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Why should it matter where your flatmate travels to?

 Sandra Grieve 29 May 2018 Public Health Forum

Research has shown that living with someone who has travelled to South Asia and the Middle East increases the chance of carrying antibiotic resistant superbugs.

superbug
Published in the Journal of Antimicrobial Chemotherapy, the research involved four areas of England where faecal samples were analysed for superbugs. Travellers to areas where there are high rates of antibiotic resistant bacteria (AMR) are more likely to carry ESBL-producing Enterobacteriaceae (ESBLPE) or superbugs. Being difficult to treat, and with public health implications, researchers aimed to estimate the CTX-M ESBLPE faecal colonisation in the general adult population of England and identify risk factors.

Drug-resistant bacteria

Enterobacteriaceae include E.coli and Klebsiella, part of the gram-negative family of bacteria known to be becoming more resistant to antibiotics. If they have ESBL genes they are resistant to normal antibiotic treatment. Although prevalence varied, people across all study areas carried these superbugs. 

Compared with Europeans, carriage was double in Middle Eastern and South Asian patients. Those with the highest prevalence had travelled to South Asia – India, Pakistan, Bangladesh, or were born in South Asia. This mirrors other European studies which showed travellers to countries outside Europe have a 10-fold higher prevalence of ESBLPE bacteria than the local population. Travel to South Asia was the most important risk factor, others being antibiotic use and diarrhoea.

International travel is an important factor. A significant percentage of travellers become colonised by resistant intestinal bacteria like ESBLPE and can transmit the strains to others and to medical facilities on return home. For travel health advisors, risk assessment before and after travel is a fundamental part of care. When any traveller returns home unwell, it’s important to establish and document where they’ve been.

Overuse of antibiotics

As a global issue, nurses advising travellers from the UK also have a part to play. Holidays and visiting friends and relatives are the top two reasons for UK travellers going abroad. Europe is the top destination, but the Asia-Pacific region is a growing market. Hygiene, food and water advice are paramount but monitoring consumption can be difficult.

Sanitation and hygiene are improving globally but travellers’ diarrhoea remains the most common ailment, affecting up to 60% of those visiting high-risk destinations. Various organisms cause diarrhoea, most episodes resolving spontaneously within a few days. Travellers should be prepared to manage symptoms, especially avoiding dehydration.

Antibiotics can be considered for moderate to severe cases and have been shown to shorten the duration and decrease the severity of illness. When combined with an antimotility drug, duration is shortened further. Worldwide, antibiotic overuse and misuse has led to the formation of bacteria with ESBL genes, although there are other superbugs. Antibiotics are sold over the counter without a prescription or diagnosis in Asia and in other developing countries. This inappropriate use can fuel drug resistance.

In Europe, AMR is seen as one of the biggest threats to public health. A report addressing resistance in humans and animals indicates that AMR resistance is high in both humans and animals.

The UK study concluded that CTX-M ESBLPE are established in the general population in England with higher prevalence in those from certain countries of origin or a history of recent travel.
Sandra Grieve

Sandra Grieve

RCN Public Health Forum committee member

Independent travel health specialist nurse