Patients hospitalized abroad as importers of multiresistant bacteria - a cross-sectional study.

Patients hospitalized abroad as importers of multiresistant bacteria - a cross-sectional study.

Clin Microbiol Infect. 2017 Feb 11;:

Authors: Khawaja T, Kirveskari J, Johansson S, Väisänen J, Djupsjöbacka A, Nevalainen A, Kantele A

Abstract
OBJECTIVES: The pandemic spread of multidrug-resistant (MDR) bacteria poses a threat to healthcare worldwide, with highest prevalence in indigent regions of the (sub)tropics. As hospitalization constitutes a major risk factor for colonization, infection control management in low-prevalence countries urgently needs background data on patients hospitalized abroad.
METHODS: We collected data on 1122 patients who, after hospitalization abroad, were treated at the Helsinki University Hospital between 2010 and 2013. They were screened for methicillin resistant Staphylococcus aureus (MRSA), extended-spectrum betalactamase-producing Enterobacteriaceae (ESBL-PE), vancomycin-resistant Enterococci (VRE), carbapenemase-producing Enterobacteriaceae (CPE), multiresistant Pseudomonas aeruginosa (MRPA), and multiresistant Acinetobacter baumannii (MRAB). Risk factors for colonization were explored by multivariate analysis.
RESULTS: MDR colonization rates were higher for those hospitalized in the (sub)tropics (55%; 208/377)) compared to temperate zones (17%; 125/745). For ESBL-PE the percentages were 50 (190/377) versus 12 (92/745), CPE 3.2 (12/377) versus 0.4 (3/745), and MRSA 6.6 (25/377) versus 2.4 (18/745). Colonization rates proved highest in those returning from South Asia (77.6%; 38/49), followed by those having visited Latin America (60%; 9/16), Africa (60%; 15/25) and East and Southeast Asia (52.5%; 94/179). Destination, interhospital transfer, short time interval to hospitalization, young age, surgical intervention, residence abroad, visiting friends and relatives, and antimicrobial use proved independent risk factors for colonization.
CONCLUSIONS: Post-hospitalization colonization rates proved higher in the (sub)tropics than elsewhere; 11% (38/333) of carriers developed an MDR infection. We identified several independent risk factors for contracting MDR bacteria. The data provides a basis for infection control guidelines in low-prevalence countries.

PMID: 28196696 [PubMed - as supplied by publisher]

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