Article
Acquisition of antimicrobial resistance determinants in Enterobacterales by international travelers from a large urban setting in Brazil
Registro en:
TUFIC-GARUTTI, Samantha dos Santos et al. Acquisition of antimicrobial resistance determinants in Enterobacterales by international travelers from a large urban setting in Brazil. Travel Medicine and Infectious Disease, v. 41, p. 1-9, 2021
1477-8939
10.1016/j.tmaid.2021.102028
Autor
Tufic-Garutti, Samantha dos Santos
Ramalho, João Vitor Almeida Ramalho
Longo, Luís Guilherme de Araújo
Oliveira, Gabriela Caramano de
Rocha, Gabriel Taddeucci
Vilar, Lucas Cecílio
Costa, Marcellus Dias da
Picão, Renata Cristina
Girão, Valéria Brígido de Carvalho
Santoro-Lopes, Guilherme
Moreira, Beatriz Meurer
Rodrigues, Káris Maria de Pinho
Resumen
Background: Antimicrobial resistance is increased by international mobility. We present data about intestinal
colonization of travelers departing from a middle-income country.
Methods: Travelers were recruited from 2015 to 2019, collected an anal stool specimen and answered a questionnaire before and after travel. Enterobacterales isolates were investigated for antimicrobial resistance;
extended-spectrum beta-lactamase (ESBL) and carbapenemase production; plasmid-encoded cephalosporinases
(pAmpC), plasmid-mediated quinolone resistance (PMQR) and mcr genes by PCR and sequencing; and association with travel related variables.
Results: Among 210 travelers, 26 (12%) carried multidrug-resistant Enterobacterales (MDR-E) and 18 (9%) ESBLproducing Enterobacterales (ESBL-E) before travel, with an increased prevalence from 1% to 11% over the study
years. Acquisition of MDR-E and ESBL-E occurred in 59 (32%) and 43 (22%) travelers, respectively, mostly
blaCTX-M-15 carrying Escherichia coli. One traveler acquired one isolate carrying blaOXA-181 gene, and two others,
isolates carrying mcr-1. PMQR were detected in 14 isolates of returning travelers. The risk of MDR-E acquisition
was higher in Southeast Asia and the Indian subcontinent, and after using antimicrobial agents.
Conclusion: We describe an increasing pre-travel prevalence of ESBL-E colonization in subjects departing from
this middle-income country over time. Travel to known risk areas and use of antimicrobial agents during travel
were associated with acquisition of MDR-E. Travel advice is critical to mitigating this risk, as colonization by
MDR-E may raise the chances of antimicrobial-resistant infections.