Colonization of Travelers Departing From Rio De Janeiro With Extended-Spectrum Beta-Lactamase (Esbl) ‒ Producing Escherichia Coli

Colonization by ESBL-producing Escherichia coli (ESBL-E) represents a threat to global public health, and international travel contributes to the dissemination of this microorganism worldwide. Antimicrobial use and travel destination are the main risk factors for ESBL-E colonization during travel. Thus, investigating acquisition of this microorganism by travelers remains relevant. Travelers seen at Cives-UFRJ were invited to participate. Two fecal specimens, collected on the day of consultation and after return, were obtained through self-collection with an anal swab. Demographic and travel data were obtained through the consultation record and a questionnaire sent to the participant after return. In the laboratory, the material is placed in STGG medium. Aliquots of this material are plated on MacConkey Agar without selective pressure, MacConkey Agar containing 2 µg of ceftriaxone, and in soybean tryptone broth with zinc sulfate enriched with 1 disk containing 10 µg of ertapenem. After 24 hours of incubation, if there is growth, 3 to 5 colonies are selected, identified as E. coli through MALDI-TOF-MS, and stored in Skim Milk medium. Samples grown under selective pressure are subjected to specific phenotypic tests. Paired samples (outbound/return) were obtained from 74 travelers. The rate of ESBL-E colonization before travel was 15% (11 travelers), and 2 remained colonized after travel. Of the 63 travelers not colonized, 22% (14 travelers) returned colonized with ESBL-E. The destinations visited by those who returned colonized were: Sub-Saharan Africa, specifically Malawi and Tanzania (4); India (3); Peru and Bolivia (3); Southeast Asia (2); Amazonia (1); and Guatemala (1). During the study period, considering all travelers seen at the service, 42% traveled to Sub-Saharan Africa, with 13 to Tanzania and Malawi; 30% to Peru and Bolivia; 15% to Southeast Asia; and 13% to India. When correlating the number of travelers by destination, the percentage of travelers to Malawi and Tanzania who return colonized (31%) is noteworthy, compared with India (15%) and Southeast Asia (9%), which before the pandemic represented the destinations with the highest risk of ESBL-E colonization in travel. It is possible that the risk map changed after the pandemic. Increasing the sample and analyzing other risk factors will help in this assessment.