasteur, Centre Médical, Centre d'Infectiologie Necker-Pasteur.
authors.forename: Catherine
authors.initials: C
authors.lastname: Goujon
authors.affiliation: AP-HP, Hôpital Bichat.
authors.forename: Pascal
authors.initials: P
authors.lastname: Ralaimazava
authors.affiliation: AP-HP, Hôpital Saint-Antoine, Maladies Infectieuses et Tropicales, Paris.
authors.forename: Pauline
authors.initials: P
authors.lastname: Campa
authors.affiliation: AP-HP, Hôpital Saint-Antoine, Maladies Infectieuses et Tropicales, Paris.
authors.forename: Pierre-Marie
authors.initials: PM
authors.lastname: Girard
authors.affiliation: AP-HP, Hôpital de Bicêtre, Maladies Infectieuses et Tropicales, Le Kremlin-Bicêtre.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Wyplosz
authors.affiliation: AP-HP, Hôpital de Bicêtre, Maladies Infectieuses et Tropicales, Le Kremlin-Bicêtre.
authors.forename: Daniel
authors.initials: D
authors.lastname: Vittecoq
authors.affiliation: AP-HP, Hôpital Avicenne, Maladies Infectieuses et Tropicales, Bobigny.
authors.forename: Olivier
authors.initials: O
authors.lastname: Bouchaud
authors.affiliation: AP-HP, Hôpital Tenon, Maladies Infectieuses et Tropicales, Paris.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Le Loup
authors.affiliation: AP-HP, Hôpital Tenon, Maladies Infectieuses et Tropicales, Paris.
authors.forename: Gilles
authors.initials: G
authors.lastname: Pialoux
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat, Laboratoire de Bactériologie.
authors.forename: Marion
authors.initials: M
authors.lastname: Perrier
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat, Laboratoire de Bactériologie.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Wieder
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat, Laboratoire de Bactériologie.
authors.forename: Nabila
authors.initials: N
authors.lastname: Moussa
authors.affiliation: Département d'Epidémiologie et Recherche Clinique, AP-HP, Hôpital Bichat, URC Paris-Nord INSERM, CIC 1425-EC, UMR 1123.
authors.forename: Marina
authors.initials: M
authors.lastname: Esposito-Farèse
authors.affiliation: Département d'Epidémiologie et Recherche Clinique, AP-HP, Hôpital Bichat, URC Paris-Nord.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Hoffmann
authors.affiliation: Institut de Veille Sanitaire, Saint Maurice.
authors.forename: Bruno
authors.initials: B
authors.lastname: Coignard
authors.affiliation: Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137 Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité AP-HP, Hôpital Bichat, Unité d'Hygiène et de Lutte contre les Infections Nosocomiales, Paris, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Lucet
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat, Laboratoire de Bactériologie Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137 Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité
authors.forename: Antoine
authors.initials: A
authors.lastname: Andremont
authors.affiliation: Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137 Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité AP-HP, Hôpital Bichat.
authors.forename: Sophie
authors.initials: S
authors.lastname: Matheron
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology*; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010297:Paris / Q000453:epidemiology; D013997:Time Factors; D014195:Travel; D014329:Tropical Climate; D055815:Young Adult
keywords: ESBL; antibiotics; carbapenemase; importation; relative abundance