796. International Travel and the Global Spread of ESBL-Producing E. coli
Session: Abstracts: Oral Abstract Session: Bacterial Clinical Studies I
Friday, October 22, 2010: 2:30 PM
Background: Extended Spectrum Beta-Lactamase (ESBL) genes are spreading worldwide among the Enterobacteriaceae (EB), though mechanisms of global transfer are incompletely understood.  Travelers are known to become colonized with E. coli that reflect local antimicrobial susceptibility patterns, and a high prevalence of ESBL-producing bacteria has been reported in several geographic regions.  Retrospective studies suggest that travel is a risk factor for carriage and infection with ESBL-producing E.coli.  We sought to assess the frequency of acquisition of new ESBL-producing EB during international travel.

Methods:  After IRB approval, subjects traveling to developing regions were recruited from the Weill Cornell Travel Medicine practice in New York City.  Stool specimens, collected the week before travel and the week after return, were selectively cultured for ESBL-producing EB using cefpodoxime in MacConkey broth, followed by disk diffusion using CLSI guidelines.  The VITEK-2 was used for species identification and antimicrobial susceptibility testing.  Pre-travel stool culturing was repeated for all positive post-travel stools.

Results:   Of 105 subjects consented to participate, 40 returned pre-travel stools, and 28 returned both pre-and post-travel stools.  Seven of the 28 (25%) had an ESBL-producing E. coli in the post-travel stool which was not present in the pre-travel stool.  One of the 40 (2.5%) pre-travel stools contained an ESBL-producing E. coli, which was not present in the post-travel stool of that subject.  Acquisition of ESBL producing E. coli occurred in travelers to South Asia (2), South America (1), Central America (1), Southeast Asia (1), North Africa (1) and East Africa (1).  Further study of the ESBL-producers is underway.

Conclusion:   International travelers acquire and import ESBL-producing E. coli during travel.  While study numbers are too small to quantify the frequency of acquisition, it appears that this is not a rare event.  In addition to confirming a suspected source of ESBL dissemination, this study highlights the use of travelers as sentinels in studies of global antimicrobial resistance.

Subject Category: A. Antimicrobial agents and Resistance

Scott A. Weisenberg, M.D. , Medicine, Weill Cornell Medical College, New York, NY
Jose Mediavilla, BS , University of Medicine and Dentistry of NJ, PHRI TB Center, Newark, NJ
Kyu Rhee, MD , Weill Medical College of Cornell University, New York, NY
Barry Kreiswirth, PhD , University of Medicine and Dentistry of NJ, PHRI TB Center, Newark, NJ
Stephen Jenkins, PhD , Weill Cornell Medical Center; NewYork-Presbyterian Hospital, New York, NY


S. A. Weisenberg, Yes
Merck: Received research grant from Merck for study of ESBLs in travelers. Merck did not influence the conduct of the study., Research grant

J. Mediavilla, None

K. Rhee, None

B. Kreiswirth, Yes
Cubist: Investigator,
Pfizer : Investigator,

S. Jenkins, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 21 with the exception of research findings presented at IDSA press conferences.


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