International Travel as a Risk Factor for Carriage of Extended-Spectrum β-Lactamase-Producing Escherichia coli in a Large Sample of European Individuals-The AWARE Study

Daloha Rodríguez-Molina; Fanny Berglund; Hetty Blaak; Carl-Fredrik Flach; Merel Kemper; Luminita Marutescu; Gratiela Pircalabioru Gradisteanu; Marcela Popa; Beate Spießberger; Laura Wengenroth; Mariana Carmen Chifiriuc; D G Joakim Larsson; Dennis Nowak; Katja Radon; Ana Maria de Roda Husman; Andreas Wieser; Heike Schmitt

doi:10.3390/ijerph19084758

International Travel as a Risk Factor for Carriage of Extended-Spectrum β-Lactamase-Producing Escherichia coli in a Large Sample of European Individuals-The AWARE Study

Daloha Rodríguez-Molina
, Fanny Berglund
, Hetty Blaak
, Carl-Fredrik Flach
, Merel Kemper
, Luminita Marutescu
, Gratiela Pircalabioru Gradisteanu
, Marcela Popa
, Beate Spießberger
, Laura Wengenroth
, Mariana Carmen Chifiriuc
, D G Joakim Larsson
, Dennis Nowak
, Katja Radon
, Ana Maria de Roda Husman
, Andreas Wieser
, Heike Schmitt

IRAS OH Epidemiology Microbial Agents

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Antibiotic resistance (AR) is currently a major threat to global health, calling for a One Health approach to be properly understood, monitored, tackled, and managed. Potential risk factors for AR are often studied in specific high-risk populations, but are still poorly understood in the general population. Our aim was to explore, describe, and characterize potential risk factors for carriage of Extended-Spectrum Beta-Lactamase-resistant Escherichia coli (ESBL-EC) in a large sample of European individuals aged between 16 and 67 years recruited from the general population in Southern Germany, the Netherlands, and Romania. Questionnaire and stool sample collection for this cross-sectional study took place from September 2018 to March 2020. Selected cultures of participants' stool samples were analyzed for detection of ESBL-EC. A total of 1183 participants were included in the analyses: 333 from Germany, 689 from the Netherlands, and 161 from Romania. Travels to Northern Africa (adjusted Odds Ratio, aOR 4.03, 95% Confidence Interval, CI 1.67-9.68), Sub-Saharan Africa (aOR 4.60, 95% CI 1.60-13.26), and Asia (aOR 4.08, 95% CI 1.97-8.43) were identified as independent risk factors for carriage of ESBL-EC. Therefore, travel to these regions should continue to be routinely asked about by clinical practitioners as possible risk factors when considering antibiotic therapy.

Original language	English
Article number	4758
Pages (from-to)	1-19
Journal	International Journal of Environmental Research and Public Health
Volume	19
Issue number	8
DOIs	https://doi.org/10.3390/ijerph19084758
Publication status	Published - 2 Apr 2022

Bibliographical note

Funding Information:
Funding: AWARE (Antibiotic Resistance in Wastewater: Transmission Risks for Employees and Residents around Wastewater Treatment Plants) is supported by the European Commission (JPI-EC-AMR ERA-Net Cofund grant no 681055), the Bundesministerum für Bildung und Forschung, DLR Projektträger (01KI1708), UEFISCDI project ERANET-JPI-EC-AMR-AWARE-WWTP No. 26/2017, the Netherlands Organisation for Health Research and Development, The Hague, the Netherlands (ZonMw, grant 547001007), and the Swedish Research Council VR Grant No. 2016-06512.

Funding Information:
Acknowledgments: AWARE (Antibiotic Resistance in Wastewater: Transmission Risks for Employees and Residents around Wastewater Treatment Plants) is supported by the European Commission (JPI-EC-AMR ERA-Net Cofund grant no 681055), the Bundesministerum für Bildung und Forschung, DLR Projektträger (01KI1708), UEFISCDI project ERANET-JPI-EC-AMR-AWARE-WWTP No. 26/2017, the Netherlands Organisation for Health Research and Development, The Hague, the Netherlands (ZonMw, grant 547001007), and the Swedish Research Council VR Grant No. 2016-06512.

Publisher Copyright:
© 2022 by the authors. Licensee MDPI, Basel, Switzerland.

Keywords

ESBL E. coli
antibiotic resistance
antimicrobial resistance
risk factors
travels

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.3390/ijerph19084758Licence: CC BY

ijerph-19-04758Final published version, 1.33 MBLicence: CC BY

Cite this

Rodríguez-Molina, D., Berglund, F., Blaak, H., Flach, C.-F., Kemper, M., Marutescu, L., Pircalabioru Gradisteanu, G., Popa, M., Spießberger, B., Wengenroth, L., Chifiriuc, M. C., Larsson, D. G. J., Nowak, D., Radon, K., de Roda Husman, A. M., Wieser, A., & Schmitt, H. (2022). International Travel as a Risk Factor for Carriage of Extended-Spectrum β-Lactamase-Producing Escherichia coli in a Large Sample of European Individuals-The AWARE Study. International Journal of Environmental Research and Public Health, 19(8), 1-19. Article 4758. https://doi.org/10.3390/ijerph19084758

