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

被引:53
作者
Kantele, Anu [1 ,2 ,3 ,4 ]
Mero, Sointu [5 ]
Kirveskari, Juha [5 ]
Laaveri, Tinja [1 ,2 ]
机构
[1] Univ Helsinki, Div Infect Dis, Inflammat Ctr, POB 348, FIN-00029 Helsinki, Finland
[2] Helsinki Univ Hosp, POB 348, FIN-00029 Helsinki, Finland
[3] Med Ctr Aava, Aava Travel Clin, Annankatu 32, FIN-00100 Helsinki, Finland
[4] Karolinska Inst, Infect Dis Unit, SE-17176 Stockholm, Sweden
[5] Helsinki Univ Hosp, HUSLAB, Div Clin Microbiol, POB 400, FIN-00029 Helsinki, Finland
关键词
Extended-spectrum beta-lactamase; ESBL; Colonization; Travel; Antibiotics; LACTAMASE-PRODUCING ENTEROBACTERIACEAE; FECAL ESCHERICHIA-COLI; RISK-FACTORS; INTERNATIONAL TRAVEL; MULTICENTER COHORT; DIARRHEA; COLONIZATION; SPREAD; MULTIRESISTANT; ACQUISITION;
D O I
10.1016/j.tmaid.2017.01.003
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background: 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-betalactam antibiotics complicates the treatment of potential ESBL-PE infections. Methods: 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. Results: 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. Conlusions: 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. (C) 2017 The Author(s). Published by Elsevier Ltd.
引用
收藏
页码:23 / 30
页数:8
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