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Colonization with extended-spectrum beta-lactamase-producing and carbapenemase-producing Enterobacteriaceae in international travelers returning to Germany.
Int J Med Microbiol. 2015 Jan; 305(1):148-56.IJ

Abstract

Two hundred and twenty-five healthy German volunteers traveling to 53 different countries (mostly in Asia, Africa and South America) were enrolled in a prospective cohort study. Stool samples and data on potential travel-associated risk factors (such as type of travel, nutritional habits, occurrence of gastroenteritis) were collected before and after traveling. Screening for extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) and carbapenemase-producing Enterobacteriaceae (CPE) was performed using selective media (CHROMagar™ ESBL/CPE plates). Isolates with confirmed ESBL-phenotype were examined for the presence of blaCTX-M, blaTEM, blaSHV, and blaVIM, blaIMP, blaNDM, blaKPC, blaOXA-48 genes by PCR amplification and sequencing. Antimicrobial susceptibility testing was performed using conventional microbroth dilution. Pre-travel analysis of 205 fully evaluable participants revealed an ESBL-PE prevalence rate of 6.8% (14/205). Among 191 participants that were ESBL-negative before travel, 58 (30.4%) were colonized by ESBL-producing Escherichia coli, and 5 (8.6%) additionally carried ESBL-producing Klebsiella pneumoniae upon return. However, no carbapenem-resistant Enterobacteriaceae were detected. ESBL-genotyping revealed that 52/54 (96.6%) E. coli and 4/4 (100%) K. pneumoniae strains available for sequencing produced CTX-M enzymes, mostly CTX-M-15 (33/56, 58.9%), and 2/54 (3.7%) E. coli strains produced SHV-12 enzymes. Travel to India was associated with the highest ESBL-PE acquisition rate (11/15, 73.3%; p=0.015), followed by South East Asia (22/46, 47.8%; p=0.038). Evaluation of travel-associated risk factors demonstrated significance for the occurrence of gastroenteritis (p=0.011). Strictly practiced hand hygiene and exclusive consumption of packaged beverages showed no protective effect. The ESBL-PE persistence rate after 6 months was 8.6% (3/35). We conclude that global efforts are needed to address the further spread of ESBL-PE in the community. Active surveillance and contact isolation precautions may be recommended at admission to medical facilities especially for patients who traveled to India and South East Asia in the previous 6 months.

Authors+Show Affiliations

Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Liebigstr. 20, D-04103 Leipzig, Germany. Electronic address: christoph.luebbert@medizin.uni-leipzig.de.Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Liebigstr. 20, D-04103 Leipzig, Germany.Center for Infectious Diseases and Infection Control, Jena University Hospital, Erlanger Allee 101, D-07740 Jena, Germany.Center for Infectious Diseases and Infection Control, Jena University Hospital, Erlanger Allee 101, D-07740 Jena, Germany.Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Liebigstr. 20, D-04103 Leipzig, Germany.Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Liebigstr. 20, D-04103 Leipzig, Germany.Center for Infectious Diseases and Infection Control, Jena University Hospital, Erlanger Allee 101, D-07740 Jena, Germany.Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Liebigstr. 21, D-04103 Leipzig, Germany.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25547265

