Dynamics of intestinal multidrug-resistant bacteria colonisation contracted by visitors to a high-endemic setting: a prospective, daily, real-time sampling study.
Dynamics of intestinal multidrug-resistant bacteria colonisation contracted by visitors to a high-endemic setting: a prospective, daily, real-time sampling study.
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DOI：
10.1016/s2666-5247(20)30224-x
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发表时间：
2021-04
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影响因子：
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通讯作者：
McNally A
中科院分区：
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作者：
Kantele A;Kuenzli E;Dunn SJ;Dance DAB;Newton PN;Davong V;Mero S;Pakkanen SH;Neumayr A;Hatz C;Snaith A;Kallonen T;Corander J;McNally A
抗生素耐药性在低收入和中等收入国家非常普遍。国际旅行大大有助于肠道多重耐药革兰氏阴性菌的全球传播。每年前往低收入和中等收入国家的数亿游客都暴露于肠道多重耐药革兰氏阴性细菌，导致其中30-70%的人在返回时被定植。高暴露环境中的殖民过程记录不多，因为数据仅来自旅行前和旅行后的采样。我们在访问低收入和中等收入国家时，通过探索每日粪便样本来表征殖民动态。在这项前瞻性、每日实时采样研究中，20名前往老挝的欧洲游客自愿提供每日粪便样本，并完成22天的每日问卷调查。最初在老挝万象Mahosot医院对样本进行评估，以获得产超广谱β-内酰胺酶（ESBL）革兰氏阴性菌，然后在英国伯明翰大学MicrobesNG对分离株进行全基因组测序。该研究的主要结果是获得肠道多重耐药细菌获得动力学的数据。在2015年9月18日至9月20日期间，招募了23名志愿者，其中20名（87%）欧洲志愿者被纳入最终研究人群。虽然在研究结束时定植率为70%，但每日采样显示，所有参与者在研究期间的某个时间点都获得了产ESBL革兰氏阴性菌;定植状态每天都在变化。全基因组测序分析归因于新菌株的顺序收购，在最初的多重耐药革兰氏阴性菌株的可检测的殖民化的损失的瞬态模式的殖民化。19名（95%）参与者获得了2至7个菌株。在鉴定的83种独特菌株中（53种大肠埃希菌，10种克雷伯菌属和20种其他产ESBL革兰氏阴性菌），其中一些菌株由多达4名（20%）参与者共享。据我们所知，这是第一项实时监测旅行期间获得多重耐药革兰氏阴性细菌定植动态的研究。我们的数据显示，多个短暂的定植事件表明不断的微生物竞争，并表明旅行者暴露于比以前认为的更大的多重耐药细菌负担。这些数据强调了预防旅行者腹泻和限制抗生素使用的必要性，解决了导致殖民的两个主要因素。芬兰政府卫生科学研究补贴、斯堪的纳维亚抗微生物化疗学会、Sigrid Jusélius基金会、生物技术和生物科学研究理事会、惠康信托基金会、医学研究理事会、皇家学会、抗微生物耐药性联合规划倡议和欧洲研究理事会。
Antimicrobial resistance is highly prevalent in low-income and middle-income countries. International travel contributes substantially to the global spread of intestinal multidrug-resistant Gram-negative bacteria. Hundreds of millions of annual visitors to low-income and middle-income countries are all exposed to intestinal multidrug-resistant Gram-negative bacteria resulting in 30–70% of them being colonised at their return. The colonisation process in high-exposure environments is poorly documented because data have only been derived from before travel and after travel sampling. We characterised colonisation dynamics by exploring daily stool samples while visiting a low-income and middle-income countries. In this prospective, daily, real-time sampling study 20 European visitors to Laos volunteered to provide daily stool samples and completed daily questionnaires for 22 days. Samples were initially assessed at Mahosot Hospital, Vientiane, Laos, for acquisition of extended-spectrum β-lactamase-producing (ESBL) Gram-negative bacteria followed by whole-genome sequencing of isolates at MicrobesNG, University of Birmingham, Birmingham, UK. The primary outcome of the study was to obtain data on the dynamics of intestinal multidrug-resistant bacteria acquisition. Between Sept 18 and Sept 20, 2015, 23 volunteers were recruited, of whom 20 (87%) European volunteers were included in the final study population. Although colonisation rates were 70% at the end of the study, daily sampling revealed that all participants had acquired ESBL-producing Gram-negative bacteria at some point during the study period; the colonisation status varied day by day. Whole-genome sequencing analysis ascribed the transient pattern of colonisation to sequential acquisition of new strains, resulting in a loss of detectable colonisation by the initial multidrug-resistant Gram-negative strains. 19 (95%) participants acquired two to seven strains. Of the 83 unique strains identified (53 Escherichia coli, 10 Klebsiella spp, and 20 other ESBL-producing Gram-negative bacteria), some were shared by as many as four (20%) participants. To our knowledge, this is the first study to characterise in real-time the dynamics of acquiring multidrug-resistant Gram-negative bacterial colonisation during travel. Our data show multiple transient colonisation events indicative of constant microbial competition and suggest that travellers are exposed to a greater burden of multidrug-resistant bacteria than previously thought. The data emphasise the need for preventing travellers' diarrhoea and limiting antibiotic use, addressing the two major factors predisposing colonisation. The Finnish Governmental Subsidy for Health Science Research, The Scandinavian Society for Antimicrobial Chemotherapy, the Sigrid Jusélius Foundation, Biotechnology and Biological Sciences Research Council; Wellcome Trust, Medical Research Council; The Royal Society; Joint Programming Initiative on Antimicrobial Resistance, and European Research Council.