Colonisation with Escherichia coli resistant to “critically important” antibiotics: a high risk for international travellers
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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.
KeywordsAzithromycin Resistant Strain Resistant Isolate AmpC Tinidazole
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.
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