Martin Angelin1, Joakim Forsell2, Margareta Granlund3, Birgitta Evengård4, Helena Palmgren5, Anders Johansson6. 1. Department of Clinical Microbiology, Infectious Diseases, Umeå University, SE-901 85 Umeå, Sweden. Electronic address: martin.angelin@umu.se. 2. Department of Clinical Microbiology, Bacteriology, Umeå University, SE-901 85 Umeå, Sweden. Electronic address: joakim.forsell@climi.umu.se. 3. Department of Clinical Microbiology, Bacteriology, Umeå University, SE-901 85 Umeå, Sweden. Electronic address: margareta.granlund@climi.umu.se. 4. Department of Clinical Microbiology, Infectious Diseases, Umeå University, SE-901 85 Umeå, Sweden. Electronic address: birgitta.evengard@umu.se. 5. Department of Clinical Microbiology, Infectious Diseases, Umeå University, SE-901 85 Umeå, Sweden. Electronic address: helena.palmgren@infdis.umu.se. 6. Laboratory for Molecular Infection Medicine Sweden, Department of Clinical Microbiology, Bacteriology, Umeå University, SE-901 85 Umeå, Sweden. Electronic address: anders.f.johansson@umu.se.
Abstract
BACKGROUND: The increase of antibiotic resistance in clinically important bacteria is a worldwide threat, especially in healthcare environments. International travel is a risk factor for gut colonization with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE). The risk for healthcare students of being colonized with ESBL-PE when participating in patient-related work abroad has not been previously investigated. METHODS: Swedish healthcare students travelling for pre-clinical and clinical courses outside Scandinavia submitted faecal samples and survey data before and after travel. The faecal samples were screened for ESBL-PE and carbapenemase-producing Enterobacteriaceae (CPE). Screening results and survey data were analysed to identify risk factors for colonization. RESULTS: In the 99 subjects who submitted a full set of samples, 35% were colonized with a new ESBL-PE strain during travel. No CPE was found. The most important risk factor for ESBL-PE colonization was travel destination, and the highest colonization rate was found in the South-East Asia region. Antibiotic treatment during travel was an independent risk factor for ESBL-PE colonization but patient-related work was not significantly associated with an increased risk. CONCLUSIONS: Patient-related work abroad was not a risk factor for ESBL-PE suggesting that transmission from patients is uncommon. Pre-travel advice on avoiding unnecessary antibiotic treatment during travel is recommended.
BACKGROUND: The increase of antibiotic resistance in clinically important bacteria is a worldwide threat, especially in healthcare environments. International travel is a risk factor for gut colonization with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE). The risk for healthcare students of being colonized with ESBL-PE when participating in patient-related work abroad has not been previously investigated. METHODS: Swedish healthcare students travelling for pre-clinical and clinical courses outside Scandinavia submitted faecal samples and survey data before and after travel. The faecal samples were screened for ESBL-PE and carbapenemase-producing Enterobacteriaceae (CPE). Screening results and survey data were analysed to identify risk factors for colonization. RESULTS: In the 99 subjects who submitted a full set of samples, 35% were colonized with a new ESBL-PE strain during travel. No CPE was found. The most important risk factor for ESBL-PE colonization was travel destination, and the highest colonization rate was found in the South-East Asia region. Antibiotic treatment during travel was an independent risk factor for ESBL-PE colonization but patient-related work was not significantly associated with an increased risk. CONCLUSIONS:Patient-related work abroad was not a risk factor for ESBL-PE suggesting that transmission from patients is uncommon. Pre-travel advice on avoiding unnecessary antibiotic treatment during travel is recommended.
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