Anu Kantele1, Sointu Mero2, Juha Kirveskari3, Tinja Lääveri4. 1. Inflammation Center, Division of Infectious Diseases, University of Helsinki and Helsinki University Hospital, POB 348, FIN-00029 HUS, Helsinki, Finland; Aava Travel Clinic, Medical Centre Aava, Annankatu 32, FIN-00100 Helsinki, Finland; Unit of Infectious Diseases, Karolinska Institutet, Solna, SE-17176 Stockholm, Sweden. Electronic address: anu.kantele@hus.fi. 2. Division of Clinical Microbiology, Helsinki University Hospital, HUSLAB, POB 400, FIN-00029 HUS, Helsinki, Finland. Electronic address: sointu.mero@hus.fi. 3. Division of Clinical Microbiology, Helsinki University Hospital, HUSLAB, POB 400, FIN-00029 HUS, Helsinki, Finland. Electronic address: jussi.kirveskari@luukku.com. 4. Inflammation Center, Division of Infectious Diseases, University of Helsinki and Helsinki University Hospital, POB 348, FIN-00029 HUS, Helsinki, Finland. Electronic address: tinja.laaveri@hus.fi.
Abstract
BACKGROUND: One third of travellers to the poor regions of the (sub)tropics become colonized by extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE). Co-resistance to non-beta-lactam antibiotics complicates the treatment of potential ESBL-PE infections. METHODS: We analysed co-resistance to non-beta-lactams among travel-acquired ESBL-PE isolates of 90 visitors to the (sub)tropics with respect to major risk factors of colonization: destination, age, travellers' diarrhoea (TD) and antibiotic (AB) use. RESULTS: Of the ESBL-PE isolates, 53%, 52%, 73%, and 2% proved co-resistant to ciprofloxacin, tobramycin, co-trimoxazole, and nitrofurantoin, respectively. The rates were similar among those with (TD+) or without (TD-) travellers' diarrhoea. Among fluoroquinolone-users vs. AB non-users, the co-resistance rates for ciprofloxacin were 95% versus 37% (p = 0.001), for tobramycin 85% versus 43% (p = 0.005), co-trimoxazole 85% versus 68% (p = 0.146), and nitrofurantoin 5% versus 2% (p = 0.147). In multivariable analysis co-resistance to ciprofloxacin was associated with increasing age, fluoroquinolone use, and tobramycin resistance. CONLUSIONS: While TD predisposes to ESBL-PE non-selectively, antimicrobial use favours strains resistant to drug taken and, simultaneously, any drug with resistance genetically linked to the drug used. Antibiotics taken during travel predispose to ESBL-PE with a high co-resistance rate.
BACKGROUND: One third of travellers to the poor regions of the (sub)tropics become colonized by extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE). Co-resistance to non-beta-lactam antibiotics complicates the treatment of potential ESBL-PE infections. METHODS: We analysed co-resistance to non-beta-lactams among travel-acquired ESBL-PE isolates of 90 visitors to the (sub)tropics with respect to major risk factors of colonization: destination, age, travellers' diarrhoea (TD) and antibiotic (AB) use. RESULTS: Of the ESBL-PE isolates, 53%, 52%, 73%, and 2% proved co-resistant to ciprofloxacin, tobramycin, co-trimoxazole, and nitrofurantoin, respectively. The rates were similar among those with (TD+) or without (TD-) travellers' diarrhoea. Among fluoroquinolone-users vs. AB non-users, the co-resistance rates for ciprofloxacin were 95% versus 37% (p = 0.001), for tobramycin 85% versus 43% (p = 0.005), co-trimoxazole 85% versus 68% (p = 0.146), and nitrofurantoin 5% versus 2% (p = 0.147). In multivariable analysis co-resistance to ciprofloxacin was associated with increasing age, fluoroquinolone use, and tobramycin resistance. CONLUSIONS: While TD predisposes to ESBL-PE non-selectively, antimicrobial use favours strains resistant to drug taken and, simultaneously, any drug with resistance genetically linked to the drug used. Antibiotics taken during travel predispose to ESBL-PE with a high co-resistance rate.
Authors: Melissa A Pender; Timothy Smith; Ben J Brintz; Prativa Pandey; Sanjaya K Shrestha; Sinn Anuras; Samandra Demons; Siriporn Sornsakrin; Ladaporn Bodhidatta; James A Platts-Mills; Daniel T Leung Journal: J Travel Med Date: 2022-07-14 Impact factor: 39.194
Authors: Anne F Voor In 't Holt; Kees Mourik; Berend Beishuizen; Adriënne S van der Schoor; Annelies Verbon; Margreet C Vos; Juliëtte A Severin Journal: Antimicrob Resist Infect Control Date: 2020-05-20 Impact factor: 4.887
Authors: Robert Steffen; Zhi-Dong Jiang; Mónica L Gracias Garcia; Prithi Araujo; Michael Stiess; Tanju Nacak; Roland Greinwald; Herbert L DuPont Journal: J Travel Med Date: 2018-01-01 Impact factor: 8.490
Authors: Anu Kantele; Tinja Lääveri; Sointu Mero; Inka M K Häkkinen; Juha Kirveskari; Brian D Johnston; James R Johnson Journal: Clin Infect Dis Date: 2020-01-02 Impact factor: 9.079
Authors: Tinja Lääveri; Jessica A Vlot; Alje P van Dam; Hanni K Häkkinen; Gerard J B Sonder; Leo G Visser; Anu Kantele Journal: BMC Infect Dis Date: 2018-07-23 Impact factor: 3.090
Authors: Thomas Grönthal; Monica Österblad; Marjut Eklund; Jari Jalava; Suvi Nykäsenoja; Katariina Pekkanen; Merja Rantala Journal: Euro Surveill Date: 2018-07