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Prolonged carriage of resistant E. coli by returned travellers: clonality, risk factors and bacterial characteristics

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Abstract

The aim of this study was to delineate the potential risks and dynamics of the prolonged carriage of resistant E. coli in returned travellers. A sample of 274 previously collected E. coli resistant to ceftriaxone (CRO), ciprofloxacin, gentamicin and/or nalidixic acid recovered from 102 travellers was studied. Travellers were assessed pre-travel then longitudinally (maximum 6 months) with peri-rectal/rectal swabs. Clonality was determined by REP-PCR and the presence of O25b-ST131 was assessed. Comparison was made longitudinally for individuals and between identified co-travellers. The risk of prolonged carriage was lower for CRO than for ciprofloxacin or gentamicin resistance. Repeated isolation of the same phenotype at different time points occurred in 19% of initial CRO-resistant carriers compared with 50% of ciprofloxacin- or gentamicin-resistant carriers. The duration of carriage was also longer for the latter resistance phenotypes (75th quartile 8 vs 62 and 63 days respectively). In multivariate analysis, risks of prolonged carriage included antimicrobial use whilst travelling (3.3, 1.3–8.4) and phylogenetic group B2 (9.3, 3.4–25.6) and D (3.8, 1.6–8.8). Clonality amongst longitudinal isolates from the same participant was demonstrated in 92% of participants who were assessable and most marked amongst CRO-resistant isolates. ST-131 was surprisingly infrequent (3% of participants). Prolonged carriage of ciprofloxacin- and gentamicin-resistant isolates is more frequent and prolonged than CRO resistance after travel. Risks of prolonged carriage indicate a contribution of host and bacterial factors to this carriage. These require further elucidation. The strong clonality identified suggests that carriage of a “phenotype” was mediated by persistence of bacteria/plasmid combinations rather than persistence of the plasmid after horizontal transfer to other bacteria.

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Acknowledgements

Thank you to Prof. Mark Schembri for his review of this manuscript.

Conflict of interests

BR, KK, HS, MJ and DP declare that they have no conflicts of interest.

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Authors and Affiliations

  1. UQ Centre for Clinical Research, University of Queensland, Royal Brisbane and Women’s Hospital Campus, Building 71/918, Herston, Brisbane, Queensland, Australia, 4006

    B. A. Rogers, H. E. Sidjabat & D. L. Paterson

  2. Infectious Diseases & Microbiology, Canberra Hospital, Australian National University Medical School, Woden, ACT, Australia

    K. J. Kennedy & P. Collignon

  3. School of Population Health, University of Queensland, Herston, Queensland, Australia

    M. Jones

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  1. B. A. Rogers
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  2. K. J. Kennedy
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  3. H. E. Sidjabat
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  4. M. Jones
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  5. P. Collignon
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  6. D. L. Paterson
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Correspondence to B. A. Rogers.

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Rogers, B.A., Kennedy, K., Sidjabat, H.E. et al. Prolonged carriage of resistant E. coli by returned travellers: clonality, risk factors and bacterial characteristics. Eur J Clin Microbiol Infect Dis 31, 2413–2420 (2012). https://doi.org/10.1007/s10096-012-1584-z

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  • DOI: https://doi.org/10.1007/s10096-012-1584-z

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