Colonização intestinal por Escherichia coli multirresistente em viajantes atendidos em uma clínica de medicina de viagens do Rio de Janeiro

Abstract

Travelling is an important factor for acquisition of multidrug-resistant (MR) bacteria, specially extended-spectrum beta-lactamase (ESBL) and carbapenemase producing bacteria and those carring genes associated with plasmid mediated fluorquinolone resistance (PMQR). The risk factors related to acquisition of these microorganisms are the destination region, usage of antimicrobial agents, and ocurrence of diarrhea during travel. The aim of this study was to determine the frequency of acquisition of colonization by MR Escherichia coli by travelers attended at Centro de Medicina dos Viajantes of UFRJ (CIVES), including isolates producing ESBL, carbapenemases, carrying PMQR and plasmid mediated polymyxin resistance (mcr) genes. The study was performed between 2015 and 2018 and travelers over 18 years of age attended at CIVES were invited to participate in the study. A comportamental questionnaire was applied and the participants were oriented to collect a anal stool specimen with a cotton swab before travel and upon return. Stool samples were sent to microbiology laboratory and stored into STGG media. Aliquots were plated onto plain Mac Conkey agar (MCA), MCA supplemented with ceftriaxone, and trypticase soy broth containing ertapenem disk. Identification of isolates as E. coli was performed by MALDI-TOF mass spectrometry. Cultures in MCA supplemented with ceftriaxone were used for ESBL-producing testing. The ESBL gene, carbapenemases and PMQR and mcr were detected by PCR. Two isolates per participant, one pre-travel and one upon return, were selected for antimicrobial susceptibility tests (isolates were classified as MR) and typing by random amplification of polymorphic DNA (RAPD). Phylogroups were determined for all isolates. In addition, we investigated the variables associated with acquisition of MR or ESBL producing E. coli isolates. We included 153 (68%) of 224 participants, most of them female; the mean age was 38 years. The highest frequencies of acquisition were in the Southeast Asia subcontinent. Most ESBL encoding genes were bla CTX-M15 and in only one isolate the bla OXA-48 was detected. The frequency of acquisition of ESBL-producing E. coli in travels was 20%, and MR E. coli was 28%. The isolates obtained after travel were more resistant than the isolates obtained before travel to gentamicin, ampicillin, cephalosporins and sulfamethoxazole+trimethoprim. Most isolates belonged to phylogroups A or C, followed by B1 and B2. RAPD typing discriminated 103 profiles, three of them containing two isolates, and 100 other different profiles evidencing a diversity of clonal types within the samples of travelers intestinal microbiota. The analysis of other variables showed that acquisition of colonization of ESBL producing E. coli after travel was associated with tourism travel (p=0.020) and destination area (p=0.003). Acquisition of MR E. coli was associated with destination area (p=0.007). Brazilian travelers acquired MR E. coli during travellings in similar frequency when compared to travelers from developed countries.