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The Carriage Of Multiresistant Bacteria After Travel (COMBAT) prospective cohort study: methodology and design
Maris S Arcilla, Jarne M van Hattem, Martin C J Bootsma
1Department of Medical Microbiology, School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, PO 5800, 6202 AZ Maastricht, the Netherlands. j.penders@maastrichtuniversity.nl.
Background:
Antimicrobial resistance (AMR) is one of the major threats to public health around the world. Besides the intense use and misuse of antimicrobial agents as the major force behind the increase in antimicrobial resistance, the exponential increase of international travel may also substantially contribute to the emergence and spread of AMR. However, knowledge on the extent to which international travel contributes to this is still limited. The Carriage Of Multiresistant Bacteria After Travel (COMBAT) study aims to 1. determine the acquisition rate of multiresistant Enterobacteriaceae during foreign travel 2. ascertain the duration of carriage of these micro-organisms 3. determine the transmission rate within households 4. identify risk factors for acquisition, persistence of carriage and transmission of multiresistant Enterobacteriaceae.
Methods/Design:
The COMBAT-study is a large-scale multicenter longitudinal cohort study among travellers (n = 2001) and their non-travelling household members (n = 215). Faecal samples are collected before and immediately after travel and 1 month after return from all participants. Follow-up faecal samples are collected 3, 6 and 12 months after return from travellers (and their non-travelling household members) who acquired multiresistant Enterobacteriaceae. Questionnaires are collected from all participants at each time-point. Faecal samples are screened phenotypically for the presence of extended-spectrum beta-lactamase (ESBL) or carbapenemase-producing Enterobacteriaceae. Positive post-travel isolates from travellers with negative pre-travel samples are genotypically analysed for ESBL and carbapenemase genes with microarray and gene sequencing.
Discussion:
The design and scale of the COMBAT-study will enable us to provide much needed detailed insights into the risks and dynamics of introduction and spread of ESBL- and carbapenemase-producing Enterobacteriaceae by healthy travellers and the potential need and measures to monitor or manage these risks.
Trial Registration:
The study is registered at clinicaltrials.gov under accession number NCT01676974.
Insights
International travel significantly contributes to the spread of antimicrobial resistance (AMR). The COMBAT study investigates the acquisition and transmission of multiresistant bacteria by travelers, identifying key risk factors.
Area of Science:
- Public Health
- Infectious Diseases
- Microbiology
Background:
- Antimicrobial resistance (AMR) is a global public health threat.
- International travel accelerates the emergence and spread of AMR.
- Limited knowledge exists on travel's contribution to AMR.
Purpose of the Study:
- Determine acquisition rates of multiresistant Enterobacteriaceae during travel.
- Ascertain carriage duration and household transmission rates.
- Identify risk factors for acquisition, carriage, and transmission.
Main Methods:
- Large-scale, multicenter longitudinal cohort study (COMBAT study).
- 2001 travelers and 215 household members.
- Faecal sample collection pre-travel, post-travel, and at 1, 3, 6, 12 months.
- Phenotypic and genotypic screening for ESBL/carbapenemase-producing Enterobacteriaceae.
Main Results:
- Data on acquisition, carriage duration, and transmission dynamics are being collected.
- Risk factors for acquisition, persistence, and spread are being identified.
- Genotypic analysis of resistant isolates provides detailed insights.
Conclusions:
- The COMBAT study provides crucial insights into AMR spread via travelers.
- Informs potential measures to monitor and manage AMR risks.
- Highlights the role of international travel in global AMR dynamics.
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