title: Risk factors for colonization with extended-spectrum beta-lactamase producing Enterobacteriaceae in healthcare students on clinical assignment abroad: A prospective study.
abstract: BACKGROUND
  The increase of antibiotic resistance in clinically important bacteria is a worldwide threat, especially in healthcare environments. International travel is a risk factor for gut colonization with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE). The risk for healthcare students of being colonized with ESBL-PE when participating in patient-related work abroad has not been previously investigated.
  
  
  METHODS
  Swedish healthcare students travelling for pre-clinical and clinical courses outside Scandinavia submitted faecal samples and survey data before and after travel. The faecal samples were screened for ESBL-PE and carbapenemase-producing Enterobacteriaceae (CPE). Screening results and survey data were analysed to identify risk factors for colonization.
  
  
  RESULTS
  In the 99 subjects who submitted a full set of samples, 35% were colonized with a new ESBL-PE strain during travel. No CPE was found. The most important risk factor for ESBL-PE colonization was travel destination, and the highest colonization rate was found in the South-East Asia region. Antibiotic treatment during travel was an independent risk factor for ESBL-PE colonization but patient-related work was not significantly associated with an increased risk.
  
  
  CONCLUSIONS
  Patient-related work abroad was not a risk factor for ESBL-PE suggesting that transmission from patients is uncommon. Pre-travel advice on avoiding unnecessary antibiotic treatment during travel is recommended.
authors.affiliation: Department of Clinical Microbiology, Infectious Diseases, Umeå University, SE-901 85 Umeå, Sweden. Electronic address: martin.angelin@umu.se.
authors.forename: Martin
authors.initials: M
authors.lastname: Angelin
authors.affiliation: Department of Clinical Microbiology, Bacteriology, Umeå University, SE-901 85 Umeå, Sweden. Electronic address: joakim.forsell@climi.umu.se.
authors.forename: Joakim
authors.initials: J
authors.lastname: Forsell
authors.affiliation: Department of Clinical Microbiology, Bacteriology, Umeå University, SE-901 85 Umeå, Sweden. Electronic address: margareta.granlund@climi.umu.se.
authors.forename: Margareta
authors.initials: M
authors.lastname: Granlund
authors.affiliation: Department of Clinical Microbiology, Infectious Diseases, Umeå University, SE-901 85 Umeå, Sweden. Electronic address: birgitta.evengard@umu.se.
authors.forename: Birgitta
authors.initials: B
authors.lastname: Evengård
authors.affiliation: Department of Clinical Microbiology, Infectious Diseases, Umeå University, SE-901 85 Umeå, Sweden. Electronic address: helena.palmgren@infdis.umu.se.
authors.forename: Helena
authors.initials: H
authors.lastname: Palmgren
authors.affiliation: Laboratory for Molecular Infection Medicine Sweden, Department of Clinical Microbiology, Bacteriology, Umeå University, SE-901 85 Umeå, Sweden. Electronic address: anders.f.johansson@umu.se.
authors.forename: Anders
authors.initials: A
authors.lastname: Johansson
mesh_terms: D000328:Adult; D001210:Asia, Southeastern; D001426:Bacterial Proteins / Q000096:biosynthesis; D004755:Enterobacteriaceae / Q000187:drug effects / Q000201:enzymology* / Q000254:growth & development / Q000378:metabolism*; D005243:Feces / Q000382:microbiology*; D005260:Female; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013334:Students / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013548:Sweden; D013997:Time Factors; D014195:Travel / Q000706:statistics & numerical data; D055815:Young Adult; D001618:beta-Lactamases / Q000096:biosynthesis
chemical_list: D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase
keywords: Anti-bacterial agents; Beta-lactamases; Drug resistance; Enterobacteriaceae; Travel