Abstract
BackgroundOne third of travellers to low- and middle-income regions of the tropics and subtropics become colonized by extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE). The risk varies by destination and, for each traveller, may be substantially further increased by travellers’ diarrhoea (TD) and antibiotic use. Despite the risk of TD in Africa, ESBL-PE acquisition rates in all studies are lower there than in Asia. Africa has become increasingly popular as a destination for international travellers, yet minimal data are available from the continent’s subregions and countries.MethodsWe analysed subregion- and country-specific data on carriage and risk factors for ESBL-PE colonization pooled from three prospective studies conducted between 2009 and 2013 among Finnish and Dutch travellers. The data were subjected to multivariable analysis of risk factors. In addition, we compared our data to two recent large investigations reporting data by subregion and country.ResultsOur joint analysis comprised data on 396 travellers. The ESBL-PE colonization rate was highest in Northern Africa, followed by Middle and Eastern Africa, and lowest in Southern and Western Africa. Of individual countries with more than 15 visitors, the highest rates were seen for Egypt (12/17; 70.6%), Ghana (6/23; 26.1%), and Tanzania (14/81; 17.3%); the rates among travellers to Egypt were comparable to those reported in South and Southeast Asia. In a pooled multivariable analysis, travel destination, age, overnight hospitalisation abroad, TD, and use of fluoroquinolones were independently associated with increased ESBL-PE colonization rates.ConlusionsEven in areas with relatively low risk of colonization, antimicrobials clearly predispose to colonization with ESBL-PE. Travellers to Africa should be cautioned against unnecessary use of antibiotics.
Highlights
One third of travellers to low- and middle-income regions of the tropics and subtropics become colonized by extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE)
Every third traveller from industrialised countries that visits developing regions becomes colonized by extended -spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) [1,2,3,4,5,6,7,8,9,10,11]
Collection of stool samples and identification of Extended-spectrum beta-lactamase (ESBL)-PE strains We have described earlier in detail the approaches to collection of samples and methods used for identification of ESBL-PE and carbapenemase-producing Enterobacteriaceae (CPE) [4, 6, 10]
Summary
One third of travellers to low- and middle-income regions of the tropics and subtropics become colonized by extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE). Several other additional factors have been shown in single studies: type of travel, meal location and consumption of certain food products, such as ice cream and pastries [1, 3,4,5,6,7, 9,10,11, 14] While these factors all predispose to ESBL-PE colonization in general, studies presenting colonization risk factors by individual geographic areas are few [5, 11], and none have focused exclusively on Africa. As the continent attracts increasing numbers of travellers [15], we decided to review the data published and pool subregion-derived findings of our three earlier investigations [4 6, 10] Combining these data with subregional carriage rates from two recent studies [7, 11], our paper offers an insight into the subregion-related colonization risk of travellers to Africa
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