Carbapenemase-producing Enterobacteriaceae in a group of Polish travelers returning from South and South-East Asia, June 2017 – June 2018. Environment- or healthcare-associated?
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Medical University, Poznań, Poland
H. Święcicki University Hospital, Central Microbiology Laboratory, Poznań, Poland
Department of Genetics and Pharmaceutical Microbiology, University of Medical Sciences, Poznań, Poland
Hanna Tomczak   

Central Microbiology Laboratory, H. Święcicki University Hospital, Przybyszewskiego 49, 60-355, Poznań, Poland
Carbapenemase-producing Enterobacteriaceae have spread rapidly through the countries and continents to become a global concern. One of the main reservoirs of NDM-1 positive strains from the Enterobacteriaceae family is the Indian subcontinent (Bangladesh, Pakistan, India).

Material and methods:
During June 2017 – June 2018, rectal swab samples were collected routinely in all patients returning to Poland from South and South-East Asia. During molecular examinations gene blaNDM-1 encoding NDM-1 carbapenemase was detected.

31 patients were examined after returning to Poland from a trip to South and South-East Asia. The presence of New Delhi Metallo-β-lactamase-1 producing Escherichia coli and Klebsiella pneumoniae was confirmed in three patients (9.7%) returning to Poland from travels to India. All the positive patients were hospitalized during the trip in a New Delhi hospital.

Digestive tract carriage of NDM in a group of Polish travelers is a significant health and epidemiological problem. The study confirms the necessity for screening for carbapenemase-producing Enterobacteriaceae (CPE), particularly among travellers. Rectal swabs should be collected in every case of patients returning from international trips, and the possibility of environment-associated infections should be emphasized.

