Staying in a hotel or private accommodation during travel to low or middle-income countries (LMICs) in tropical regions is associated with contracting drug-resistant bacteria, researchers have suggested in a recent study. According to the research being presented at this year’s European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), younger travellers aged between 20-30 years were found to be at increased risk compared with those in other age groups.
People travelling to either Western, Southern or Eastern Asia faced the highest risk of contracting the resistant bacteria. They had a four times higher risk of being colonised with ESBL-producing bacteria than those who visited other LMICs in tropical and subtropical regions. The study of 230 people from Germany travelling to LMICs found that travellers who mainly stayed in a hotel or private accommodation had a four times higher risk in each case of returning home with multi-drug resistant bacteria in their gut than those who mainly stayed in other types of tourist accommodations like guest houses, hostels, or camping. Oral Bacteria May Up Risk of Pancreatic Cancer.
According to the authors, the study is the first to report staying in a hotel as a risk factor for colonisation with extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-PE), which are resistant to multiple antibiotics.”Previous studies had already reported this for staying in private accommodation, but it was unexpected that hotel might also be a risk factor,” said co-author Dr Lynn Meurs.
“Colonization in itself does not lead to any health problems. However, there is a risk of infection with bacteria that patients are colonised with, especially in hospitalized patients. Should that occur with extended-spectrum beta-lactamase producing Enterobacteriaceae, these infections such as urinary tract infections, pneumonia, and sepsis, may be more difficult to treat than infections with bacteria that are susceptible to standard antibiotics,” Meurs added.
As the previous study did not set out to investigate the effect of a hotel stay on ESBL-PE colonisation, further studies are needed to assess whether the surprising association between a hotel stay and ESBL-colonization is reproducible, and what factors may cause such an association, researchers said. To investigate how intercontinental travel impacts the spread of ESBL-producing bacteria, Meurs and colleagues studied risk factors for intestinal ESBL-PE colonisation in 230 people attending a travel clinic at the Leipzig University Hospital, Germany, before travelling between March 2016 and March 2017.
The researchers collected stool samples for testing from participants before and after they travelled outside Germany. All travellers completed questionnaires on risk factors including the countries they visited, length of time spent in the country, type of residence, symptoms, antibiotic treatment, healthcare use, diet, and hygiene. Modelling was used to identify risk factors for travel-associated ESBL-PE colonisation. Seven travellers who tested ESBL-PE-positive before travel were excluded from the analysis.
Results showed that around one in five travellers contracted ESBL-producing bacteria during their trip abroad. The data also showed that people who stayed in a hotel or in private accommodation were in each case four times more likely to contract ESBL-producing bacteria than those staying in a residence like a hostel, guest house or camping. The risk of ESBL-PE colonisation also varied with age.
Travellers aged 20-30 years are at five-time increased odds of contracting drug-resistant bacteria compared to travellers aged 50 years and over. The authors suggested that is most likely because people aged 20-30 years in this study travelled longer than travellers from other age categories. As such, they may have been exposed longer to ESBL-PE and therefore have a higher risk of returning home colonised.
“Many people visit low- and middle-income countries in tropical and semi-tropical regions every year. With around 20 per cent of travellers returning positive for these resistant bacteria, our findings reconfirm that intercontinental travel, especially to already known high-risk areas, likely contributes to their global spread,” said Dr Meurs. “We, therefore, recommend raising awareness in returning (high-risk) travellers. They should know that they may be carrying drug-resistant bacteria in the weeks after travel and how they can effectively prevent the spread to other persons, for example through adequate hand hygiene,” recommended Meurs.
This observational study in one travel clinic cannot prove that the type of accommodation causes colonisation with ESBL-producing bacteria, but only suggests the possibility of such an effect.