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title = "International Travel as a Risk Factor for Carriage of Extended-Spectrum β-Lactamase-Producing Escherichia coli in a Large Sample of European Individuals-The AWARE Study",

abstract = "Antibiotic resistance (AR) is currently a major threat to global health, calling for a One Health approach to be properly understood, monitored, tackled, and managed. Potential risk factors for AR are often studied in specific high-risk populations, but are still poorly understood in the general population. Our aim was to explore, describe, and characterize potential risk factors for carriage of Extended-Spectrum Beta-Lactamase-resistant Escherichia coli (ESBL-EC) in a large sample of European individuals aged between 16 and 67 years recruited from the general population in Southern Germany, the Netherlands, and Romania. Questionnaire and stool sample collection for this cross-sectional study took place from September 2018 to March 2020. Selected cultures of participants' stool samples were analyzed for detection of ESBL-EC. A total of 1183 participants were included in the analyses: 333 from Germany, 689 from the Netherlands, and 161 from Romania. Travels to Northern Africa (adjusted Odds Ratio, aOR 4.03, 95\% Confidence Interval, CI 1.67-9.68), Sub-Saharan Africa (aOR 4.60, 95\% CI 1.60-13.26), and Asia (aOR 4.08, 95\% CI 1.97-8.43) were identified as independent risk factors for carriage of ESBL-EC. Therefore, travel to these regions should continue to be routinely asked about by clinical practitioners as possible risk factors when considering antibiotic therapy. ",

keywords = "ESBL E. coli, antibiotic resistance, antimicrobial resistance, risk factors, travels",

author = "Daloha Rodr{\'i}guez-Molina and Fanny Berglund and Hetty Blaak and Carl-Fredrik Flach and Merel Kemper and Luminita Marutescu and \{Pircalabioru Gradisteanu\}, Gratiela and Marcela Popa and Beate Spie{\ss}berger and Laura Wengenroth and Chifiriuc, \{Mariana Carmen\} and Larsson, \{D G Joakim\} and Dennis Nowak and Katja Radon and \{de Roda Husman\}, \{Ana Maria\} and Andreas Wieser and Heike Schmitt",

note = "Funding Information: Funding: AWARE (Antibiotic Resistance in Wastewater: Transmission Risks for Employees and Residents around Wastewater Treatment Plants) is supported by the European Commission (JPI-EC-AMR ERA-Net Cofund grant no 681055), the Bundesministerum f{\"u}r Bildung und Forschung, DLR Projekttr{\"a}ger (01KI1708), UEFISCDI project ERANET-JPI-EC-AMR-AWARE-WWTP No. 26/2017, the Netherlands Organisation for Health Research and Development, The Hague, the Netherlands (ZonMw, grant 547001007), and the Swedish Research Council VR Grant No. 2016-06512. Funding Information: Acknowledgments: AWARE (Antibiotic Resistance in Wastewater: Transmission Risks for Employees and Residents around Wastewater Treatment Plants) is supported by the European Commission (JPI-EC-AMR ERA-Net Cofund grant no 681055), the Bundesministerum f{\"u}r Bildung und Forschung, DLR Projekttr{\"a}ger (01KI1708), UEFISCDI project ERANET-JPI-EC-AMR-AWARE-WWTP No. 26/2017, the Netherlands Organisation for Health Research and Development, The Hague, the Netherlands (ZonMw, grant 547001007), and the Swedish Research Council VR Grant No. 2016-06512. Publisher Copyright: {\textcopyright} 2022 by the authors. Licensee MDPI, Basel, Switzerland.",

year = "2022",

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doi = "10.3390/ijerph19084758",

language = "English",

volume = "19",

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Rodríguez-Molina, D, Berglund, F, Blaak, H, Flach, C-F, Kemper, M, Marutescu, L, Pircalabioru Gradisteanu, G, Popa, M, Spießberger, B, Wengenroth, L, Chifiriuc, MC, Larsson, DGJ, Nowak, D, Radon, K, de Roda Husman, AM, Wieser, A & Schmitt, H 2022, 'International Travel as a Risk Factor for Carriage of Extended-Spectrum β-Lactamase-Producing Escherichia coli in a Large Sample of European Individuals-The AWARE Study', International Journal of Environmental Research and Public Health, vol. 19, no. 8, 4758, pp. 1-19. https://doi.org/10.3390/ijerph19084758

International Travel as a Risk Factor for Carriage of Extended-Spectrum β-Lactamase-Producing Escherichia coli in a Large Sample of European Individuals-The AWARE Study. / Rodríguez-Molina, Daloha; Berglund, Fanny; Blaak, Hetty et al.
In: International Journal of Environmental Research and Public Health, Vol. 19, No. 8, 4758, 02.04.2022, p. 1-19.

