title: High Rate of Multidrug-Resistant Gram-Negative Bacilli Carriage and Infection in Hospitalized Returning Travelers: A Cross-Sectional Cohort Study.
abstract: BACKGROUND
  Carriage of and infection with multidrug-resistant Gram-negative bacilli (MDR-GNB) are a potential cause of concern in travelers with no history of hospitalization abroad.
  
  
  METHODS
  All consecutive returning travelers hospitalized in our department between February 2012 and January 2013 were prospectively screened for MDR-GNB gastrointestinal tract carriage or infection. We compared the prevalence of MDR-GNB in travelers to a non-travelers nonexposed group. Then among the travelers, MDR-GNB carriers were compared to noncarriers to determine risk factors of acquisition of MDR-GNB.
  
  
  RESULTS
  Overall, 359 patients (191 travelers, 168 non-travelers) were included, and 25 (6.4%), including 23 travelers, harbored MDR-GNB. Five travelers had an MDR-GNB infection while 18 were asymptomatic enteric carriers. MDR-GNB carriage or infection was significantly more frequent in travelers (11.0% vs 1.2% for non-travelers, odds ratio (OR) = 11.3, p < 0.001) and in patients born outside France (OR = 1.67; p = 0.03). Among travelers, in multivariate analysis, factors independently associated with MDR-GNB carriage or infection were traveling to Asia (OR = 3.1; p = 0.01) and visiting friends and relatives (VFR) or migrants (OR=3.6; p = 0.01).
  
  
  CONCLUSIONS
  The 10-fold higher prevalence rate of MDR-GNB in travelers raises the issues of systematic screening of all travelers, and of the choice of first line antibiotic therapy when treating urinary tract infections in travelers, especially those VFR, migrants, and those returning from Asia.
authors.affiliation: Infectious and Tropical Diseases Department, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France.|Sorbonne Universités, UPMC Univ Paris, Paris, France.
authors.forename: Loïc
authors.initials: L
authors.lastname: Epelboin
authors.affiliation: Department of Bacteriology and Hygiene, Sorbonne Universités, Paris, France.|Centre d'Immunologie et des Maladies Infectieuses, CIMI, team E13 (Bacteriology), Paris, France.|INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses, CIMI, team E13 (Bacteriology), Paris, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Robert
authors.affiliation: Infectious and Tropical Diseases Department, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France.
authors.forename: Ellina
authors.initials: E
authors.lastname: Tsyrina-Kouyoumdjian
authors.affiliation: INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses, CIMI, team E13 (Bacteriology), Paris, France.
authors.forename: Sonia
authors.initials: S
authors.lastname: Laouira
authors.affiliation: Infectious and Tropical Diseases Department, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France.
authors.forename: Vanina
authors.initials: V
authors.lastname: Meyssonnier
authors.affiliation: Infectious and Tropical Diseases Department, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France.|Sorbonne Universités, UPMC Univ Paris, Paris, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Caumes
mesh_terms: D000328:Adult; D001208:Asia; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D017053:Infection Control / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D014195:Travel / Q000706:statistics & numerical data*; D055815:Young Adult