BACKGROUND: multidrug-resistant Enterobacteriaceae (MRE) are widespread in the community, especially in tropical regions. Travelers are at risk of acquiring MRE in these regions, but the precise extent of the problem is not known. METHODS: from February 2012 to April 2013, travelers attending six international vaccination centers in the Paris area prior to traveling to tropical regions were asked to provide a feces sample before and after their trip. Those found to have acquired MRE were asked to send feces samples 1, 2, 3, 6 and 12 months after their return, or until MRE was no longer detected. The fecal relative abundance of MRE among all Enterobacteriaceae was determined in each carrier. RESULTS: among 824 participating travelers, 574 provided feces samples before and after travel and were not MRE carriers before departure. Of these, 292 (50.9%) acquired an average of 1.8 MRE. Three travelers (0.5%) acquired carbapenemase-producing Enterobacteriaceae. The acquisition rate was higher in Asia (142/196, 72.4%) than in sub-Saharan Africa (93/195, 47.7%) or Latin America (57/183, 31.1%). MRE acquisition was associated with the type of travel, diarrhea and exposure to beta-lactam during the travel. Three months after return, 4.7% of all the travelers carried MRE. Carriage lasted longer in travelers returning from Asia and in travelers with a high relative abundance of MRE at return. CONCLUSIONS: MRE acquisition is very frequent among travelers to tropical regions. Travel to these regions should be considered a risk factor of MRE carriage during the first 3 months after return, but not beyond.
Auteur : Ruppe E, Armand Lefevre L, Estellat C, Consigny PH, El Mniai A, Boussadia Y, Goujon C, Ralaimazava P, Campa P, Girard PM, Wyplosz B, Vittecoq D, Bouchaud O, Le Loup G, Pialoux G, Perrier M, Wieder I, Moussa N, Esposito Farese M, Hoffmann I, Coignard B, Lucet JC, Andremont A, Matheron S
Clinical Infectious Diseases, 2015, vol. 61, n°. 4, p. 593-600