Extended-spectrum β-lactamase-producing enterobacteriaceae among travelers from the Netherlands

Abstract

A prospective cohort study was performed among travelers from the Netherlands to investigate the acquisition of carbapenemase-producing Enterobacteriaceae (CP-E) and extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) and associated risk factors. Questionnaires were administered and rectal swab samples were collected and tested before and after traveler return. Of 370 travelers, 32 (8.6%) were colonized with ESBL-E before trave,; 113 (30.5%) acquired an ESBL-E during travel, and 26 were still colonized 6 months after return. No CP-E were found. Independent risk factors for ESBL-E acquisition were travel to South and East Asia. Multilocus sequence typing showed extensive genetic diversity among Escherichia coli. Predominant ESBLs were CTX-M enzymes. The acquisition rate, 30.5%, of ESBL-E in travelers from the Netherlands to all destinations studied was high. Active surveillance for ESBL-E and CP-E and contact isolation precautions may be recommended at admission to medical facilities for patients who traveled to Asia during the previous 6 months.

Keywords: CP-E; ESBL; ESBL-E; Enterobacteriaceae; Escherichia coli; Holland; Klebsiella pneumoniae; antibiotic; antimicrobial resistance; bacteria; carbapenemase; extended-spectrum β-lactamase; sequence type; the Netherlands; travel health; travelers.

Figure 1

Participant colonization by Enterobacteriaceae species immediately before, immediately after, and 6 months after travel. ESBL-E, extended-spectrum β-lactamase producing–Enterobacteriaceae.

Figure 2

Multilocus sequence typing of Escherichia coli (n = 146) from the post-travel isolates of 133 travelers from the Netherlands. The numbers indicate the most prevalent sequence types (STs). Gray shadow indicates that >1 ST belongs to the same complex. The following sequences belong to STC10: ST4,10, 34, 43, 44, 48, 167, 193, 215, 218, 227, and 617. Thick connecting lines indicate single-locus variants; thin connecting lines indicate variants with 2–3 loci differences; dashed connecting lines indicate variants with 4 loci differences; dotted connecting lines indicate 5–7 loci differences.