Colonisation with Escherichia coli resistant to “critically important” antibiotics: a high risk for international travellers

  • K. Kennedy
  • P. Collignon


Antimicrobial resistance among community-acquired isolates of Escherichia coli is increasing globally, with international travel emerging as a risk for colonisation and infection. The aim was to determine the rate and duration of colonisation with resistant E. coli following international travel. One hundred and two adult hospital staff and contacts from Canberra, Australia, submitted perianal/rectal swabs before and following international travel. Swabs were cultured selectively to identify E. coli resistant to gentamicin, ciprofloxacin and/or third-generation cephalosporins. Those with resistant E. coli post-travel were tested monthly for persistent colonisation. Colonisation with antibiotic-resistant E. coli increased significantly from 7.8% (95% confidence interval [CI] 3.8–14.9) pre-travel to 49% (95% CI 39.5–58.6) post-travel. Those colonised were more likely to have taken antibiotics whilst travelling; however, travel remained a risk independent of antibiotic use. Colonisation with resistant E. coli occurred most frequently following travel to Asia. While over half of those carrying resistant E. coli post-travel had no detectable resistant strains two months after their return, at least 18% remained colonised at six months. Colonisation with antibiotic-resistant E. coli occurs commonly after international travel, and can be persistent. Medical practitioners should be aware of this risk, particularly when managing patients with suspected Gram-negative sepsis.


Azithromycin Resistant Strain Resistant Isolate AmpC Tinidazole 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We would like to acknowledge The Canberra Hospital Private Practice Fund for providing financial support, Dr. Geethanie Fernando and the microbiology staff of ACT Pathology, Jan Bell of SA Pathology (Women’s and Children’s Hospital Adelaide) and Dr. Marian Currie of The Academic Unit of Medicine, Australian National University.

Role of funding source

The Canberra Hospital Private Practice Fund provided funding for the study. The study sponsor was not involved in the study design, collection of data, interpretation of data, writing of the report or decision to submit the paper for publication. The corresponding author had full access to all of the data and had final responsibility for the decision to submit the paper for publication.

Conflict of interest

Both KK and PC declare that they have no conflict of interest.


