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The role of international travel in the worldwide spread of multiresistant Enterobacteriaceae

From international tourists to war-displaced refugees, more people are on the move than ever before. This provides the opportunity for a variety of antimicrobial-resistant bacteria to be carried from one geographic location to another. The Enterobacteriaceae are among the most important causes of serious hospital-acquired and community-onset bacterial infections in humans, and resistance to antimicrobial agents in these bacteria has become an increasingly relevant problem. International travel and tourism are important modes for the acquisition and spread of antimicrobial-resistant Enterobacteriaceae, especially CTX-M-producing Escherichia coli. Infections with KPC-, VIM-, OXA-48- and NDM-producing Enterobacteriaceae in developed countries have been associated with visiting and being hospitalised in endemic areas such as the USA, Greece and Israel for KPCs, Greece for VIMs, Turkey for OXA-48, and the Indian subcontinent for NDMs. To combat the spread of antimicrobial-resistant Enterobacteriaceae, the French Healthcare Safety Advisory Committee recently issued national recommendations for screening and contact isolation precautions for patients transferred from, or hospitalised outside, France. For effective public and patient health interventions, it is important to understand the role of international travel in the spread of antimicrobial-resistant Enterobacteriaceae. We urgently need well-designed studies to evaluate the transmission potential and risks for colonisation and infections due to multiresistant Enterobacteriaceae in travellers who have recently visited or have been hospitalised in endemic areas. The emergence of CTX-M-, KPC- and NDM-producing bacteria is a good example of the role that globalisation plays in the rapid dissemination of new antibiotic resistance mechanisms.

Author: van der Bij AK, Pitout JD

Citation: J Antimicrob Chemother. 2012 Sep;67(9):2090-100. doi: 10.1093/jac/dks214. Epub 2012 Jun 7.

Published: 01/06/2012

Publication Type: Journal article

Publisher: Journal of Antimicrobial Chemotherapy