Colonization with extended-spectrum beta-lactamase-producing Escherichia coli and traveler’s diarrhea attack rates among travelers to India: a systematic review and meta-analysis

• Published in: Tropical Diseases, Travel Medicine and Vaccines
• Main Authors: Basilua Andre Muzembo, Kei Kitahara, Ayumu Ohno, Keinosuke Okamoto, Shin-Ichi Miyoshi
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2022
• Subjects: ESBL-EC; Traveler’s diarrhea; International travelers; India; Meta-analysis; Arctic medicine. Tropical medicine; RC955-962; Arctic; Canada
• Online Access: https://doi.org/10.1186/s40794-022-00179-1; https://doaj.org/article/f445418f5b004bd587e2df6b697bbc1e

Abstract Background India is an attractive destination for travelers. Unfortunately, numerous reports exist on traveler’s diarrhea (TD) and fecal colonization with extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-EC) among international travelers visiting India. Here, we systematically reviewed studies published on the acquisition of ESBL-EC and TD attack rates among international visitors to India. Methods Design: Systematic review and meta-analysis. A systematic search was performed using Google Scholar, PubMed, EMBASE, Web of Science, and gray literature from 2000 to December 2021, for studies containing data for ESBL-EC acquisition or TD experience related to a trip to India. Random effects models were used to compute the prevalence of ESBL-EC acquisition and TD attack. Results The literature search yielded a total of 5023 records. Of these, 31 met our inclusion criteria for systematic review and only 17 could be meta-analyzed (9 for TD, and 8 for ESBL-EC). The overall pooled attack rate of TD was 39% (95% confidence interval, CI: 25–53%). In studies where travelers' memory was used to diagnose TD, the pooled attack rate of TD was slightly higher (42%, 95% CI: 21–64%) compared to those where TD was objectively documented (33%, 95% CI: 17–49%). There were significant risks to be colonized with ESBL-EC among the travelers who experienced TD. The pooled rate of ESBL-EC colonization was 72% (CI: 67–78%). Most ESBL-EC produced CTX-M-15 enzyme. Furthermore, most of the travelers who acquired ESBL-EC were from highly industrialized countries recruited from travel clinics: Canada (n = 80), Germany (n = 69), Netherlands (n = 20), Sweden (n = 18), Japan (n = 10), Finland (n = 8), USA (n = 7), Spain (n = 5), and Denmark (n = 3). Conclusions TD pooled attack rate and ESBL-EC acquisition among international travelers visiting India were high in this study. However, we cannot make generalizations based upon this TD pooled attack rate for the current situation, due to a lack of current data. Our study ...