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This study investigated Swiss expatriates residing abroad (\u2265\u20093 months) to assess their colonization status upon returning to Switzerland. Selective culture-based methods were implemented to detect third-generation cephalosporins- (3GC-R), carbapenems- (CR), and colistin-resistant (COL-R) strains. Whole-genome sequencing was used to characterize antimicrobial resistance genes, sequence type (ST), and phylogroup of MDR-Ent. Epidemiological data were analyzed using uni- and multivariable models to identify risk factors, providing crude and adjusted odds ratios (ORs). Among 196 participants living across Africa, Asia, the Americas, and Europe, the overall MDR-Ent colonization prevalence was 42.9%. Continent of residence emerged as a significant risk factor (<jats:italic>p<\/jats:italic>\u2009=\u20090.04) for colonization: Africa (adjusted OR\u2009=\u20093.4, 95% CI 1.0\u201311.0) and Asia (adjusted OR\u2009=\u20094.7, 95% CI 1.5\u201315.0). Extended-spectrum \u03b2-lactamase-producing <jats:italic>Escherichia coli<\/jats:italic> (<jats:italic>Ec<\/jats:italic>) was the most frequent isolated species (<jats:italic>n<\/jats:italic>\u2009=\u2009107 out of 119 Ent). Most 3GC-R-<jats:italic>Ec<\/jats:italic> possessed <jats:italic>bla<\/jats:italic>\n            <jats:sub>CTX\u2212M<\/jats:sub> genes (<jats:italic>n<\/jats:italic>\u2009=\u200989; 83.2%) and pandemic lineages were frequent (e.g., ST69 and ST131, <jats:italic>n<\/jats:italic>\u2009=\u200918). No CR-Ent were detected, but some COL-R strains (<jats:italic>n<\/jats:italic>\u2009=\u200918; of which 15 <jats:italic>Ec<\/jats:italic>) harbored the <jats:italic>mcr-1.1<\/jats:italic> gene. Expatriates represent an understudied population at risk of MDR-Ent colonization. This population may contribute to the importation and potential dissemination of dangerous bacteria into low-prevalence countries, as shown in this Swiss study, warranting further investigation and surveillance.<\/jats:p>","DOI":"10.1007\/s10096-025-05069-w","type":"journal-article","created":{"date-parts":[[2025,2,14]],"date-time":"2025-02-14T21:23:46Z","timestamp":1739568226000},"page":"1007-1014","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Epidemiology and risk factors of expatriates returning to Switzerland colonized at the intestinal level with multidrug-resistant Enterobacterales"],"prefix":"10.1007","volume":"44","author":[{"given":"Edgar I.","family":"Campos-Madueno","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Aldeia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie C.","family":"Roumet","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Limacher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Parham","family":"Sendi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Endimiani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,2,14]]},"reference":[{"key":"5069_CR1","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","volume":"399","author":"C Antimicrobial Resistance","year":"2022","unstructured":"Antimicrobial Resistance C (2022) Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. 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The study was conducted in accordance with the research guidelines of the Declaration of Helsinki and the research requirements of the University of Bern.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Nothing to declare.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosure statement"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}