Antimicrobial Resistance Acquisition After International Travel in U.S. Travelers
Journal Article - Open Access
SAN ANTONIO MILITARY MEDICAL CENTER FT SAM HOUSTON TX FORT SAM HOUSTON United States
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Prior studies have shown an increase in multidrug-resistant MDR E. coli colonization from two percent in U.S.-based to 11 in deployed, healthy military personnel. It is unclear if colonization with MDR organisms occurs through deployment exposures or risks related to routine overseas travel. This study prospectively evaluates rates and risk factors associated with MDR gram-negative bacterial and methicillin-resistant S. aureus MRSA colonization after international travel. Methods Participants traveled internationally for five or more days. Pre- and post-travel, colonizing bacteria from oropharyngeal, nares, groin, and peri-rectal PR areas were collected using BD Culture Swab MaxV. Identification and susceptibilities were done utilizing the BD Phoenix Automated Microbiology System. Non-MDR pre- and post-travel MDR bacteria within a subject were compared by pulsed-field gel electrophoresis PFGE. A questionnaire solicited demographics and potential risk factors for MDR acquisition. Results Of 58 participants, 41 were male and median age was 64 years. Pre- and post-travel swabs were obtained a median of ten and seven days before and after travel, respectively. Itineraries included 18 participants traveling to the Caribbean and Central America, 17 to Asia, 16 to Africa, 5 to Europe, 4 to South and North America. Seventeen of 22 travelers used atovaquoneproguanil for malaria prophylaxis. The only MDR organism isolated was extended-spectrum -lactamase ESBL-producing E. coli in five 9 participants post-travel all PR and unrelated by PFGE. There were no statistically significant associations between exposure risks and new ESBL-producing E.coli colonization. Of 36 participants colonized with E. coli pre- and post-travel, new resistance was detected TMPSMX in 42 of isolates p 0.01, tetracycline in 44 p 0.01, and ampicillin-sulbactam in 33 p 0.09. No participants were colonized with MRSA pre- or post-travel.
- Military Forces and Organizations