Prolonged Carriage and Potential Onward Transmission of Carbapenemase-Producing Enterobacteriaceae in Dutch Travelers

Figures & data

Figure 1. Genetic relatedness among travel-acquired carbapenemase-producing Escherichia coli.

Red and blue bars indicate isolates with identical amplification fragment length polymorphism pattern. Cut-off for identical strains is set at 90% as indicated by the right dashed line.

^†Isolated from chromID^® ESBL agar.

^‡Isolated from chromID OXA-48 agar.

2a: Subject 2a; 2b: Subject 2b; 4: Subject 4; t = 1: Within 1 week after travel; t = 2: 1 month after travel; t = 3: 3 months after travel; t = 4: 6 months after travel.

Table 1. Characteristics of travelers that acquired carbapenemase-producing Enterobacteriaceae during travel, characteristics of journeys made, characteristics of acquired carbapenemase-producing Enterobacteriaceae isolates and dynamics of acquired carbapenemase-producing Enterobacteriaceae over time.

Characteristics of travelers				Characteristics of journeys				Characteristics of acquired CPE			Dynamics of CPE over time
Traveler	Age	Sex	Chronic diseases	Countries visited	Duration (days)	Period	Purpose of visit	Species	MLST	ESBL gene(s)	Before travel	On return	1 month after travel	3 months after travel	6 months after travel	12 months after travel
1	64	F	Type II diabetes	Myanmar	16	July 2013	Maritime study trip	Enterobacter cloacae complex	ND	None	–^†	IMI-2 ^† ^‡	–^†	–^†	–^†	–^†
2a	58	F		Indonesia	22	August 2013	Backpack holiday	Escherichia coli	ST38	CTX-M-14	–^†	OXA-244 ^†,†	OXA-244 ^†,†	OXA-244 ^†,†	OXA-244 ^§¶	–^§
2b	59	M	‘Cardiac arrythmia’	Indonesia	22	August 2013	Backpack holiday	E. coli	ST38	CTX-M-14	–^†	–^†	–^†	OXA-244 ^†,†	–^§	–^§
3	41	M		Turkey, Greece	14	September 2013	Active/backpack holiday	Klebsiella pneumoniae	ST363	None	–^†	OXA-48 ^§,#	–^§	–^§	–^§	–^§
4	37	F	Asthma, hypothyroidism	China, Thailand, Vietnam, Japan, Hong Kong and Singapore	22	October 2013	Luxury/wellness holiday	E. coli	ST2914	CTX-M-15 and CTX-M-55	–^†	NDM-1/2^†,†	NDM-1/2^†,†	–^†	–^†	–^†
5	64	F	Seborrheic eczema	Myanmar	22	October 2013	Active/backpack holiday	E. coli	ST162	CTX-M-15	–^†	NDM-7^†,†	–^†	–^†	–^†	–^†

Travelers 2a and 2b belong to the same household. None of the travelers had sought medical care during their travel, all but one (subject 3) reported diarrhea during travel and one traveler (subject 5) had used broad-spectrum antibiotics.

^† Screening with chromID^® ESBL agar.

^‡ Isolated from chromID ESBL agar.

^§ Screening with both chromID ESBL agar and chromID OXA-48 agar.

^¶ Isolated from both chromID ESBL and chromID OXA-48 agar.

^# Isolated from chromID OXA-48 agar.

–: No CPE isolated; CPE: Carbapenemase-producing Enterobacteriaceae; ESBL: Extended-spectrum β-lactamase-producing Enterobacteriaceae; ND: Not determined; MLST: Multilocus sequence typing