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Abstract

Extended-spectrum β-lactamase-producing (ESBL-Ec) are frequently acquired during international travel, contributing to the global spread of antimicrobial resistance. Human-adapted ESBL-Ec are predicted to exhibit increased intestinal carriage duration, resulting in a higher likelihood of onward human-to-human transmission. Yet, bacterial determinants of increased carriage duration are unknown. Previous studies analysed small traveller cohorts, with short follow-up times, or did not employ high-resolution molecular typing, and were thus unable to identify bacterial traits associated with long-term carriage after recent acquisition. We aimed to identify which ESBL-Ec lineages are associated with increased carriage duration after return from international travel.

In a prospective cohort study of 2001 international travellers, we analysed 160 faecal ESBL-Ec isolates from all 38 travellers who acquired ESBL-Ec during travel and subsequently carried ESBL-Ec for at least 12 months after return, by whole-genome sequencing. For 17 travellers, we confirmed the long-term carriage of ESBL-Ec strains through single nucleotide variant typing. To identify determinants of increased carriage duration, we compared the 17 long-term carriers (≥12 months of carriage) with 33 age-, sex- and destination-matched short-term carriers (<1 month of carriage). Long-read sequencing was employed to investigate long-term ESBL plasmid carriage.

We show that in healthy travellers with very low antibiotic usage, extra-intestinal pathogenic lineages of (ExPEC) are significantly more likely to persist than other lineages. The long-term carriage of from ExPEC lineages is mainly driven by sequence type 131 and phylogroup D .

Although ExPEC lineages frequently cause extra-intestinal infections such as bloodstream infections, our results indicate that ExPEC lineages are also efficient intestinal colonizers, which potentially contributes to their onward transmission.

Funding
This study was supported by the:
  • Amsterdam University Medical Centers (Award Flexibele OiO grant (internal))
    • Principle Award Recipient: ConstanceSchultsz
  • HORIZON EUROPE Framework Programme (Award 643476)
    • Principle Award Recipient: NotApplicable
  • ZonMw (Award 50-51700-98-120)
    • Principle Award Recipient: NotApplicable
  • This is an open-access article distributed under the terms of the Creative Commons Attribution License.
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/content/journal/acmi/10.1099/acmi.0.000541.v4
2024-02-12
2024-02-26
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