Research output: Contribution to journal › Article › Academic › peer-review

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AU - Rodríguez-Molina, Daloha

AU - Berglund, Fanny

AU - Blaak, Hetty

AU - Flach, Carl-Fredrik

AU - Kemper, Merel

AU - Marutescu, Luminita

AU - Pircalabioru Gradisteanu, Gratiela

AU - Popa, Marcela

AU - Spießberger, Beate

AU - Wengenroth, Laura

AU - Chifiriuc, Mariana Carmen

AU - Larsson, D G Joakim

AU - Nowak, Dennis

AU - Radon, Katja

AU - de Roda Husman, Ana Maria

AU - Wieser, Andreas

AU - Schmitt, Heike

N1 - Funding Information: Funding: AWARE (Antibiotic Resistance in Wastewater: Transmission Risks for Employees and Residents around Wastewater Treatment Plants) is supported by the European Commission (JPI-EC-AMR ERA-Net Cofund grant no 681055), the Bundesministerum für Bildung und Forschung, DLR Projektträger (01KI1708), UEFISCDI project ERANET-JPI-EC-AMR-AWARE-WWTP No. 26/2017, the Netherlands Organisation for Health Research and Development, The Hague, the Netherlands (ZonMw, grant 547001007), and the Swedish Research Council VR Grant No. 2016-06512. Funding Information: Acknowledgments: AWARE (Antibiotic Resistance in Wastewater: Transmission Risks for Employees and Residents around Wastewater Treatment Plants) is supported by the European Commission (JPI-EC-AMR ERA-Net Cofund grant no 681055), the Bundesministerum für Bildung und Forschung, DLR Projektträger (01KI1708), UEFISCDI project ERANET-JPI-EC-AMR-AWARE-WWTP No. 26/2017, the Netherlands Organisation for Health Research and Development, The Hague, the Netherlands (ZonMw, grant 547001007), and the Swedish Research Council VR Grant No. 2016-06512. Publisher Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland.

PY - 2022/4/2

Y1 - 2022/4/2

N2 - Antibiotic resistance (AR) is currently a major threat to global health, calling for a One Health approach to be properly understood, monitored, tackled, and managed. Potential risk factors for AR are often studied in specific high-risk populations, but are still poorly understood in the general population. Our aim was to explore, describe, and characterize potential risk factors for carriage of Extended-Spectrum Beta-Lactamase-resistant Escherichia coli (ESBL-EC) in a large sample of European individuals aged between 16 and 67 years recruited from the general population in Southern Germany, the Netherlands, and Romania. Questionnaire and stool sample collection for this cross-sectional study took place from September 2018 to March 2020. Selected cultures of participants' stool samples were analyzed for detection of ESBL-EC. A total of 1183 participants were included in the analyses: 333 from Germany, 689 from the Netherlands, and 161 from Romania. Travels to Northern Africa (adjusted Odds Ratio, aOR 4.03, 95% Confidence Interval, CI 1.67-9.68), Sub-Saharan Africa (aOR 4.60, 95% CI 1.60-13.26), and Asia (aOR 4.08, 95% CI 1.97-8.43) were identified as independent risk factors for carriage of ESBL-EC. Therefore, travel to these regions should continue to be routinely asked about by clinical practitioners as possible risk factors when considering antibiotic therapy.

AB - Antibiotic resistance (AR) is currently a major threat to global health, calling for a One Health approach to be properly understood, monitored, tackled, and managed. Potential risk factors for AR are often studied in specific high-risk populations, but are still poorly understood in the general population. Our aim was to explore, describe, and characterize potential risk factors for carriage of Extended-Spectrum Beta-Lactamase-resistant Escherichia coli (ESBL-EC) in a large sample of European individuals aged between 16 and 67 years recruited from the general population in Southern Germany, the Netherlands, and Romania. Questionnaire and stool sample collection for this cross-sectional study took place from September 2018 to March 2020. Selected cultures of participants' stool samples were analyzed for detection of ESBL-EC. A total of 1183 participants were included in the analyses: 333 from Germany, 689 from the Netherlands, and 161 from Romania. Travels to Northern Africa (adjusted Odds Ratio, aOR 4.03, 95% Confidence Interval, CI 1.67-9.68), Sub-Saharan Africa (aOR 4.60, 95% CI 1.60-13.26), and Asia (aOR 4.08, 95% CI 1.97-8.43) were identified as independent risk factors for carriage of ESBL-EC. Therefore, travel to these regions should continue to be routinely asked about by clinical practitioners as possible risk factors when considering antibiotic therapy.

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KW - antimicrobial resistance

KW - risk factors

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Rodríguez-Molina D, Berglund F, Blaak H, Flach CF, Kemper M, Marutescu L et al. International Travel as a Risk Factor for Carriage of Extended-Spectrum β-Lactamase-Producing Escherichia coli in a Large Sample of European Individuals-The AWARE Study. International Journal of Environmental Research and Public Health. 2022 Apr 2;19(8):1-19. 4758. doi: 10.3390/ijerph19084758

International Travel as a Risk Factor for Carriage of Extended-Spectrum β-Lactamase-Producing Escherichia coli in a Large Sample of European Individuals-The AWARE Study

Abstract

Bibliographical note

Keywords

UN SDGs

Access to Document

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