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Travel, Diarrhea, Antibiotics, Antimicrobial Resistance and Practice Guidelines—a Holistic Approach to a Health Conundrum

  • Tropical, Travel and Emerging Infections (L Chen and A Boggild, Section Editors)
  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Given the recent interest in the interface between travelers’ diarrhea (TD) management guidelines and antimicrobial resistance from both the patient and population perspectives, we have undertaken a review of the evidence with an aim towards practical and pragmatic recommendations.

Recent Findings

Antimicrobial resistance continues to be an existential threat. Therefore, an update is needed on the pathogens that cause TD, the role of antibiotics, the potential changes in microbiome and acquisiton of multi-drug resistant (MDR) bacteria, and lastly the impact of MDR acquisition of the traveler on individual, community, and global health through a holistic framework.

Summary

Important research gaps and opportunities in this area are identified, as well as practical guidance for the travel medicine community offered.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Glaesser D, Kester J, Paulose H, Alizadeh A, Valentin B. Global travel patterns: an overview. J Travel Med. 2017;24(4). https://doi.org/10.1093/jtm/tax007.

  2. Cox JA, Vlieghe E, Mendelson M, Wertheim H, Ndegwa L, Villegas MV, et al. Antibiotic stewardship in low- and middle-income countries: the same but different? Clinical microbiology and infection: the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 2017;23(11):812–8.

    CAS  Google Scholar 

  3. Frost I, Van Boeckel TP, Pires J, Craig J, Laxminarayan R. Global geographic trends in antimicrobial resistance: the role of international travel. J Travel Med. 2019;26(8). https://doi.org/10.1093/jtm/taz036.

  4. •• Tribble DR. Resistant pathogens as causes of traveller’s diarrhea globally and impact(s) on treatment failure and recommendations. J Travel Med. 2017;24(suppl_1):S6–S12 A thorough review of the current literature regarding microbiological resistance and clinical resistence among common pathogens in travelers.

    PubMed  PubMed Central  Google Scholar 

  5. Kosek M, Yori PP, Olortegui MP. Shigellosis update: advancing antibiotic resistance, investment empowered vaccine development, and green bananas. Curr Opin Infect Dis. 2010;23(5):475–80.

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Li YL, Tewari D, Yealy CC, Fardig D, M'Ikanatha NM. Surveillance for travel and domestically acquired multidrug-resistant human Shigella infections-Pennsylvania, 2006-2014. Health Security. 2016;14(3):143–51.

    PubMed  Google Scholar 

  7. Heffernan H, Woodhouse R, Hewison C, Sherwood J. Antimicrobial resistance among Shigella in New Zealand. N Z Med J. 2018;131(1477):56–62.

    PubMed  Google Scholar 

  8. Sadeghabadi AF, Ajami A, Fadaei R, Zandieh M, Heidari E, Sadeghi M, et al. Widespread antibiotic resistance of diarrheagenic Escherichia coli and Shigella species. J Res Med Sci. 2014;19(Suppl 1):S51–5.

    PubMed  PubMed Central  Google Scholar 

  9. Poramathikul K, Bodhidatta L, Chiek S, Oransathid W, Ruekit S, Nobthai P, et al. Multidrug-resistant Shigella infections in patients with diarrhea, Cambodia, 2014-2015. Emerg Infect Dis. 2016;22(9):1640–3.

    PubMed  PubMed Central  Google Scholar 

  10. Guiral E, Gonçalves Quiles M, Muñoz L, Moreno-Morales J, Alejo-Cancho I, Salvador P, et al. Emergence of Resistance to Quinolones and β-Lactam Antibiotics in Enteroaggregative and Enterotoxigenic Escherichia coli Causing Traveler's Diarrhea. Antimicrob Agents Chemother. 2019;63(2). https://doi.org/10.1128/AAC.01745-18.

  11. Williams E, Lew TE, Fuller A, Spelman DW, Jenney AW. A case of multi-drug resistant ESBL-producing Shigella sonnei acute acalculous cholecystitis and gastroenteritis in a returned traveller. J Travel Med. 2018;25(1). https://doi.org/10.1093/jtm/tay029.

  12. Margulieux KR, Srijan A, Ruekit S, Nobthai P, Poramathikul K, Pandey P, et al. Extended-spectrum beta-lactamase prevalence and virulence factor characterization of enterotoxigenic Escherichia coli responsible for acute diarrhea in Nepal from 2001 to 2016. Antimicrob Resist Infect Control. 2018;7:87.

