Risk factors for colonization with extended-spectrum beta-lactamase producing Enterobacteriaceae in healthcare students on clinical assignment abroad: A prospective study

• Published in: Travel medicine and infectious disease Vol. 13; no. 3; pp. 223 - 229
• Main Authors: Angelin, Martin, Forsell, Joakim, Granlund, Margareta, Evengård, Birgitta, Palmgren, Helena, Johansson, Anders
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.05.2015; Elsevier Limited
• Subjects: Adult; Anti-bacterial agents; Antibiotic resistance; Antibiotics; Asia, Southeastern; Bacteria; Bacterial Proteins - biosynthesis; Beta-lactamases; beta-Lactamases - biosynthesis; Colonization; Data processing; Drug resistance; Education; Enterobacteriaceae; Enterobacteriaceae - drug effects; Enterobacteriaceae - enzymology; Enterobacteriaceae - growth & development; Enterobacteriaceae - metabolism; Enzymes; Feces - microbiology; Female; Health care; Health Personnel - statistics & numerical data; Humans; Identification systems; Infectious Disease; Laboratories; Male; Medical personnel; Middle Aged; Mortality; Patients; Prospective Studies; Regression analysis; Risk Factors; Statistical analysis; Students - statistics & numerical data; Study abroad; Surveys and Questionnaires; Sweden; Time Factors; Travel; Travel - statistics & numerical data; Travel medicine; Young Adult; Asia, Southeastern; Sweden; Travel; Drug resistance; Anti-bacterial agents; Beta-lactamases; Enterobacteriaceae
• ISSN: 1477-8939; 1873-0442; 1873-0442
• DOI: 10.1016/j.tmaid.2015.04.007

The increase of antibiotic resistance in clinically important bacteria is a worldwide threat, especially in healthcare environments. International travel is a risk factor for gut colonization with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE). The risk for healthcare students of being colonized with ESBL-PE when participating in patient-related work abroad has not been previously investigated. Swedish healthcare students travelling for pre-clinical and clinical courses outside Scandinavia submitted faecal samples and survey data before and after travel. The faecal samples were screened for ESBL-PE and carbapenemase-producing Enterobacteriaceae (CPE). Screening results and survey data were analysed to identify risk factors for colonization. In the 99 subjects who submitted a full set of samples, 35% were colonized with a new ESBL-PE strain during travel. No CPE was found. The most important risk factor for ESBL-PE colonization was travel destination, and the highest colonization rate was found in the South–East Asia region. Antibiotic treatment during travel was an independent risk factor for ESBL-PE colonization but patient-related work was not significantly associated with an increased risk. Patient-related work abroad was not a risk factor for ESBL-PE suggesting that transmission from patients is uncommon. Pre-travel advice on avoiding unnecessary antibiotic treatment during travel is recommended.