Extended-spectrum beta-lactamase-producing Escherichia coli in patients with travellers’ diarrhoea

Abstract

The identification of patients carrying extended-spectrum beta-lactamase (ESBL)-producing bacteria is important, since these patients are at risk of receiving inappropriate empirical therapy if they become infected. The purpose of this study was to investigate the occurrence of ESBL-producing bacteria in patients with travellers’ diarrhoea. Patients with travellers’ diarrhoea (N = 242) having delivered stool samples for the diagnosis of Salmonella, Shigella, Yersinia or Campylobacter, were also examined for ESBL-producing Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis. The overall prevalence of faecal carriage of ESBL-producing bacteria was 24% (58/242). Of the patients who had travelled in Europe, 3% (2/63) were found to be ESBL carriers in comparison to 36% (50/138) of those who had travelled outside Europe. ESBL-producing E. coli was especially common among patients returning from India (11/14), Egypt (19/38; 50%) and Thailand (8/38; 22%). In total, 90% of the genes of the ESBL-positive samples were of CTX-M type. The CTX-M-1 group dominated, followed by the CTX-M-9 group. The repetitive sequence-based PCR fingerprint pattern showed that there was no similarity between the ESBL strains found. Patients who have travelled outside Europe are at high risk of being colonized with ESBL-producing Enterobacteriaceae, and, if infected, are also at risk of receiving inappropriate empirical antibiotic therapy.

Acknowledgements

This material was presented in part at the Swedish Medical Society annual meeting in Gothenburg, November 26–28, 2008 and was awarded best poster in the field of infectious diseases. We wish to acknowledge the assistance of the following: Hans-Bertil Hansson, County Medical Officer for Communicable Disease Control, Skåne, Sweden; Agneta Hamberg and Lisbeth Elfstrom, laboratory technicians, Medical Microbiology, Department of Laboratory Medicine, Malmö, Lund University, Sweden; Maria Rissler, Secretary at the Department of Infectious Diseases, Malmö, Lund University; Jonas Björk, Competence Centre for Clinical Research, Lund University; Karin Tegmark Wisell, Department of Antibiotic Resistance and Hospital Hygiene, Swedish Institute for Infectious Disease Control. This project was funded by the Swedish Strategic Programme against Antibiotic Resistance.

Declaration of interest: None to declare.