[Travels and spreading of multi-resistant bacteria]

The increasing number of international travel for tourism, business and for medical reasons rises the risk of spreading of multi-resistant bacteria. It has been shown that an intercontinental travel, mainly to Asia (Indian Subcontinent), promotes a colonization of the digestive tract, mainly by multi-resistant Enterobacteriaceae (MRE) and increases the risk of symptomatic infections caused by these agents. The colonization of the digestive tract by MRE is reported in 29-88% of travelers. It sustains 3 to 12 months, respectively in 10% and 2% of travelers. Risk factors for the acquisition of colonization with MRE include: travel duration and destination, treatment with betalactam antibiotics during the travel, the use of local medical services, including hospitalization, presence of gastrointestinal symptoms during the travel (mainly diarrhea), age >65 years. The need of the hospitalization during the travel increases the risk of colonization, but is not a prerequisite factor for the acquisition of the colonization, as cases of the MRE carriage are reported in patients who had never used medical services outside the country. It indicates other possible transmission routes, including food. In order to reduce the risk of MRE spreading, it is recommended to ask patients about a history of travel and treatment within the last 12 months. All patient who report such events and require hospitalization in their home countries should be microbiologically screened. Hospitalized patients colonized with multiple resistant bacteria require an isolation or cohortation. Educational activities related to the hand hygiene compliance should be performed. The risk of the home transmission of MRE is not high, it lasts for a short period (up to 3 months). Routine microbiological testing for all persons returning from an international or intercontinental travel is not recommended, neither microbiological screening among their households.