Etienne Ruppé1, Laurence Armand-Lefèvre1, Candice Estellat2, Paul-Henri Consigny3, Assiya El Mniai4, Yacine Boussadia5, Catherine Goujon3, Pascal Ralaimazava6, Pauline Campa7, Pierre-Marie Girard7, Benjamin Wyplosz8, Daniel Vittecoq8, Olivier Bouchaud9, Guillaume Le Loup10, Gilles Pialoux10, Marion Perrier4, Ingrid Wieder4, Nabila Moussa4, Marina Esposito-Farèse5, Isabelle Hoffmann11, Bruno Coignard12, Jean-Christophe Lucet13, Antoine Andremont1, Sophie Matheron14. 1. Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat, Laboratoire de Bactériologie Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137 Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité 2. Département d'Epidémiologie et Recherche Clinique, AP-HP, Hôpital Bichat, URC Paris-Nord INSERM, CIC 1425-EC, UMR 1123 Université Paris Diderot, UMR 1123, Sorbonne Paris Cité 3. Institut Pasteur, Centre Médical, Centre d'Infectiologie Necker-Pasteur. 4. Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat, Laboratoire de Bactériologie. 5. Département d'Epidémiologie et Recherche Clinique, AP-HP, Hôpital Bichat, URC Paris-Nord INSERM, CIC 1425-EC, UMR 1123. 6. AP-HP, Hôpital Bichat. 7. AP-HP, Hôpital Saint-Antoine, Maladies Infectieuses et Tropicales, Paris. 8. AP-HP, Hôpital de Bicêtre, Maladies Infectieuses et Tropicales, Le Kremlin-Bicêtre. 9. AP-HP, Hôpital Avicenne, Maladies Infectieuses et Tropicales, Bobigny. 10. AP-HP, Hôpital Tenon, Maladies Infectieuses et Tropicales, Paris. 11. Département d'Epidémiologie et Recherche Clinique, AP-HP, Hôpital Bichat, URC Paris-Nord. 12. Institut de Veille Sanitaire, Saint Maurice. 13. Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137 Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité AP-HP, Hôpital Bichat, Unité d'Hygiène et de Lutte contre les Infections Nosocomiales, Paris, France. 14. Institut national de la santé et de la recherche médicale (INSERM), Infection, Antimicrobiens, Modélisation, Evolution (IAME), Unité Mixte de Recherche (UMR) 1137 Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité AP-HP, Hôpital Bichat.
Abstract
BACKGROUND: Multidrug-resistant Enterobacteriaceae (MRE) are widespread in the community, especially in tropical regions. Travelers are at risk of acquiring MRE in these regions, but the precise extent of the problem is not known. METHODS: From February 2012 to April 2013, travelers attending 6 international vaccination centers in the Paris area prior to traveling to tropical regions were asked to provide a fecal sample before and after their trip. Those found to have acquired MRE were asked to send fecal samples 1, 2, 3, 6, and 12 months after their return, or until MRE was no longer detected. The fecal relative abundance of MRE among all Enterobacteriaceae was determined in each carrier. RESULTS: Among 824 participating travelers, 574 provided fecal samples before and after travel and were not MRE carriers before departure. Of these, 292 (50.9%) acquired an average of 1.8 MRE. Three travelers (0.5%) acquired carbapenemase-producing Enterobacteriaceae. The acquisition rate was higher in Asia (142/196 [72.4%]) than in sub-Saharan Africa (93/195 [47.7%]) or Latin America (57/183 [31.1%]). MRE acquisition was associated with the type of travel, diarrhea, and exposure to β-lactams during the travel. Three months after return, 4.7% of the travelers carried MRE. Carriage lasted longer in travelers returning from Asia and in travelers with a high relative abundance of MRE at return. CONCLUSIONS: MRE acquisition is very frequent among travelers to tropical regions. Travel to these regions should be considered a risk factor of MRE carriage during the first 3 months after return, but not beyond. CLINICAL TRIALS REGISTRATION: NCT01526187.
BACKGROUND: Multidrug-resistant Enterobacteriaceae (MRE) are widespread in the community, especially in tropical regions. Travelers are at risk of acquiring MRE in these regions, but the precise extent of the problem is not known. METHODS: From February 2012 to April 2013, travelers attending 6 international vaccination centers in the Paris area prior to traveling to tropical regions were asked to provide a fecal sample before and after their trip. Those found to have acquired MRE were asked to send fecal samples 1, 2, 3, 6, and 12 months after their return, or until MRE was no longer detected. The fecal relative abundance of MRE among all Enterobacteriaceae was determined in each carrier. RESULTS: Among 824 participating travelers, 574 provided fecal samples before and after travel and were not MRE carriers before departure. Of these, 292 (50.9%) acquired an average of 1.8 MRE. Three travelers (0.5%) acquired carbapenemase-producing Enterobacteriaceae. The acquisition rate was higher in Asia (142/196 [72.4%]) than in sub-Saharan Africa (93/195 [47.7%]) or Latin America (57/183 [31.1%]). MRE acquisition was associated with the type of travel, diarrhea, and exposure to β-lactams during the travel. Three months after return, 4.7% of the travelers carried MRE. Carriage lasted longer in travelers returning from Asia and in travelers with a high relative abundance of MRE at return. CONCLUSIONS: MRE acquisition is very frequent among travelers to tropical regions. Travel to these regions should be considered a risk factor of MRE carriage during the first 3 months after return, but not beyond. CLINICAL TRIALS REGISTRATION: NCT01526187.
Authors: A Brembilla; F Mauny; A Garcia; K G Koura; P Deloron; J-F Faucher Journal: Eur J Clin Microbiol Infect Dis Date: 2016-02-10 Impact factor: 3.267
Authors: Heather A Joseph; Mubina Agboatwalla; Jacqueline Hurd; Kara Jacobs-Slifka; Adam Pitz; Anna Bowen Journal: Am J Trop Med Hyg Date: 2016-05-02 Impact factor: 2.345