When travelers introduce multidrug-resistant germs

Dangerous germs from India and Southeast Asia

01/16/2015

Travelers are increasingly importing multidrug-resistant germs from India and Southeast Asia to their home countries. A study by microbiologists at Leipzig University Hospital shows that one-third of all long-distance travelers in risky areas bring unnoticed dangerous bacteria, against which hardly any antibiotics work, home. How exactly the transmission of the multidrug-resistant germs takes place is still unknown. Simple hygiene measures such as thorough hand washing and the use of packaged drinks during travel do not provide sufficient protection, according to the researchers.

Multidrug-resistant bacteria from India and Southeast Asia can cause dangerous infections in immunocompromised people
Over a period of twelve months, the researchers investigated the risk of introducing bacteria (pathogen import) through long-distance travel. „For the first time in a larger cohort, we were able to show for Germany that almost one third of travelers actually live in multidrug-resistant pathogens after returning home from areas with a high pathogen density“, explains Dr. Christoph Lübbert, Head of the Department of Infection and Tropical Medicine at the University Hospital Leipzig. The expert on gastroenterology, infectology and tropical medicine evaluated data from 225 travelers before and after a trip to areas with a high incidence of multidrug-resistant pathogens (MRE). „This applies above all to the Indian subcontinent and Southeast Asia, as well as to various countries in Africa and Central and South America, where these problematic pathogens occur much more frequently than in our country“, Lübbert reports. The internist focused on investigating so-called ESBL-producing bacteria that are resistant to the majority of available antibiotics. While the intestinal bacteria are safe for healthy people and cause no discomfort, the pathogens in immunocompromised individuals can cause life-threatening infections.

Pathways of multidrug-resistant bacteria are still unclear
As the internist further reports, the exact transmission routes of the dangerous bacteria are not yet fully understood. „Our study provides some guidance here, because neither thorough hand hygiene nor the exclusive use of packaged beverages during the trip had a convincing protective effect“, so Lübbert.

The evaluation of the data showed that the pathogens are most commonly introduced to India. More than 70 percent of travelers in this region were carriers of multidrug-resistant bacteria. Nearly 50 percent of travelers in Southeast Asia also carried the germs in themselves. A diarrheal disease (gastroenteritis) acquired during the stay abroad increases the transmission risk, according to another study published in the renowned specialist journal „International Journal of Medical Microbiology ".

Overall, 30.4 percent of the 225 healthy volunteers (mean age: 34 years) were found to be colonized with ESBL-producing bacteria. „This value confirms similar current investigations in Scandinavia and the Netherlands and is higher than previously assumed,“ explains the expert in tropical medicine. Earlier studies estimated significantly lower rates, ranging from 14 to 25 percent.

Screening of multidrug-resistant germs is urgently required in hospitals for travelers from India and Southeast Asia
„Our study shows that the fight against multidrug-resistant pathogens requires a global approach in order to be successful in the future“, emphasizes Lübbert. „Systematic admission screening for ESBL-producing bacteria in patients who have been to India or Southeast Asia within the past six months can effectively prevent the risk of undetected transmission in health care settings, and especially in hospitals.“ The internist also advises to isolate the patients until the results of the examination are available. „Screening for employees in the food industry and catering after such trips could also be a preventive measure for the future“, so Lübbert. (Ag)