Abstract
BackgroundWe performed this study 1) to determine the prevalence of community-associated extended spectrum beta-lactamase producing Enterobacteriaceae (ESBLPE) colonization and infection in New York City (NYC); 2) to determine the prevalence of newly-acquired ESBLPE during travel; 3) to look for similarilties in contemporaneous hospital-associated bloodstream ESBLPE and travel-associated ESBLPE.MethodsSubjects were recruited from a travel medicine practice and consented to submit pre- and post-travel stools, which were assessed for the presence of ESBLPE. Pre-travel stools and stools submitted for culture were used to estimate the prevalence of community-associated ESBLPE. The prevalence of ESBLPE-associated urinary tract infections was calculated from available retrospective data. Hospital-associated ESBLPE were acquired from saved bloodstream isolates. All ESBLPE underwent multilocus sequence typing (MLST) and ESBL characterization.ResultsOne of 60 (1.7%) pre- or non-travel associated stool was colonized with ESBLPE. Among community-associated urine specimens, 1.3% of Escherichia coli and 1.4% of Klebsiella pneumoniae were identified as ESBLPE. Seven of 28 travelers (25.0%) acquired a new ESBLPE during travel. No similarities were found between travel-associated ESBLPE and hospital-associated ESBLPE. A range of imported ESBL genes were found, including CTX-M-14 and CTX-15.ConclusionESBL colonization and infection were relatively low during the study period in NYC. A signficant minority of travelers acquired new ESBLPE during travel.
Highlights
Extended spectrum beta-lactamase (ESBL) producing Enterobacteriaceae (ESBLPE) are an emerging cause of communityacquired infection worldwide [1,2,3,4], often resistant to standard antimicrobial choices
A separate convenience sample of ten archived ESBL-producing E. coli blood culture isolates cultured from inpatients from the same study period were obtained from the Clinical Microbiology Laboratory at NYPH/WCMC to look for similarities in multilocus sequence typing (MLST) pattern and ESBL gene content between travel-associated and hospital-associated bacteria
One of 40 (2.5%) subjects who returned a pre-travel stool was colonized by an ESBLPE, whereas none of 20 (0.0%) additional communityassociated non-travel related stool samples were positive for ESBLPE
Summary
Extended spectrum beta-lactamase (ESBL) producing Enterobacteriaceae (ESBLPE) are an emerging cause of communityacquired infection worldwide [1,2,3,4], often resistant to standard antimicrobial choices. We performed this study to: 1) characterize the prevalence of community-associated ESBLPE colonization and infection in New York City (NYC); 2) determine the frequency of acquisition of new ESBLPE during international travel; and 3) explore similarities between hospital-associated ESBLPE and any newly-imported ESBL-producing bacteria. We performed this study 1) to determine the prevalence of community-associated extended spectrum betalactamase producing Enterobacteriaceae (ESBLPE) colonization and infection in New York City (NYC); 2) to determine the prevalence of newly-acquired ESBLPE during travel; 3) to look for similarilties in contemporaneous hospital-associated bloodstream ESBLPE and travel-associated ESBLPE
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