Tourism leads to the worldwide spread of multi-resistant pathogens

Multi-resistant germs are spread worldwide through international travel
The global spread of multi-resistant pathogens is a massive problem in medicine. A current study comes to the conclusion that tourism plays an important role in the spread of resistant germs. "A large proportion of travelers who visit a country with low hygiene standards bring multiresistant intestinal germs to their home country," reports the CRM Center for Travel Medicine of the study results.

The Dutch research team led by Dr. John Penders from the University Medical Center in Maastricht has examined the spread of multi-resistant germs in the course of global tourism and comes to a worrying result: Many travelers carry relevant pathogens and spread them to the local population. Global tourism has a significant influence on the spread of multi-resistant germs. The results of the study were published in the specialist journal "The Lancet Infectious Diseases".

Spread of ESBL-forming bacteria examined
"International travel contributes to the spread of antimicrobial resistance," the researchers explain. For their study, they examined the spread of so-called "extensive-ß-lactamase-producing Enterobacteriaceae" (ESBL-E). The ESBL-forming bacteria are resistant to many antibiotics and it is therefore often difficult to treat corresponding infections. A total of 2001 Dutch travelers and 215 non-traveling household members were examined in the current study using faecal samples and questionnaires on demography, diseases and behavior - before the trip, immediately after return and one, three, six and 12 months afterwards.

Particularly high risk when traveling to Southeast Asia
The researchers' results were terrifying. "Of the 1,847 travelers who were ESBL-negative before the trip and provided samples after their return, 633 (34.3 percent) had acquired ESBL-E during the international trip," reports Dr. Penders and colleagues. In travelers to South Asia, 136 out of 181 subjects were carriers of the bacteria after the trip (more than 75 percent). The scientists explain that the use of antibiotics during travel, diarrhea from travel and pre-existing chronic bowel diseases are key indicators of the risk of ESBL-E intake.

Household members are often infected
On average, colonization with the bacteria persisted 30 days after the trip, but 577 subjects remained colonized even after 12 months. The researchers were also able to prove that the pathogens were passed on to household members in 13 cases. "The probability of ESBL-E being transferred to another household member was 12%," the researchers write. However, the ESBL-forming bacteria “don't have to make you sick per se,” explains the CRM. "For many carriers, these germs never become a problem - it is even normal to a certain extent that we all carry multiresistant bacteria within us," says Professor Dr. med. Tomas Jelinek, Scientific Director of CRM.

Risks from multi-resistant pathogens
According to Prof. Jelinek, the multi-resistant pathogens can "become a massive problem in people with a weakened immune system, chronic illness or recent surgery." Various forms of infection are possible, which are then difficult to treat due to the resistance of the germ. "We need both doctors and travelers to be more aware of the problem of the multi-resistant pathogens acquired on long-distance trips and widespread in Germany," said Jelinek.

Information about the risk of international travel is required
According to the experts, international travelers should pay particular attention to careful hygiene during and after the trip. For example, most germs would be transmitted through the hands. Here, regular and thorough hand washing can protect people at risk to a certain extent, explains Jelinek. If a visit to a doctor or clinic is required after the trip, "returning travelers should proactively inform the doctors that and when they were abroad," reports the CRM. But doctors are also in demand, says Prof. Jelinek. On the one hand in the clarification of willingness to travel about risk factors, on the other hand in the consideration of possible imported resistance by returning travelers.

The doctors are also challenged
The Dutch scientists conclude that the spread of ESBL-E during and after international travel is worrying. Travelers to high-risk areas of an ESBL-E acquisition should therefore be considered potential carriers of ESBL-E for up to 12 months after their return, Dr. Corresponding infections "need to be more in focus both in the treatment of travelers themselves and as a potential danger to other patients - for example during hospital stays," said Prof. Jelinek in the CRM press release. (fp)

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