Fluoroquinolone antibiotic users select fluoroquinolone-resistant ESBL-producing Enterobacteriaceae (ESBL-PE) – Data of a prospective traveller study

• Published in: Travel medicine and infectious disease 2017-03, Vol.16, p.23-30
• Main Authors: Kantele, Anu, Mero, Sointu, Kirveskari, Juha, Lääveri, Tinja
• Format: Article
• Language: English
• Subjects: Acquisitions & mergers; Adolescent; Adult; Age; Aged; Anti-Bacterial Agents - pharmacology; Antibiotics; Antimicrobial agents; Bacteria; beta-Lactamases; Carrier State - epidemiology; Carrier State - microbiology; Child; Child, Preschool; Cohort Studies; Colonization; Diarrhea; Drug resistance; Drug Resistance, Bacterial; Drugs; E coli; Enterobacteriaceae - drug effects; Enterobacteriaceae - isolation & purification; Enterobacteriaceae Infections - epidemiology; Enterobacteriaceae Infections - microbiology; ESBL; Extended-spectrum beta-lactamase; Feces - microbiology; Female; Fluoroquinolones - pharmacology; Health risk assessment; Humans; Infant; Infant, Newborn; Infections; Infectious diseases; Intensive care; Male; Medicin och hälsovetenskap; Microbial Sensitivity Tests; Middle Aged; Pathogens; Risk Factors; Travel; Travel - statistics & numerical data; Travel medicine; Tropical environments; Variables; Young Adult
• ISSN: 1477-8939; 1873-0442; 1873-0442
• DOI: 10.1016/j.tmaid.2017.01.003

One third of travellers to the poor regions of the (sub)tropics become colonized by extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE). Co-resistance to non-beta-lactam antibiotics complicates the treatment of potential ESBL-PE infections. We analysed co-resistance to non-beta-lactams among travel-acquired ESBL-PE isolates of 90 visitors to the (sub)tropics with respect to major risk factors of colonization: destination, age, travellers' diarrhoea (TD) and antibiotic (AB) use. Of the ESBL-PE isolates, 53%, 52%, 73%, and 2% proved co-resistant to ciprofloxacin, tobramycin, co-trimoxazole, and nitrofurantoin, respectively. The rates were similar among those with (TD+) or without (TD-) travellers' diarrhoea. Among fluoroquinolone-users vs. AB non-users, the co-resistance rates for ciprofloxacin were 95% versus 37% (p = 0.001), for tobramycin 85% versus 43% (p = 0.005), co-trimoxazole 85% versus 68% (p = 0.146), and nitrofurantoin 5% versus 2% (p = 0.147). In multivariable analysis co-resistance to ciprofloxacin was associated with increasing age, fluoroquinolone use, and tobramycin resistance. While TD predisposes to ESBL-PE non-selectively, antimicrobial use favours strains resistant to drug taken and, simultaneously, any drug with resistance genetically linked to the drug used. Antibiotics taken during travel predispose to ESBL-PE with a high co-resistance rate.