Low Enteric Colonization with Multidrug-Resistant Pathogens in Soldiers Returning from Deployments- Experience from the Years 2007-2015.
This assessment describes the enteric colonization of German soldiers 8-12 weeks after returning from mostly but not exclusively subtropical or tropical deployment sites with third-generation cephalosporin-resistant Enterobacteriaceae, vancomycin-resistant enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA). Between 2007 and 2015, 828 stool samples from returning soldiers were enriched in nonselective broth and incubated on selective agars for Enterobacteriaceae expressing extended-spectrum beta-lactamases (ESBL), VRE and MRSA. Identification and resistance testing of suspicious colonies was performed using MALDI-TOF-MS, VITEK-II and agar diffusion gradient testing (bioMérieux, Marcy-l'Étoile, France). Isolates with suspicion of ESBL were characterized by ESBL/ampC disc-(ABCD)-testing and molecular approaches (PCR, Sanger sequencing). Among the returnees, E. coli with resistance against third-generation cephalosporins (37 ESBL, 1 ESBL + ampC, 1 uncertain mechanism) were found in 39 instances (4.7%). Associated quinolone resistance was found in 46.2% of these isolates. Beta-lactamases of the blaCTX-M group 1 predominated among the ESBL mechanisms, followed by the blaCTX-M group 9, and blaSHV. VRE of vanA-type was isolated from one returnee (0.12%). MRSA was not isolated at all. There was no clear trend regarding the distribution of resistant isolates during the assessment period. Compared with colonization with resistant bacteria described in civilians returning from the tropics, the colonization in returned soldiers is surprisingly low and stable. This finding, together with high colonization rates found in previous screenings on deployment, suggests a loss of colonization during the 8- to 12-week period between returning from the deployments and assessment.
Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital of Hamburg, Hamburg, Germany.|Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany.
Hagen
H
Frickmann
Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital of Hamburg, Hamburg, Germany.
Dorothea
D
Wiemer
Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital of Hamburg, Hamburg, Germany.
Claudia
C
Frey
Deployment Health Surveillance Capability, NATO Center of Excellence for Military Medicine, Munich, Germany.
Ralf Matthias
RM
Hagen
Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital of Hamburg, Hamburg, Germany.
Rebecca
R
Hinz
Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany.
Andreas
A
Podbielski
Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany.
Thomas
T
Köller
Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany.
Philipp
P
Warnke
D000362:Agar; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002353:Carrier State; D003470:Culture Media / Q000737:chemistry; D004755:Enterobacteriaceae / Q000187:drug effects / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D005260:Female; D015870:Gene Expression; D005858:Germany; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008889:Military Personnel; D014195:Travel; D014329:Tropical Climate; D065507:Vancomycin-Resistant Enterococci / Q000187:drug effects / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification*; D018440:beta-Lactam Resistance / Q000235:genetics; D001618:beta-Lactamases / Q000235:genetics* / Q000378:metabolism
D000900:Anti-Bacterial Agents; D003470:Culture Media; D000362:Agar; D001618:beta-Lactamases