Citation

Lübbert, Christoph, et al. "Colonization With Extended-spectrum Beta-lactamase-producing and Carbapenemase-producing Enterobacteriaceae in International Travelers Returning to Germany." International Journal of Medical Microbiology : IJMM, vol. 305, no. 1, 2015, pp. 148-56.
Lübbert C, Straube L, Stein C, et al. Colonization with extended-spectrum beta-lactamase-producing and carbapenemase-producing Enterobacteriaceae in international travelers returning to Germany. Int J Med Microbiol. 2015;305(1):148-56.
Lübbert, C., Straube, L., Stein, C., Makarewicz, O., Schubert, S., Mössner, J., Pletz, M. W., & Rodloff, A. C. (2015). Colonization with extended-spectrum beta-lactamase-producing and carbapenemase-producing Enterobacteriaceae in international travelers returning to Germany. International Journal of Medical Microbiology : IJMM, 305(1), 148-56. https://doi.org/10.1016/j.ijmm.2014.12.001
Lübbert C, et al. Colonization With Extended-spectrum Beta-lactamase-producing and Carbapenemase-producing Enterobacteriaceae in International Travelers Returning to Germany. Int J Med Microbiol. 2015;305(1):148-56. PubMed PMID: 25547265.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Colonization with extended-spectrum beta-lactamase-producing and carbapenemase-producing Enterobacteriaceae in international travelers returning to Germany. AU - Lübbert,Christoph, AU - Straube,Laurentia, AU - Stein,Claudia, AU - Makarewicz,Oliwia, AU - Schubert,Stefan, AU - Mössner,Joachim, AU - Pletz,Mathias W, AU - Rodloff,Arne C, Y1 - 2014/12/09/ PY - 2014/09/01/received PY - 2014/12/01/revised PY - 2014/12/02/accepted PY - 2014/12/31/entrez PY - 2014/12/31/pubmed PY - 2015/9/9/medline KW - Active surveillance, Community KW - Antimicrobial resistance KW - CPE KW - CTX-M KW - ESBL SP - 148 EP - 56 JF - International journal of medical microbiology : IJMM JO - Int. J. Med. Microbiol. VL - 305 IS - 1 N2 - Two hundred and twenty-five healthy German volunteers traveling to 53 different countries (mostly in Asia, Africa and South America) were enrolled in a prospective cohort study. Stool samples and data on potential travel-associated risk factors (such as type of travel, nutritional habits, occurrence of gastroenteritis) were collected before and after traveling. Screening for extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) and carbapenemase-producing Enterobacteriaceae (CPE) was performed using selective media (CHROMagar™ ESBL/CPE plates). Isolates with confirmed ESBL-phenotype were examined for the presence of blaCTX-M, blaTEM, blaSHV, and blaVIM, blaIMP, blaNDM, blaKPC, blaOXA-48 genes by PCR amplification and sequencing. Antimicrobial susceptibility testing was performed using conventional microbroth dilution. Pre-travel analysis of 205 fully evaluable participants revealed an ESBL-PE prevalence rate of 6.8% (14/205). Among 191 participants that were ESBL-negative before travel, 58 (30.4%) were colonized by ESBL-producing Escherichia coli, and 5 (8.6%) additionally carried ESBL-producing Klebsiella pneumoniae upon return. However, no carbapenem-resistant Enterobacteriaceae were detected. ESBL-genotyping revealed that 52/54 (96.6%) E. coli and 4/4 (100%) K. pneumoniae strains available for sequencing produced CTX-M enzymes, mostly CTX-M-15 (33/56, 58.9%), and 2/54 (3.7%) E. coli strains produced SHV-12 enzymes. Travel to India was associated with the highest ESBL-PE acquisition rate (11/15, 73.3%; p=0.015), followed by South East Asia (22/46, 47.8%; p=0.038). Evaluation of travel-associated risk factors demonstrated significance for the occurrence of gastroenteritis (p=0.011). Strictly practiced hand hygiene and exclusive consumption of packaged beverages showed no protective effect. The ESBL-PE persistence rate after 6 months was 8.6% (3/35). We conclude that global efforts are needed to address the further spread of ESBL-PE in the community. Active surveillance and contact isolation precautions may be recommended at admission to medical facilities especially for patients who traveled to India and South East Asia in the previous 6 months. SN - 1618-0607 UR - https://www.unboundmedicine.com/medline/citation/25547265/Colonization_with_extended_spectrum_beta_lactamase_producing_and_carbapenemase_producing_Enterobacteriaceae_in_international_travelers_returning_to_Germany_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1438-4221(14)00160-X DB - PRIME DP - Unbound Medicine ER -