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Volume 20, Number 4—April 2014

Research

High Rates of Antimicrobial Drug Resistance Gene Acquisition after International Travel, the Netherlands

Christian J.H. von Wintersdorff, John Penders, Ellen E. Stobberingh, Astrid M.L. Oude Lashof, Christian J.P.A. Hoebe, Paul H.M. Savelkoul, and Petra F.G. WolffsComments to Author 
Author affiliations: Maastricht University Medical Center, Maastricht, the Netherlands (C.J.H. von Wintersdorff, J. Penders, E.E. Stobberingh, A.M.L. Oude Lashof, C.J.P.A. Hoebe, P. Savelkoul, P.H.M. Wolffs); South Limburg Public Health Service, Geleen, the Netherlands (C.J.P.A. Hoebe)

Main Article

Table 3

Associations between travel-associated risk factors and rates of blaCTX-M, qnrB, and qnrS acquisition among 122 healthy travelers from the Netherlands, 2010–2012*

Traveler characteristic
No. travelers
Antimicrobial drug resistance genes acquired by travelers
blaCTX-M
qnrB
qnrS
No. (%)
OR (95% CI)‡

No. (%)
OR (95% CI)‡

No. (%)
OR (95% CI)‡
Region visited
Europe and America§¶ 16† 1 (6.3) 1.00 6 (37.5) 1.00 3 (18.8) 1.00
Southeast Asia 28† 5 (17.9) 3.34 
(0.34–33.14) 7 (25.0) 0.47 (0.12–1.90) 21 (75.0) 15.74 
(3.13–79.24)
Indian subcontinent 31† 18 (58.1) 26.22 
(2.86–240.18) 10 (32.3) 0.71 (0.18–2.71) 19 (61.3) 9.23 
(1.94–43.87)
Northern Africa 16† 5 (31.3) 7.28 
(0.70–75.92) 5 (31.3) 0.64 (0.14–2.98) 7 (43.8) 2.90 (0.54–15.57)
Southern Africa
17†
5 (29.4)
5.57 
(0.56–55.77)

5 (29.4)
0.65 (0.15–2.84)

6 (35.3)
2.41 (0.46–12.66)
Sex
71 25 (35.2) 1.00 25 (35.2) 1.00 41 (57.7) 1.00
M
51
13 (25.5)
0.62 (0.23–1.67)

15 (29.4)
1.06 (0.44–2.57)

21 (41.2)
0.39 (0.15–1.00)
Antimicrobial drug use
No§ 107 32 (29.9) 1.00 35 (32.7) 1.00 52 (48.6) 1.00
Yes
15
6 (40.0)
1.44 (0.40–5.25)

5 (33.3)
1.28 (0.36–4.51)

10 (66.7)
1.64 (0.43–6.22)
Traveler’s diarrhea
No§ 77 20 (26.0) 1.00 25 (32.5) 1.00 40 (51.9) 1.00
Yes
45
18 (40.0)
1.84 (0.70–4.82)

15 (33.3)
0.97 (0.40–2.37)

22 (48.9)
0.65 (0.26–1.63)
*OR, odds ratio. Boldface indicates statistical significance (p<0.05).
†Numbers do not total 122 because the 14 travelers who visited multiple or unknown regions were added to a remainder category not included in this table.
‡ORs and 95% CIs of the associations between risk factor and acquisition of resistance gene (negative before travel and positive after travel) by multivariable logistic regression analysis. Models included the following variables: travel destination, age, travel duration, sex, and antimicrobial drug use within 3 mo. preceding the travel, and traveler’s diarrhea.
§Reference category.
¶Southern Europe, Central and South America, previously reported non–high-risk regions, were pooled to establish an adequately sized reference category.

Main Article

*These authors contributed equally to this article and are co–first authors.

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