    PubMed  PubMed Central  Google Scholar 

  13. Kantele A, Lääveri T, Mero S, Häkkinen IMK, Kirveskari J, Johnston BD, et al. Despite Predominance of Uropathogenic/Extraintestinal Pathotypes Among Travel-acquired Extended-spectrum β-Lactamase-producing Escherichia coli, the Most Commonly Associated Clinical Manifestation Is Travelers' Diarrhea. Clin Infect Dis. 2020;70(2):210–8. https://doi.org/10.1093/cid/ciz182.

  14. • Baker S, Thomson N, Weill FX, Holt KE. Genomic insights into the emergence and spread of antimicrobial-resistant bacterial pathogens. Science (New York, NY). 2018;360(6390):733–8 An excellent reivew on the confluence of whole-genome sequencing and measurement of anti-microbial resistance with a vision towards the future and change in the way resistance is measured globally and understood.

    CAS  Google Scholar 

  15. • Macgowan AP. Clinical implications of antimicrobial resistance for therapy. J Antimicrob Chemother. 2008;62(Suppl 2):ii105-14 Dated but excellent review article on the difference and importance between microbial resistance and clinical resistance.

    PubMed  Google Scholar 

  16. Sanders JW, Frenck RW, Putnam SD, Riddle MS, Johnston JR, Ulukan S, et al. Azithromycin and loperamide are comparable to levofloxacin and loperamide for the treatment of traveler’s diarrhea in United States military personnel in Turkey. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2007;45(3):294–301.

    CAS  Google Scholar 

  17. •• Riddle MS, Connor P, Fraser J, Porter CK, Swierczewski B, Hutley EJ, et al. Trial evaluating ambulatory therapy of travelers’ diarrhea (TrEAT TD) study: a randomized controlled trial comparing 3 single-dose antibiotic regimens with loperamide. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2017;65(12):2008–17 In parallel with reference #34 provides the most recent high quality evidence from a randomized controlled trial which describes clinical effectiveness of antibiotics as well as rates of post-treatment ESBL-PE following single dose antibiotic therapy.

    CAS  Google Scholar 

  18. Steffen R, Jiang ZD, Gracias Garcia ML, Araujo P, Stiess M, Nacak T, et al. Rifamycin SV-MMX® for treatment of travellers' diarrhea: equally effective as ciprofloxacin and not associated with the acquisition of multi-drug resistant bacteria. J Travel Med. 2018, 25(1). https://doi.org/10.1093/jtm/tay116.

  19. Tribble DR, Sanders JW, Pang LW, Mason C, Pitarangsi C, Baqar S, et al. Traveler’s diarrhea in Thailand: randomized, double-blind trial comparing single-dose and 3-day azithromycin-based regimens with a 3-day levofloxacin regimen. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2007;44(3):338–46.

    CAS  Google Scholar 

  20. Dawadi S. The Cipro conundrum: updated guidelines not completely translated to practice. J Travel Med. 2018;25(1). https://doi.org/10.1093/jtm/tay058.

  21. Ruppe E, Andremont A, Armand-Lefevre L. Digestive tract colonization by multidrug-resistant Enterobacteriaceae in travellers: an update. Travel Med Infect Dis. 2018;21:28–35.

    PubMed  Google Scholar 

  22. Karanika S, Karantanos T, Arvanitis M, Grigoras C, Mylonakis E. Fecal colonization with extended-spectrum Beta-lactamase-producing Enterobacteriaceae and risk factors among healthy individuals: a systematic review and Metaanalysis. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 2016;63(3):310–8.

    Google Scholar 

  23. Armand-Lefevre L, Andremont A, Ruppe E. Travel and acquisition of multidrug-resistant Enterobacteriaceae. Med Mal Infect. 2018;48(7):431–41.

    CAS  PubMed  Google Scholar 

  24. •• Schwartz KL, Morris SK. Travel and the spread of drug-resistant bacteria. Curr Infect Dis Rep. 2018;20(9):29 Most recent review article of several on the role of travel and spread of MDR.

    PubMed  Google Scholar 

  25. •• Arcilla MS, van Hattem JM, Haverkate MR, Bootsma MCJ, van Genderen PJJ, Goorhuis A, et al. Import and spread of extended-spectrum beta-lactamase-producing Enterobacteriaceae by international travellers (COMBAT study): a prospective, multicentre cohort study. Lancet Infect Dis. 2017;17(1):78–85 This study is a large high high quality prospective cohort study which not only documents geographic variation and risk of ESBL-PE acquisition, but also documents clearance of colonization and person-person spread between travelers and non-ill contacts upon return.

