Prolonged carriage of resistant E. coli by returned travellers: clonality, risk factors and bacterial characteristics

  • B. A. Rogers
  • K. J. Kennedy
  • H. E. Sidjabat
  • M. Jones
  • P. Collignon
  • D. L. Paterson
Article

Abstract

The aim of this study was to delineate the potential risks and dynamics of the prolonged carriage of resistant E. coli in returned travellers. A sample of 274 previously collected E. coli resistant to ceftriaxone (CRO), ciprofloxacin, gentamicin and/or nalidixic acid recovered from 102 travellers was studied. Travellers were assessed pre-travel then longitudinally (maximum 6 months) with peri-rectal/rectal swabs. Clonality was determined by REP-PCR and the presence of O25b-ST131 was assessed. Comparison was made longitudinally for individuals and between identified co-travellers. The risk of prolonged carriage was lower for CRO than for ciprofloxacin or gentamicin resistance. Repeated isolation of the same phenotype at different time points occurred in 19% of initial CRO-resistant carriers compared with 50% of ciprofloxacin- or gentamicin-resistant carriers. The duration of carriage was also longer for the latter resistance phenotypes (75th quartile 8 vs 62 and 63 days respectively). In multivariate analysis, risks of prolonged carriage included antimicrobial use whilst travelling (3.3, 1.3–8.4) and phylogenetic group B2 (9.3, 3.4–25.6) and D (3.8, 1.6–8.8). Clonality amongst longitudinal isolates from the same participant was demonstrated in 92% of participants who were assessable and most marked amongst CRO-resistant isolates. ST-131 was surprisingly infrequent (3% of participants). Prolonged carriage of ciprofloxacin- and gentamicin-resistant isolates is more frequent and prolonged than CRO resistance after travel. Risks of prolonged carriage indicate a contribution of host and bacterial factors to this carriage. These require further elucidation. The strong clonality identified suggests that carriage of a “phenotype” was mediated by persistence of bacteria/plasmid combinations rather than persistence of the plasmid after horizontal transfer to other bacteria.

Keywords

Ceftriaxone Phylogenetic Group Resistant Isolate AmpC Accelerate Failure Time Model 
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.

Notes

Acknowledgements

Thank you to Prof. Mark Schembri for his review of this manuscript.

Conflict of interests

BR, KK, HS, MJ and DP declare that they have no conflicts of interest.

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • B. A. Rogers
    • 1
  • K. J. Kennedy
    • 2
  • H. E. Sidjabat
    • 1
  • M. Jones
    • 3
  • P. Collignon
    • 2
  • D. L. Paterson
    • 1
  1. 1.UQ Centre for Clinical ResearchUniversity of Queensland, Royal Brisbane and Women’s Hospital CampusHerston, BrisbaneAustralia
  2. 2.Infectious Diseases & MicrobiologyCanberra Hospital, Australian National University Medical SchoolWodenAustralia
  3. 3.School of Population HealthUniversity of QueenslandHerstonAustralia

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