Hsu L-Y, Apisarnthanarak A, Khan E, Suwantarat N, et al. Carbapenem-resistant Acinetobacterbaumannii and Enterobacteriaceae in South and Southeast Asia. Clin Microbiol Rev. 2017; 30: 1–22.
Kumarasamy KK, Toleman MA, Walsh TR, et al. Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study. Lancet Infect Dis. 2010; 10(9): 597–602.
Johnson AP, Woodford N. Global spread of antibiotic resistance: the example of New Delhi metallo-β-lactamase (NDM)-mediated carbapenem resistance. J Med Microbiol. 2013; 62(Pt 4): 499–513.
Bushnell G, Mitrani-Gold F, Mundy LM. Emergence of New Delhi metallo-β-lactamase type 1-producing Enterobacteriaceae and non-Enterobacteriaceae: global case detection and bacterial surveillance. Int J Infect Dis. 2013; 17(5): 325–33.
United Nations World Tourism Organization. World Tourism Barometer. 2018: 16.
Baraniak A, Izdebski R, Fiett J, et al. NDM-producing Enterobacteriaceae in Poland, 2012–14: inter-regional outbreak of Klebsiella pneumoniae ST11 and sporadic cases. J Antimicrob Chemother. 2016; 71(1): 85–91.
EUCAST, 2017. EUCAST guideline for the detection of resistance mechanisms and specific resistances of clinical and/or epidemiological importance. Version 2.0.
Ruppé E, Armand-Lefèvre L, Estellat C, et al. Acquisitionof carbapenemase-producing Enterobacteriaceae by healthy travellers to India, France, February 2012 to March 2013. Euro Surveill. 2014; 19(14). pii: 20768.
Van Hattem JM, Arcilla MS, Bootsma MCJ, et al. Prolonged carriage and potential onward transmission of carbapenemase-producing Enterobacteriaceae in Dutch travelers. Future Microbiol. 2016; 11: 857–64.
Lausch KR, Fuursted K, Larsen CS, et al. Colonisation with multi-resistant Enterobacteriaceae in hospitalised Danish patients with a history of recent travel: a cross-sectional study. Travel Med Infect Dis. 2013; 11(5): 320–3.
Lübbert C, Straube L, Stein C, et al. Colonization with extended-spectrum beta-lactamase-producing and carbapenemase-producing Enterobacteriaceae in international travelers returning to Germany. Int J Med Microbiol. 2015; 305(1): 148–56.
Paltansing S, Vlot JA, Kraakman ME, et al. Extended-spectrum β-lactamase-producing Enterobacteriaceae among travelers from the Netherlands. Emerg Infect Dis. 2013; 19(8): 1206–13.
Grabowski ME, Kang H, Wells KM, et al. Provider Role in Transmission of Carbapenem-Resistant Enterobacteriaceae. Infect Control Hosp Epidemiol. 2017; 38(11): 1329–34.
Kizny Gordon AE, Mathers AJ, Cheong EYL, et al. The Hospital Water Environment as a Reservoir for Carbapenem-Resistant Organisms Causing Hospital-Acquired Infections – A Systematic Review of the Literature. Clin Infect Dis. 2017; 64(10): 1435–44.
Walsh TR, Weeks J, Livermore D M, et al. Dissemination of NDM-1 positive bacteria in the New Delhi environment and its implications for human health: an environmental point prevalence study. Lancet Infect Dis. 2011; 11(5): 355–62.
Liu BT, Zhang XY, Wan SW, et al. Characteristics of Carbapenem-Resistant Enterobacteriaceae in Ready-to-Eat Vegetables in China. Front Microbiol. 2018; 9: 1147.
Nordmann P. Carbapenemase-producing Enterobacteriaceae: overview of a major public health challenge. Med Mal Infect. 2014; 44(2): 51–6.
Paschke C, Apelt N, Fleischmann E, et al. Controlled study on entero-pathogens in travellers returning from the tropics with and without diarrhoea. Clin Microbiol Infect. 2011; 17: 1194–1200.
De la Cabada Bauche J, DuPont HL. New Developments in Traveler‘s Diarrhea. Gastroenterol Hepatol. 2011; 7(2): 88–95.
Riddle MS, Connor BA, Beeching NJ, et al. Guidelines for the prevention and treatment of travelers‘diarrhea: a graded expert panel report. J Travel Med. 2017; 24(suppl_1): S57-S74.
MacFadden DR, Bogoch II, Brownstein JS, et al. A passage from India: association between air traffic and reported cases of New Delhi Metallo-beta-lactamase 1 from 2007 to 2012. Travel Med Infect Dis. 2015; 13(4): 295–99.
Laxminarayan R, Chaudhury RR. Antibiotic resistance in India: drivers and opportunities for action. PLoS Med. 2016; 13(3): e1001974.
Ganguly NK, Arora NK, Chandy SJ, et al. Global Antibiotic Resistance Partnership (GARP) – India Working Group. 2011. Rationalizing antibiotic use to limit antibiotic resistance in India. Indian J Med Res. 2011; 134: 281–94.
Nordmann P, Poirel L. (2014). The difficult-to-control spread of carbapenemase producers among Enterobacteriaceae worldwide. Clin Microbiol Infect. 2014; 20(9): 821–30.
McGettigan P, Roderick P, Kadam A, et al. Reserve antibiotics in India: challenges for WHO stewardship. Lancet Glob Health. 2017; 5(11):1075–76.
Berrazeg M, Diene SM, Medjahed L, et al. New Delhi Metallo-beta-lactamase around the world: an eReview using Google Maps. Euro Surveill. 2014; 19(20): 20809.
Karczewski M, Tomczak H, Piechocka-Idasiak I, et al. Is Multiresistant Klebsiella pneumoniae New Delhi Metallo-beta-Lactamase (NDM-1) a New Threat for Kidney Transplant Recipients? Transplant Proc. 2014; 7(46): 2409–10.
Marston HD, Dixon DM, Knisely JM, et al. Antimicrobial Resistance. JAMA. 2016 Sep 20; 316(11): 1193–1204.