title: High carriage rate of ESBL-producing Enterobacteriaceae at presentation and follow-up among travellers with gastrointestinal complaints returning from India and Southeast Asia.
abstract: BACKGROUND
  International travel contributes to the spread of multidrug-resistant microorganisms including extended spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE). We assessed the proportion of faecal carriers of ESBL-PE among 211 patients with gastrointestinal symptoms who returned to Berlin, Germany, after international travel.
  
  
  METHODS
  ESBL-PE were screened for on chromogenic agar, antimicrobial susceptibility testing was performed, and ESBL-genes were genotyped. Travel-related data were assessed by questionnaire.
  
  
  RESULTS
  Diarrhoea, abdominal pain and nausea were the main symptoms. Half of the travellers carried ESBL-PE (97% Escherichia coli); the proportion was highest for returnees from India (72%) and mainland Southeast Asia (59%), and comparatively lower for Africa (33%) and Central America (20%). Co-resistance to fluoroquinolones (particularly in isolates from India), gentamicin and cotrimoxazole was frequent but all isolates were carbapenem-susceptible. ESBL-PE carriage decreased with increasing timespan from return to presentation, and with age. At revisit of initially ESBL-PE positive patients half a year later, 28% (17/61) of the individuals were still carriers, CTX-M groups being congruent with the initial isolates. CTX-M groups 9 and 1/9, vegetarian diet and cat ownership tended to be associated with ESBL-PE carriage upon revisit.
  
  
  CONCLUSIONS
  Travellers, particularly those returning from India and Southeast Asia, constitute a relevant source of potential spread of ESBL-PE. Carriage declines over time but ESBL-PE persist for at least 6 months in a substantial proportion of individuals. Both genetic characteristics of the bacteria and lifestyle factors seem to contribute to persistent carriage of ESBL-PE. A recent, extra-European travel history argues for ESBL-PE screening and contact precautions for patients admitted to hospital.
authors: Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany, Department of Infectious Diseases, Virology, University Hospital Heidelberg, Heidelberg, Germany.
authors: Isabel
authors: I
authors: Barreto Miranda
authors: Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany, Laboratory Enders and Partners, Stuttgart, Germany.
authors: Ralf
authors: R
authors: Ignatius
authors: Medizinisch-Diagnostische Institute Laboratorien, Berlin, Germany.
authors: Roland
authors: R
authors: Pfüller
authors: Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors: Barbara
authors: B
authors: Friedrich-Jänicke
authors: Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany, Division of Infectiology and Pneumonology, Medical Department, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors: Florian
authors: F
authors: Steiner
authors: Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany, Division of Infectiology and Pneumonology, Medical Department, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors: Matthias
authors: M
authors: Paland
authors: Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors: Sebastian
authors: S
authors: Dieckmann
authors: Centre for Infection Medicine, Institute of Microbiology and Epizootics, Freie Universität Berlin, Berlin, Germany and.
authors: Katharina
authors: K
authors: Schaufler
authors: Centre for Infection Medicine, Institute of Microbiology and Epizootics, Freie Universität Berlin, Berlin, Germany and Robert Koch-Institute, Berlin, Germany.
authors: Lothar H
authors: LH
authors: Wieler
authors: Centre for Infection Medicine, Institute of Microbiology and Epizootics, Freie Universität Berlin, Berlin, Germany and.
authors: Sebastian
authors: S
authors: Guenther
authors: Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany, frank.mockenhaupt@charite.de.
authors: Frank P
authors: FP
authors: Mockenhaupt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D001210:Asia, Southeastern / Q000208:ethnology; D002415:Cats; D004755:Enterobacteriaceae / Q000201:enzymology*; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology* / Q000382:microbiology; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007194:India / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D057236:Travel Medicine; D055815:Young Adult; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D001618:beta-Lactamases
keywords: CTX-M; ESBL; antimicrobial resistance; extended-spectrum beta-lactamase; traveller