International travel and acquisition of multidrug-resistant Enterobacteriaceae: a systematic review

Area of Science:

• Infectious Diseases
• Microbiology
• Public Health

Background:

• International travel is a known risk factor for acquiring multidrug-resistant Enterobacteriaceae (MRE).
• Understanding the prevalence and risk factors for post-travel MRE carriage is crucial for public health surveillance.
• Previous studies suggest a link between travel and MRE acquisition, necessitating a comprehensive review.

Purpose of the Study:

• To systematically review the existing literature on the effect of international travel on the risk of faecal carriage of MRE.
• To identify secondary risk factors associated with MRE acquisition in international travelers.

Main Methods:

• A systematic literature search was performed across seven databases following PRISMA guidelines.
• Inclusion criteria required studies to report on foreign travel, screening of asymptomatic individuals, antimicrobial susceptibility, and faecal Enterobacteriaceae carriage.
• Two independent researchers screened abstracts and full texts, with a third researcher resolving disagreements.

Main Results:

• Eleven studies met the inclusion criteria, all reporting a high prevalence (>20%) of MRE carriage in travelers post-international travel.
• The highest prevalence of MRE carriage was observed in individuals returning from South Asia.
• Foreign travel was consistently associated with an elevated risk of MRE carriage.

Conclusions:

• International travel is a significant risk factor for acquiring and carrying multidrug-resistant Enterobacteriaceae.
• Travelers, particularly those returning from South Asia, are at a high risk for MRE carriage.
• Further research is warranted to determine if this increased carriage translates to a higher incidence of MRE-related infections.