Program Schedule

Rates and Risk Factors for Multidrug-resistant Bacterial Colonization Before and After International Travel

Session: Poster Abstract Session: Infectious Diseases in Travelers, Immigrants, and Refugees
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
  • Blyth Traveler Colonization Study.pdf (416.0 kB)
  • Background: Multidrug-resistant (MDR) E. coli (MDREC) colonization increases from 2% in US-based to 11% in deployed, healthy military personnel.  It is unclear if colonization with MDR organisms occurs through deployment exposures or risks related to routine overseas travel. This study evaluates rates and risk factors associated with MDR gram-negative bacterial and MRSA colonization after international travel. 

    Methods: Participants traveled internationally ≥5 days.  Pre- and post-travel, colonizing bacteria from oropharyngeal, nares, groin, and peri-rectal (PR) areas were collected using BD CultureSwabTM MaxV(+). Identification and susceptibilities were done by the BD Phoenix system.  Non-MDR pre- and post-travel MDR within a subject were compared by pulsed-field gel electrophoresis (PFGE).  A questionnaire solicited demographics and potential risk factors for MDR acquisition (purpose, itinerary, accommodations, water exposure, antimalarials, antibiotics, hospitalizations, and illness). 

    Results: Of 58 participants, 41% were male and median age was 64.  Pre- and post-travel swabs were obtained a median of 10 and 7 days before and after travel, respectively.  Itineraries included 18 to the Caribbean and Central America, 17 to Asia, 16 to Africa, 5 to Europe, 4 to South and North America.  17 of 22 taking malaria prophylaxis used atovaquone/proguanil.  Additional systemic antimicrobials included 2 ciprofloxacin, 1 erythromycin, 1 azithromycin, 1 cephalexin, and 1 unknown antibiotic.  The only MDR organism isolated was MDREC in 5 (9%) participants post-travel (all PR and unrelated by PFGE).  There were no statistically significant associations between exposure risks and new MDREC colonization.  Of 36 participants colonized with E. coli pre- and post-travel, new resistance was detected:  15 (42%) trim/sulfa (p<0.01) and 16 (44%) tetracycline (p<0.01).  Risks associated with new resistance only occurred with tetracycline; notably local water ingestion (p<0.05).  No participants were colonized with MRSA pre- or post-travel. 

    Conclusion: Consistent with prior studies, new antibiotic resistance was noted in colonizing E. coli after international travel.  9% of participants acquired new strains of MDREC without identified risks.

    Dana M. Blyth, M.D.1, Katrin Mende, PhD1,2, Ashley M. Maranich, M.D.1, Miriam L. Beckius, MPH1, Kristie Harnisch1, Crystal Rosemann1, Wendy C. Zera, BS2, Clinton K. Murray, MD1 and Kevin S. Akers, MD1, (1)San Antonio Military Medical Center, JBSA Fort Sam Houston, TX, (2)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD


    D. M. Blyth, None

    K. Mende, None

    A. M. Maranich, None

    M. L. Beckius, None

    K. Harnisch, None

    C. Rosemann, None

    W. C. Zera, None

    C. K. Murray, None

    K. S. Akers, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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