    PubMed  Google Scholar 

  26. Bernasconi OJ, Kuenzli E, Pires J, Tinguely R, Carattoli A, Hatz C, et al. Travelers can import colistin-resistant Enterobacteriaceae, including those possessing the plasmid-mediated mcr-1 gene. Antimicrob Agents Chemother. 2016;60(8):5080–4.

    CAS  PubMed  PubMed Central  Google Scholar 

  27. Payne M, Croxen MA, Lee TD, Mayson B, Champagne S, Leung V, et al. Mcr-1-positive colistin-resistant Escherichia coli in traveler returning to Canada from China. Emerg Infect Dis. 2016;22(9):1673–5.

    PubMed  PubMed Central  Google Scholar 

  28. Henig O, Rojas LJ, Bachman MA, Rudin SD, Brennan BM, Soehnlen MK, et al. Identification of four patients with colistin-resistant Escherichia coli containing the mobile colistin resistance mcr-1 gene from a single health system in Michigan. Infect Control Hosp Epidemiol. 2019;40(9):1059–62.

    PubMed  Google Scholar 

  29. Nakayama T, Kumeda Y, Kawahara R, Yamaguchi T, Yamamoto Y. Carriage of colistin-resistant, extended-spectrum beta-lactamase-producing Escherichia coli harboring the mcr-1 resistance gene after short-term international travel to Vietnam. Infection and drug resistance. 2018;11:391–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  30. Bernasconi OJ, Dona V, Pires J, Kuenzli E, Hatz C, Luzzaro F, et al. Deciphering the complete deletion of the mgrB locus in an unusual colistin-resistant Klebsiella pneumoniae isolate colonising the gut of a traveller returning from India. Int J Antimicrob Agents. 2018;51(3):529–31.

    CAS  PubMed  Google Scholar 

  31. von Wintersdorff CJ, Wolffs PF, van Niekerk JM, Beuken E, van Alphen LB, Stobberingh EE, et al. Detection of the plasmid-mediated colistin-resistance gene mcr-1 in faecal metagenomes of Dutch travellers. J Antimicrob Chemother. 2016;71(12):3416–9.

    Google Scholar 

  32. Giraldi G, Montesano M, Napoli C, Frati P, La Russa R, Santurro A, et al. Healthcare-Associated Infections Due to Multidrug-Resistant Organisms: a Surveillance Study on Extra Hospital Stay and Direct Costs. Curr Pharm Biotechnol. 2019;20(8):643–52. https://doi.org/10.2174/1389201020666190408095811.

    Article  CAS  PubMed  Google Scholar 

  33. Woerther PL, Andremont A, Kantele A. Travel-acquired ESBL-producing Enterobacteriaceae: impact of colonization at individual and community level. J Travel Med. 2017;24(suppl_1):S29–s34.

    PubMed  PubMed Central  Google Scholar 

  34. Rohde AM, Zweigner J, Wiese-Posselt M, Schwab F, Behnke M, Kola A, et al. Incidence of infections due to third generation cephalosporin-resistant Enterobacteriaceae - a prospective multicentre cohort study in six German university hospitals. Antimicrob Resist Infect Control. 2018;7:159.

    PubMed  PubMed Central  Google Scholar 

  35. Talan DA, Takhar SS, Krishnadasan A, Abrahamian FM, Mower WR, Moran GJ, et al. Fluoroquinolone-Resistant and Extended-Spectrum β-Lactamase-Producing Escherichia coli Infections in Patients with Pyelonephritis, United States(1). Emerg Infect Dis. 2016;22(9). https://doi.org/10.3201/eid2209.160148.

  36. Osthoff M, McGuinness SL, Wagen AZ, Eisen DP. Urinary tract infections due to extended-spectrum beta-lactamase-producing gram-negative bacteria: identification of risk factors and outcome predictors in an Australian tertiary referral hospital. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases. 2015;34:79–83.

    Google Scholar 

  37. Ranjan Dash N, Albataineh MT, Alhourani N, Khoudeir AM, Ghanim M, Wasim M, et al. Community-acquired urinary tract infections due to extended-spectrum beta -lactamase-producing organisms in United Arab Emirates. Travel Med Infect Dis. 2018;22:46–50.

    PubMed  Google Scholar 

  38. Lofmark S, Sjostrom K, Makitalo B, Edquist P, Tegmark Wisell K, Giske CG. Carbapenemase-producing Enterobacteriaceae in Sweden 2007-2013: experiences from seven years of systematic surveillance and mandatory reporting. Drug resistance updates : reviews and commentaries in antimicrobial and anticancer chemotherapy. 2015;20:29–38.

