International Travel as a Risk Factor for Carriage of Extended-Spectrum β-Lactamase-Producing Escherichia coli in a Large Sample of European Individuals-The AWARE Study

• Published in: International journal of environmental research and public health 2022-04, Vol.19 (8), p.4758
• Main Authors: Rodríguez-Molina, Daloha, Berglund, Fanny, Blaak, Hetty, Flach, Carl-Fredrik, Kemper, Merel, Marutescu, Luminita, Pircalabioru Gradisteanu, Gratiela, Popa, Marcela, Spießberger, Beate, Wengenroth, Laura, Chifiriuc, Mariana Carmen, Larsson, D G Joakim, Nowak, Dennis, Radon, Katja, de Roda Husman, Ana Maria, Wieser, Andreas, Schmitt, Heike
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age; Aged; Antacids; Anti-Bacterial Agents - therapeutic use; Antibiotic resistance; antibiotic-resistance genes; Antibiotics; Antimicrobial agents; antimicrobial resistance; Bacteria; beta-Lactamases - genetics; coli; colonization; Confidence intervals; Cross-Sectional Studies; Drug resistance; Drug Resistance, Bacterial; E coli; Education; enterobacteriaceae; Environmental & Occupational; Environmental Health and Occupational Health; Environmental Sciences & Ecology; ESBL E; Escherichia coli; Escherichia coli Infections - drug therapy; Escherichia coli Infections - epidemiology; Ethics; Europe - epidemiology; exposure; Farms; Feces; Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi; Global health; health; Health facilities; Health risks; Households; Humans; International travel; Middle Aged; Miljömedicin och yrkesmedicin; Population; Prevalence; Public; Public health; Public Health, Global Health, Social Medicine and Epidemiology; Questionnaires; Risk analysis; Risk Factors; Risk management; Secondary education; Travel; Travel-Related Illness; travels; Variables; Water treatment; workers; Young Adult; β Lactamase
• ISSN: 1660-4601; 1661-7827; 1660-4601
• DOI: 10.3390/ijerph19084758

Antibiotic resistance (AR) is currently a major threat to global health, calling for a One Health approach to be properly understood, monitored, tackled, and managed. Potential risk factors for AR are often studied in specific high-risk populations, but are still poorly understood in the general population. Our aim was to explore, describe, and characterize potential risk factors for carriage of Extended-Spectrum Beta-Lactamase-resistant (ESBL-EC) in a large sample of European individuals aged between 16 and 67 years recruited from the general population in Southern Germany, the Netherlands, and Romania. Questionnaire and stool sample collection for this cross-sectional study took place from September 2018 to March 2020. Selected cultures of participants' stool samples were analyzed for detection of ESBL-EC. A total of 1183 participants were included in the analyses: 333 from Germany, 689 from the Netherlands, and 161 from Romania. Travels to Northern Africa (adjusted Odds Ratio, aOR 4.03, 95% Confidence Interval, CI 1.67-9.68), Sub-Saharan Africa (aOR 4.60, 95% CI 1.60-13.26), and Asia (aOR 4.08, 95% CI 1.97-8.43) were identified as independent risk factors for carriage of ESBL-EC. Therefore, travel to these regions should continue to be routinely asked about by clinical practitioners as possible risk factors when considering antibiotic therapy.