  1. 1.
    Hawser SP, Bouchillon SK, Hoban DJ, Badal RE, Hsueh PR, Paterson DL (2009) Emergence of high levels of extended-spectrum-β-lactamase-producing Gram-negative bacilli in the Asia-Pacific region: data from the Study for Monitoring Antimicrobial Resistance Trends (SMART) program, 2007. Antimicrob Agents Chemother 53:3280–3284CrossRefPubMedGoogle Scholar
  2. 2.
    Peirano G, Pitout JDD (2010) Molecular epidemiology of Escherichia coli producing CTX-M β-lactamases: the worldwide emergence of clone ST131 O25:H4. Int J Antimicrob Agents 35:316–321CrossRefPubMedGoogle Scholar
  3. 3.
    Cantón R, Coque TM (2006) The CTX-M β-lactamase pandemic. Curr Opin Microbiol 9:466–475CrossRefPubMedGoogle Scholar
  4. 4.
    Hawser SP, Bouchillon SK, Hoban DJ, Badal RE (2009) In vitro susceptibilities of aerobic and facultative anaerobic Gram-negative bacilli from patients with intra-abdominal infections worldwide from 2005–2007: results from the SMART study. Int J Antimicrob Agents 34:585–588CrossRefPubMedGoogle Scholar
  5. 5.
    Pearson J, Turnidge J, Franklin C, Bell J (2007) Prevalence of antimicrobial resistances in common pathogenic Enterobacteriaceae in Australia, 2004: report from the Australian Group on Antimicrobial Resistance. Commun Dis Intell 31:106–112PubMedGoogle Scholar
  6. 6.
    Collignon P, Powers JH, Chiller TM, Aidara-Kane A, Aarestrup FM (2009) World Health Organization ranking of antimicrobials according to their importance in human medicine: a critical step for developing risk management strategies for the use of antimicrobials in food production animals. Clin Infect Dis 49:132–141CrossRefPubMedGoogle Scholar
  7. 7.
    Calbo E, Romaní V, Xercavins M, Gómez L, Vidal CG, Quintana S et al (2006) Risk factors for community-onset urinary tract infections due to Escherichia coli harbouring extended-spectrum β-lactamases. J Antimicrob Chemother 57:780–783CrossRefPubMedGoogle Scholar
  8. 8.
    Laupland KB, Church DL, Vidakovich J, Mucenski M, Pitout JDD (2008) Community-onset extended-spectrum β-lactamase (ESBL) producing Escherichia coli: importance of international travel. J Infect 57:441–448CrossRefPubMedGoogle Scholar
  9. 9.
    Stenderup J, Orskov I, Orskov F (1983) Changes in serotype and resistance pattern of the intestinal Escherichia coli flora during travel. Results from a trial of mecillinam as a prophylactic against travellers’ diarrhoea. Scand J Infect Dis 15:367–373PubMedGoogle Scholar
  10. 10.
    Freeman JT, McBride SJ, Heffernan H, Bathgate T, Pope C, Ellis-Pegler RB (2008) Community-onset genitourinary tract infection due to CTX-M-15-producing Escherichia coli among travelers to the Indian subcontinent in New Zealand. Clin Infect Dis 47:689–692CrossRefPubMedGoogle Scholar
  11. 11.
    Tham J, Odenholt I, Walder M, Brolund A, Ahl J, Melander E (2010) Extended-spectrum beta-lactamase-producing Escherichia coli in patients with travellers’ diarrhoea. Scand J Infect Dis 42:275–280CrossRefPubMedGoogle Scholar
  12. 12.
    Corpet DE (1988) Antibiotic resistance from food. N Engl J Med 318:1206–1207PubMedGoogle Scholar
  13. 13.
    Collignon P (2009) Resistant Escherichia coli—we are what we eat. Clin Infect Dis 15:202–204CrossRefGoogle Scholar
  14. 14.
    Coudron PE (2005) Inhibitor-based methods for detection of plasmid-mediated AmpC beta-lactamases in Klebsiella spp., Escherichia coli, and Proteus mirabilis. J Clin Microbiol 43:4163–4167CrossRefPubMedGoogle Scholar
  15. 15.
    Clinical and Laboratory Standards Institute (CLSI) (2008) Performance standards for antimicrobial susceptibility testing; 18th informational supplement. M100-S18. CLSI, Wayne, PAGoogle Scholar
  16. 16.
    Hanson ND, Thomson KS, Moland ES, Sanders CC, Berthold G, Penn RG (1999) Molecular characterization of a multiply resistant Klebsiella pneumoniae encoding ESBLs and a plasmid-mediated AmpC. J Antimicrob Chemother 44:377–380CrossRefPubMedGoogle Scholar
  17. 17.
    Rasheed JK, Jay C, Metchock B, Berkowitz F, Weigel L, Crellin J et al (1997) Evolution of extended-spectrum β-lactam resistance (SHV-8) in a strain of Escherichia coli during multiple episodes of bacteremia. Antimicrob Agents Chemother 41:647–653PubMedGoogle Scholar
  18. 18.
    Pitout JD, Hossain A, Hanson ND (2004) Phenotypic and molecular detection of CTX-M-β-lactamases produced by Escherichia coli and Klebsiella spp. J Clin Microbiol 42:5715–5721CrossRefPubMedGoogle Scholar
  19. 19.
    Pérez-Pérez FJ, Hanson ND (2002) Detection of plasmid-mediated AmpC β-lactamase genes in clinical isolates by using multiplex PCR. J Clin Microbiol 40:2153–2162CrossRefPubMedGoogle Scholar
  20. 20.
    Prats G, Mirelis B, Miró E, Navarro F, Llovet T, Johnson JR et al (2003) Cephalosporin-resistant Escherichia coli among summer camp attendees with salmonellosis. Emerg Infect Dis 9:1273–1280PubMedGoogle Scholar
  21. 21.
    Mesa RJ, Blanc V, Blanch AR, Cortés P, González JJ, Lavilla S et al (2006) Extended-spectrum β-lactamase-producing Enterobacteriaceae in different environments (humans, food, animal farms and sewage). J Antimicrob Chemother 58:211–215CrossRefPubMedGoogle Scholar
  22. 22.
    Duan RS, Sit THC, Wong SSY, Wong RC, Chow KH, Mak GC et al (2006) Escherichia coli producing CTX-M β-lactamases in food animals in Hong Kong. Microb Drug Resist 12:145–148CrossRefPubMedGoogle Scholar
  23. 23.
    Hawkey PM (2008) Prevalence and clonality of extended-spectrum beta-lactamases in Asia. Clin Microbiol Infect 14(Suppl 1):159–165CrossRefPubMedGoogle Scholar
  24. 24.
    Pitout JDD, Campbell L, Church DL, Gregson DB, Laupland KB (2009) Molecular characteristics of travel-related extended-spectrum-β-lactamase-producing Escherichia coli isolates from the Calgary Health Region. Antimicrob Agents Chemother 53:2539–2943CrossRefPubMedGoogle Scholar
  25. 25.
    Hadway P, Barrett LK, Waghorn DJ, Hasan K, Bdesha A, Haldar N et al (2009) Urosepsis and bacteraemia caused by antibiotic-resistant organisms after transrectal ultrasonography-guided prostate biopsy. BJU Int 104:1556–1558CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  1. 1.Infectious Diseases and MicrobiologyThe Canberra Hospital, Australian National University Medical SchoolWodenAustralia

Personalised recommendations