目的:旅客返回时可能会被抗菌药物耐药菌定植,但是对旅行中的殖民知之甚少。我们的目标是评估在国外逗留期间广泛的抗菌耐药细菌和耐药表型的获取和定植动态,并确定粪便携带抗菌耐药细菌的风险因素。
方法:这项前瞻性队列研究(2016-2018年)的德国和荷兰参与者(n=132)填写了一份关于危险因素的问卷,并提供了每日粪便样本,during,旅行之后。样品筛选产超广谱β-内酰胺酶肠杆菌(ESBL-E),耐碳青霉烯(CarbR-GN),和非固有粘菌素抗性革兰氏阴性棒(ColR-GN),耐万古霉素屎肠球菌/粪肠球菌(VRE),和艰难梭菌。
结果:离境后一周内,定植率达到稳定水平,波动在48.5%(63/130)和58.4%(45/77,ESBL-E)左右,10.4%(11/106)和23.4%(18/77,ColR-GN),或3.0%(4/132)和6.8%(8/118,CarbR-GN)。旅行后的定植率为46.2%(61/132,ESBL-E),9.0%(12/132,ColR-GN),和3.4%(5/132,CarbR-GN)。旅行者携带mcr-1-(15/132;11.4%)或blaNDM阳性(4/132;3.0%)肠杆菌。在多变量模型中,素食与旅行期间获得ESBL-E(OR=0.4,p0.04)和ColR-GN(OR=0.1,p0.01)的风险较低相关。同样,拜访亲朋好友的旅行者获得ESBL-E(OR=0.3,p0.009)和CarbR-GN(OR=0.3,p0.01)的风险较低.未检测到VRE和艰难梭菌。
结论:在旅途中临时定居的旅行者数量超过了返回后仍定居的旅行者数量。
OBJECTIVE: Travellers may be colonized with antimicrobial-resistant bacteria on return, but little is known about colonization during travel. Our objectives were to assess the acquisition and colonization dynamics during the stay abroad for a broad range of antimicrobial-resistant bacteria and resistance phenotypes and to identify risk factors for faecal carriage of antimicrobial-resistant bacteria.
METHODS: German and Dutch participants (n = 132) of this prospective cohort
study (2016-2018) completed a questionnaire on risk factors and provided daily stool samples before, during, and after travel. Samples were screened for extended-spectrum β-lactamase producing Enterobacterales (ESBL-E), carbapenem-resistant (CarbR-GN), and non-intrinsically colistin-resistant Gram-negative rods (ColR-GN), vancomycin-resistant Enterococcus faecium/faecalis (VRE), and Clostridioides difficile.
RESULTS: Colonization rates reached a plateau within a week after departure fluctuating around 48.5% (63/130) and 58.4% (45/77, ESBL-E), 10.4% (11/106) and 23.4% (18/77, ColR-GN), or 3.0% (4/132) and 6.8% (8/118, CarbR-GN). Colonization rates after the travel were 46.2% (61/132, ESBL-E), 9.0% (12/132, ColR-GN), and 3.4% (5/132, CarbR-GN). Travellers carried mcr-1- (15/132; 11.4%) or
blaNDM-positive (4/132; 3.0%) Enterobacterales. A vegetarian diet was associated with a lower risk for the acquisition of ESBL-E (OR = 0.4, p 0.04) and ColR-GN (OR = 0.1, p 0.01) during travel in a multivariable model. Similarly, travellers visiting friends and relatives had a lower risk for the acquisition of ESBL-E (OR = 0.3, p 0.009) and CarbR-GN (OR = 0.3, p 0.01). VRE and C. difficile were not detected.
CONCLUSIONS: The number of travellers with a temporary colonization during the journey exceeded the number of travellers still colonized after return.