Long-distance travel: Every fifth person carries multi-resistant bacteria in their intestines

Jens Richter is editor-in-chief at Since July 2020, the doctor and journalist has also been responsible as COO for business operations and the strategic development of

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MunichAn antibiotic against diarrhea and other infections can be found in many first-aid kits. To be on the safe side, especially in Far Asia, the Arab countries or Africa, the risk of infection is high and the nearest doctor is often far. But the drugs fail in many cases - and make the pathogens more dangerous in the long term.

The so-called traveler's diarrhea, in particular, inspires many long-distance travelers with respect in advance. Rightly so, because lower hygiene standards, a different food preparation or simply your own immune system, which does not immediately find an answer to some pathogens in distant countries, mean an increased risk of infections.

International health organizations estimate that at least one in five long-haul travelers suffers from diarrhea - mostly within the first week of their vacation. In most cases, however, antibiotic treatment is unnecessary, says Dr. Anu Kantele from the Center for Infectious Diseases at the Central University Hospital in Helsinki. "For the vast majority of travelers, the infection is mild and clears up on its own within a few days."

Antibiotics double the risk of infection

In addition, in many cases the antibiotics were no longer effective. Because many bacteria have already developed protective mechanisms against the drugs - they are resistant. The particularly widespread bacteria of the Enterobacter genus, for example, have developed the ability to defend themselves against common antibiotics with the enzyme beta-lactamase. Infections with these multi-resistant bacteria, known for short as ESBL, are particularly serious and difficult to treat.

Worse still: Many returnees from risk countries already carry ESBL in their intestines, infection specialist Kantele has now found out. This increases the risk that the resistant germs will also spread in the home country. The study recently published in the journal Clinical Infectious Diseases examined stool samples from 430 Finns before and after a multi-day trip to destinations outside Scandinavia. In addition, the test subjects answered questions about travel destination, physical symptoms and the use of medication on both examination dates.

Alarming: More than one in five travelers (21 percent) returned to Finland with ESBL. Kantele and her employees identified certain regions traveled and the use of antibiotics against traveler's diarrhea as the most important infection risks. For example, ESBL colonies were found in the stool samples of 37 percent of the test persons after they had treated their traveler's diarrhea with antibiotics. Without antibiotics, however, it was only 11 percent. In relation to the travel destination Southeast Asia, the numbers were even higher. The infection rate there rose to 80 percent through the use of antibiotics, while only 46 percent of the test subjects who had not been treated with antibiotics contracted the multi-resistant germ.

Germ carrier for half a year

None of the 90 ESBL germ carriers complained about acute symptoms at the time of their return. The Finnish infection specialists point out, however, that the resistant strains can stay in the intestine for up to six months. Their carriers could therefore pass the germ on to other people for a long time, as well as become ill themselves at a later point in time. Enterobacter can be passed on through direct contact, but also through contaminated objects (smear infection) or contaminated food. In addition to diarrhea, certain Enterobacter species cause urinary and respiratory infections or meningitis. If they get into the bloodstream, they can cause life-threatening blood poisoning.

Hygiene instead of antibiotics

“Around 300 million people worldwide travel to these high-risk regions every year. If every fifth person brings multi-resistant germs with them when they return, it is a serious threat, ”says Kantele. The scientists advise that you should familiarize yourself with the necessary hygiene measures and avoid self-medication with antibiotics, especially before traveling to Far Asia, the Middle East or the North African countries.

The most important basic rules for protection against travel infections:

Only use boiled water from the tap, also for brushing your teeth.
Only take drinks from sealed bottles and do not use ice cubes.
Only eat freshly peeled fruit and avoid salads and other raw vegetables.
Raw meat, seafood or vegetables should only be enjoyed thoroughly heated (boiled, steamed or fried).
Beware of cold buffets, for example in hotels. The food is often left on the table for hours or has already been touched by other guests.

Should you nevertheless catch an infection on your trip, consult a doctor if possible and refrain from self-medication with antibiotics "on suspicion". If you still have to take such medication, do so strictly according to the instructions in the package insert. In particular, the prescribed daily dose and duration of intake should be adhered to.

Source: A. Kantele et al .: "Antimicrobials Increase Travelers" Risk of Colonization by Extended-Spectrum Betalactamase-Producing Enterobacteriaceae ", Clinical Infectious Diseases, Jan. 21, 2015, doi: 10.1093 / cid / ciu957

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