Rates and Risk Factors for Multidrug-resistant Bacterial Colonization Before and 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.
D. M. Blyth,
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
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