Volume 22, Number 1—January 2016
Dispatch
Increased Risk for ESBL-Producing Bacteria from Co-administration of Loperamide and Antimicrobial Drugs for Travelers’ Diarrhea1
, Sointu Mero, Juha Kirveskari, and Tinja Lääveri
Table 2
Multivariable analysis of acquisition of extended-spectrum β-lactamase-producing Enterobacteriaceae by 288 travelers on the basis of administration of treatments for travelers’ diarrhea*†
| Characteristics | Total, no. (%) | ESBL neg, no. (%) | ESBL pos, no. (%) | Univariate analysis |
Multivariable analysis with imputation |
|||
|---|---|---|---|---|---|---|---|---|
| p value | OR (95% CI) | p value | aOR (95% CI) | |||||
| Total | 288 (100) | 213 (74) | 75 (26) | NA | NA | NA | NA | |
| Study groups | ||||||||
| LO–AMD– | 139 (48) | 110 (79) | 29 (21) | NA | 1.0 | NA | 1.0 | |
| LO+AMD– | 90 (31) | 72 (80) | 18 (20) | 0.874 | 0.9 (0.5–1.8) | 0.583 | 0.8 (0.4–1.7) | |
| LO–AMD+‡ | 45 (16) | 27 (60) | 18 (40) | 0.012 | 2.5 (1.2–5.2) | 0.022 | 2.9 (1.2–7.4) | |
| LO+AMD+ | 14 (5) | 4 (29) | 10 (71) | <0.001 | 9.5 (2.8–32.4) | 0.008 | 7.4 (1.7–32.6)§ | |
| Travel destination | ||||||||
| South Asia | 46 (16) | 21 (46) | 25 (54) | NA | 1.0 | NA | 1.0 | |
| Southeast Asia | 78 (27) | 48 (62) | 30 (38) | 0.087 | 0.5 (0.3–1.1) | 0.186 | 0.6 (0.3–1.3) | |
| East Asia | 4 (1) | 2 (50) | 2 (50) | 0.867 | 0.8 (0.1–6.5) | 0.989 | 1.0 (0.1–12.3) | |
| Sub-Saharan Africa | 130 (45) | 114 (88) | 16 (12) | <0.001 | 0.1 (0.1–0.3) | <0.001 | 0.1 (0.05–0.3) | |
| North Africa and Middle East | 5 (2) | 3 (60) | 2 (40) | 0.546 | 0.6 (0.1–6.7) | 0.536 | 0.5 (0.1–3.8) | |
| South and Central America and the Caribbean | 23 (8) | 23 (100) | 0 | NA | NA | NA | NA | |
| Europe and North America | 2 (1) | 2 (100) | 0 | NA | NA | NA | NA | |
| Other factors | ||||||||
| Sharing meals with locals¶ | 52 (19) | 46 (88) | 6 (12) | 0.01 | 0.3 (0.1–0.8) | 0.017 | 0.3 (0.1–0.8) | |
| Contact with local healthcare | 32 (11) | 18 (56) | 14 (44) | <0.001 | 2.5 (1.2–5.3) | 0.314 | 1.7 (0.6–4.7) | |
*ESBL, extended-spectrum β-lactamase; OR, odds ratio; aOR, adjusted odds ratio; LO, loperamide; AMD, antimicrobial drugs; LO–AMD–,not treated with medication; LO+AMD–, treated with LO alone; LO–AMD+, treated with AMDs alone; LO+AMD+, treated with a combination of both drugs; NA, not applicable; pos, positive; neg, negative.
†Values represent proportions with a given risk factor, aOR and p values in univariate and multivariable analysis. By using backward selection of factors by Akaike Information Criteria, the following factors were eliminated of the variables in the final model: age, duration of travel, sex, alcohol, site of meals, and type of accommodation.
‡Includes 7 travelers having taken antimicrobial drugs for indications other than TD.
§aOR for interaction term of loperamide and AMDs is 3.1 (95% CI 0.6–16.6).
¶Information missing for 18 travelers.
1Preliminary results from this study were presented at the 13th Conference of the International Society of Travel Medicine (CISTM), May 24–28, 2015, Quebec City, Quebec, Canada.