in these 12 isolates with their presence being independent of traveling (Additional file 4: Fig. 2). We observed that isolates of patients 6 and 7 did not possess any AME, and the isolate of patient 8 that had only one AME (ANT(3”)-IIa). The isolates of these three patients were of the same sequence type (ST)69. Other antimicrobial genes identified were ampC, tet(A), tet(B), and tetR, which were present in isolates from travelling and non-travelling patients. The isolates from one travelling patient (patient 4) and one non-travelling patient (patient 11) lacked these additional antimicrobial resistance genes (Additional file 4: Fig. 2). Two ESBL-producing K. pneumoniae isolates were found in non-travelling patients. One isolate belonged to ST465, and contained blaTEM-1 blaCTX-M-15 and blaSHV-1, and the other isolate belonged to ST1565 and contained blaOXA-1, blaDHA-1 and blaSHV-64. For the ESBLproducing P. vulgaris no known ESBL genes were detected using the CARD database v3.0.5. However, using the disk diffusion ESBL kit (Rosco Diagnostica, Taastrup, Denmark), ESBL production was confirmed phenotypically. Table 3. Travel behavior of traveling patients carrying HRMO at admission compared to not carrying HRMO at admission Characteristic Total n=117 HRMO-positive at admission, n=7 HRMO-negative at admission, n=110 Duration T <1 month 105 (89.7) 7 (100)* 98 (89.1)* Duration T 1-3 months 9 (7.7) 0 (0) 9 (8.2) Duration T 3-6 months 2 (1.7) 0 (0) 2 (1.8) Duration T 6-12 months 1 (0.9) 0 (0) 1 (0.9) Travelling outside of Europe <1y 30 (25.6) 4 (57.1) 26 (23.6)** Travelling within Europe <1y 87 (74.4) 3 (42.9) 84 (76.4) Ice cream and pastry consumption (%) 64c (56.1) 3a (50) 61b (56.5) Meals at street food stalls (%) 10a (8.6) 0 (0) 10a (9.2) Experienced vomiting during travel (%) 3a (2.6) 0 (0) 3a (2.8) Experienced diarrhea during travel (%) 6a (5.2) 1 (14.3) 5a (4.6) Admitted to hospital during travel (%) 8 (6.8) 0 (0) 8 (7.3) Antibiotic use during travel (%) 6b (5.2) 1 (14.3) 5b (4.6) Antacid use during travel (%) 22c (19.3) 1a (16.7) 21b (19.4) Used malaria prophylaxis during travel (%) 1a (0.9) 0 (0) 1a (0.9) Relevant differences in percentages indicated in bold text Abbreviations: Duration T; duration of travel, HRMO, highly resistant microorganism, y, year. a One patient answered this question with ‘unknown’ 60 Chapter 2.2
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