Journal Article

Despite Predominance of Uropathogenic/Extraintestinal Pathotypes Among Travel-acquired Extended-spectrum β-Lactamase–producing Escherichia coli, the Most Commonly Associated Clinical Manifestation Is Travelers’ Diarrhea

Kantele, Anu, Lääveri, Tinja, Kirveskari, Juha, Johnson, James R., Johnston, Brian D., Häkkinen, Inka M. K., Mero, Sointu

2020

Overview

Abstract Background One-third of the 100 million travelers to the tropics annually acquire extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae (ESBL-PE), with undefined clinical consequences. Methods Symptoms suggesting Enterobacteriaceae infections were recorded prospectively among 430 Finnish travelers, 90 (21%) of whom acquired ESBL-PE abroad. ESBL-PE isolates underwent polymerase chain reaction–based detection of diarrheagenic Escherichia coli (DEC) pathotypes (enteroaggregative E. coli [EAEC], enteropathogenic E. coli [EPEC], enterotoxigenic E. coli [ETEC], enteroinvasive E. coli, and Shiga toxin–producing E. coli), and extraintestinal pathogenic/uropathogenic E. coli (ExPEC/UPEC). Laboratory-confirmed ESBL-PE infections were surveyed 5 years before and after travel. Results Among the 90 ESBL-PE carriers, manifestations of Enterobacteriaceae infection included travelers’ diarrhea (TD) (75/90 subjects) and urinary tract infection (UTI) (3/90). The carriers had 96 ESBL-producing E. coli isolates, 51% exhibiting a molecular pathotype: 13 (14%) were DEC (10 EAEC, 2 EPEC, 1 ETEC) (12 associated with TD) and 39 (41%) ExPEC/UPEC (none associated with UTI). Of ESBL-PE, 3 (3%) were ExPEC/UPEC-EAEC hybrids (2 associated with diarrhea, none with UTI). Potential ESBL-PE infections were detected in 15 of 90 subjects (17%). The 10-year medical record survey identified 4 laboratory-confirmed ESBL-PE infections among the 430 travelers, all in subjects who screened ESBL-PE negative after returning home from their index journeys but had traveled abroad before their infection episodes. Conclusions Half of all travel-acquired ESBL-producing E. coli strains qualified molecularly as pathogens. Extraintestinal and uropathogenic pathotypes outnumbered enteric pathotypes (41% vs 14%), yet the latter correlated more closely with symptomatic infection (0% vs 92%). Despite more ESBL-PE strains qualifying as ExPEC/UPEC than DEC, travel-acquired ESBL-PE are more often associated with TD than UTI. Of subjects with travel-acquired extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBL-PE), 87% contracted potential Enterobacteriaceae infections, mostly diarrhea. Although ESBL-PE isolates more commonly displayed extraintestinal/uropathogenic than enteric pathotypes, hosts more commonly had travelers’ diarrhea than urinary tract infection.

• Publisher: Oxford University Press
• Subject: and Commentaries / ARTICLES AND COMMENTARIES / beta-Lactamases / Diarrhea - epidemiology / Enteropathogenic Escherichia coli / Escherichia coli Infections - epidemiology / Feces / Humans / Travel