susceptibility was tested using VITEK-2 (bioMérieux, Marcy l’Etoile, France). When A. baumannii isolates and ESBL suspected isolates were also suspected for carbapenemase production, a CIM test was performed. For isolates identified as E. faecium, a vanA/vanB PCR was performed (using established procedures, unpublished). Genome sequencing and analysis To assess sequence types and presence of antimicrobial resistance genes, WGS was performed for all detected HRMO. DNA was extracted using MagNA pure 96 (Roche Applied Science, Mannheim, Germany). DNA sequencing was performed by Novogene (Beijing, China) using Illumina chemistry creating 150 bp paired end reads. Assemblies were created using Unicycler v0.4 with default parameters (7). Antimicrobial resistance genes were detected with RGI v5.1.0 using CARD database v3.0.5. Assembled genomes from Escherichia coli and Klebsiella pneumoniae were processed using the wgMLST scheme available in SeqSphere v5.1.0 (Ridom, Munster, Germany) (https://www.ridom.de/seqsphere/). Clustering trees and heatmaps were generated in R. Statistical analysis Data was presented as percentages, medians or means. In case of multiple visited regions, the region where the patient stayed the longest was used for analysis. The variable age was determined using date of birth and the date of filling out the questionnaire. Differences between groups were identified using the Chi-square statistic, T-test or if not normally distributed the independent-samples Mann-Whitney U test, using SPSS version 21 (IBM Corp., Armonk, New York, USA). P-values <0.05 were considered statistically significant. Ethics statement Written approval to conduct this study was received from the Medical Ethical Research Committee of the Erasmus MC (MEC-2017-1011). This study was not subjected to the Medical Research Involving Human Subjects Act. All patients participating in this study provided written informed consent. This study is registered in the Dutch National Trial Register (trial NL8406). Results Patient characteristics From May 18, 2018 until August 1, 2019, 776 patients were approached for participation, of which 608 (78.4%) received a travel questionnaire (Fig. 1). Out of 608 handed out questionnaires, 262 were returned (43.1%). In 27 out of 262 returned questionnaires (10.3%), one or more answers were missing. Fifteen questionnaires from 15 patients (5.7%) were excluded because of a missing admission culture. Therefore, 247 patients with accompanying questionnaires (247 out of 608, 40.6%) were included in the current study (Fig. 1). 2 55 Pre-COVID-19 international travel and addmission to hospital back home
RkJQdWJsaXNoZXIy MTk4NDMw