Epidemiology of extended-spectrum β-lactamase producing Escherichia coli in the stools of returning Japanese travelers, and the risk factors for colonization.

Kenichiro Yaita,Natsuo Tachikawa,Sohei Harada,Takumitsu Suzuki,Yukihiro Yoshimura,Kotaro Aoki,Kazuhiko Nakaharai,Yoshikazu Ishii,Axel Cloeckaert

doi:10.1371/journal.pone.0098000

Kenichiro Yaita, Natsuo Tachikawa + Show 7 more

Open Access

https://doi.org/10.1371/journal.pone.0098000

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Abstract

ObjectiveTravel overseas has recently been considered a risk factor for colonization with drug-resistant bacteria. The purpose of this study was to establish the epidemiology and risk factors associated with the acquisition of drug-resistant bacteria by Japanese travelers.MethodsBetween October 2011 and September 2012, we screened the stools of 68 Japanese returning travelers for extended-spectrum β-lactamase (ESBL) producing Escherichia coli. All specimens were sampled for clinical reasons. Based on the results, the participants were divided into an ESBL-producing E. coli positive group (18 cases; 26%) and an ESBL-producing E. coli negative group (50 cases; 74%), and a case-control study was performed. Microbiological analyses of ESBL-producing strains, including susceptibility tests, screening tests for metallo-β-lactamase, polymerase chain reaction amplification and sequencing of bla CTX-M genes, multilocus sequence typing, and whole genome sequencing, were also conducted.ResultsIn a univariate comparison, travel to India was a risk factor (Odds Ratio 13.6, 95% Confidence Interval 3.0–75.0, p<0.0001). There were no statistical differences in the characteristics of the travel, such as backpacking, purpose of travel, interval between travel return and sampling stool, and duration of travel. Although 10 of 13 analyzed strains (77%) produced CTX-M-15, no ST131 clone was detected.ConclusionWe must be aware of the possibilities of acquiring ESBL-producing E. coli during travel in order to prevent the spread of these bacteria not only in Japan but globally.

Highlights

In this era of globalization, drug-resistant bacteria are nosocomial, but may be community-acquired
Colonization during overseas travel has become a risk factor for community-acquired infection due to extended-spectrum b-lactamase (ESBL)-producing Escherichia coli [1] and the duration of colonization of ESBL-producing E. coli is longer than previously expected (10% of patients continued to carry at a 3-year follow-up) [2]
Eighteen (26%) of the participants were found to be positive for ESBL-producing E. coli (ESBL-producing E. coli positive group), and 50 (74%) were found to be negative for ESBL-producing E. coli in their stools (ESBL-producing E. coli negative group)

Summary

Introduction

In this era of globalization, drug-resistant bacteria are nosocomial, but may be community-acquired. Poor-quality drinking water, and poor sewage disposal) [3] that is contaminated with drug-resistant organisms along with selection caused by antibiotic usage after the acquisition of such organisms [4,5]. These situations cannot be overlooked even in developed countries such as Japan. No report has examined the relationship between Japanese travelers and ESBL-producing E. coli colonization, infections and risk factors have been published. The purpose of our study was to clarify the epidemiology and risk factors associated with ESBL-producing E. coli colonization in Japanese returning travelers

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Results

Conclusion