title: Patients hospitalized abroad as importers of multiresistant bacteria-a cross-sectional study.
abstract: OBJECTIVE
  The pandemic spread of multidrug-resistant (MDR) bacteria poses a threat to healthcare worldwide, with highest prevalence in indigent regions of the (sub)tropics. As hospitalization constitutes a major risk factor for colonization, infection control management in low-prevalence countries urgently needs background data on patients hospitalized abroad.
  
  
  METHODS
  We collected data on 1122 patients who, after hospitalization abroad, were treated at the Helsinki University Hospital between 2010 and 2013. They were screened for methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE), vancomycin-resistant enterococci, carbapenemase-producing Enterobacteriaceae (CPE), multiresistant Pseudomonas aeruginosa and multiresistant Acinetobacter baumannii. Risk factors for colonization were explored by multivariate analysis.
  
  
  RESULTS
  MDR colonization rates were higher for those hospitalized in the (sub)tropics (55%; 208/377) compared with temperate zones (17%; 125/745). For ESBL-PE the percentages were 50% (190/377) versus 12% (92/745), CPE 3.2% (12/377) versus 0.4% (3/745) and MRSA 6.6% (25/377) versus 2.4% (18/745). Colonization rates proved highest in those returning from South Asia (77.6%; 38/49), followed by those having visited Latin America (60%; 9/16), Africa (60%; 15/25) and East and Southeast Asia (52.5%; 94/179). Destination, interhospital transfer, short time interval to hospitalization, young age, surgical intervention, residence abroad, visiting friends and relatives, and antimicrobial use proved independent risk factors for colonization.
  
  
  CONCLUSIONS
  Post-hospitalization colonization rates proved higher in the (sub)tropics than elsewhere; 11% (38/333) of carriers developed an MDR infection. We identified several independent risk factors for contracting MDR bacteria. The data provide a basis for infection control guidelines in low-prevalence countries.
authors.affiliation: Inflammation Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: T
authors.initials: T
authors.lastname: Khawaja
authors.affiliation: Helsinki University Hospital Laboratory, Helsinki, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Kirveskari
authors.affiliation: Department of Medicine, Clinicum, University of Helsinki, Helsinki, Finland.
authors.forename: S
authors.initials: S
authors.lastname: Johansson
authors.affiliation: Department of Medicine, Clinicum, University of Helsinki, Helsinki, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Väisänen
authors.affiliation: Department of Medicine, Clinicum, University of Helsinki, Helsinki, Finland.
authors.forename: A
authors.initials: A
authors.lastname: Djupsjöbacka
authors.affiliation: Helsinki University Hospital Laboratory, Helsinki, Finland.
authors.forename: A
authors.initials: A
authors.lastname: Nevalainen
authors.affiliation: Inflammation Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Medicine, Clinicum, University of Helsinki, Helsinki, Finland; Karolinska Institutet, Solna, Stockholm, Sweden. Electronic address: anu.kantele@hus.fi.
authors.forename: A
authors.initials: A
authors.lastname: Kantele
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005387:Finland / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014195:Travel / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Antimicrobial drug resistance; Hospitalization; Infection control; Multidrug resistance; Travel