    Google Scholar 

  39. Patel U, Dasgupta P, Amoroso P, Challacombe B, Pilcher J, Kirby R. Infection after transrectal ultrasonography-guided prostate biopsy: increased relative risks after recent international travel or antibiotic use. BJU Int. 2012;109(12):1781–5.

    PubMed  Google Scholar 

  40. Ny S, Lofmark S, Borjesson S, Englund S, Ringman M, Bergstrom J, et al. Community carriage of ESBL-producing Escherichia coli is associated with strains of low pathogenicity: a Swedish nationwide study. J Antimicrob Chemother. 2017;72(2):582–8.

    CAS  PubMed  Google Scholar 

  41. Maataoui N, Mayet A, Duron S, Delacour H, Mentre F, Laouenan C, et al. High acquisition rate of extended-spectrum beta-lactamase-producing Enterobacteriaceae among French military personnel on mission abroad, without evidence of inter-individual transmission. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 2019;25(5):631.e1-.e9.

    Google Scholar 

  42. • Doi Y, Iovleva A, Bonomo RA. The ecology of extended-spectrum beta-lactamases (ESBLs) in the developed world. J Travel Med. 2017;24(suppl_1):S44–51 Thorough review article on understanding the emergence and transmission of ESBL of which travelers is one source.

    PubMed  PubMed Central  Google Scholar 

  43. Stadler T, Meinel D, Aguilar-Bultet L, Huisman JS, Schindler R, Egli A, et al. Transmission of ESBL-producing Enterobacteriaceae and their mobile genetic elements-identification of sources by whole genome sequencing: study protocol for an observational study in Switzerland. BMJ Open. 2018;8(2):e021823.

    PubMed  PubMed Central  Google Scholar 

  44. Holmes AH, Moore LS, Sundsfjord A, Steinbakk M, Regmi S, Karkey A, et al. Understanding the mechanisms and drivers of antimicrobial resistance. Lancet (London, England). 2016;387(10014):176–87.

    CAS  Google Scholar 

  45. Nurjadi D, Friedrich-Janicke B, Schafer J, Van Genderen PJ, Goorhuis A, Perignon A, et al. Skin and soft tissue infections in intercontinental travellers and the import of multi-resistant Staphylococcus aureus to Europe. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 2015;21(6):567.e1–10.

    Google Scholar 

  46. Landelle C, Legrand P, Lesprit P, Cizeau F, Ducellier D, Gouot C, et al. Protracted outbreak of multidrug-resistant Acinetobacter baumannii after intercontinental transfer of colonized patients. Infect Control Hosp Epidemiol. 2013;34(2):119–24.

    PubMed  Google Scholar 

  47. Baker KS, Dallman TJ, Ashton PM, Day M, Hughes G, Crook PD, et al. Intercontinental dissemination of azithromycin-resistant shigellosis through sexual transmission: a cross-sectional study. Lancet Infect Dis. 2015;15(8):913–21.

    PubMed  Google Scholar 

  48. Christiansen KJ, Tibbett PA, Beresford W, Pearman JW, Lee RC, Coombs GW, et al. Eradication of a large outbreak of a single strain of vanB vancomycin-resistant Enterococcus faecium at a major Australian teaching hospital. Infect Control Hosp Epidemiol. 2004;25(5):384–90.

    PubMed  Google Scholar 

  49. Struelens MJ, Monnet DL, Magiorakos AP, Santos O'Connor F, Giesecke J. European NDM-1 Survey Participants. New Delhi metallo-beta-lactamase 1-producing Enterobacteriaceae: emergence and response in Europe. Euro Surveill. 2010;15(46).

  50. Zhou YP, Wilder-Smith A, Hsu LY. The role of international travel in the spread of methicillin-resistant Staphylococcus aureus. J Travel Med. 2014;21(4):272–81.

    PubMed  Google Scholar 

  51. Bowen A, Hurd J, Hoover C, Khachadourian Y, Traphagen E, Harvey E, et al. Importation and domestic transmission of Shigella sonnei resistant to ciprofloxacin - United States, May 2014-February 2015. MMWR Morb Mortal Wkly Rep. 2015;64(12):318–20.

    PubMed  PubMed Central  Google Scholar 

  52. Baker KS, Dallman TJ, Field N, Childs T, Mitchell H, Day M, et al. Genomic epidemiology of Shigella in the United Kingdom shows transmission of pathogen sublineages and determinants of antimicrobial resistance. Sci Rep. 2018;8(1):7389.

    PubMed  PubMed Central  Google Scholar 

  53. • Riddle MS, Connor BA. The traveling microbiome. Curr Infect Dis Rep. 2016;18(9):29 Review article on travel and the microbiome which considers issues of colonization resistance, post-infectious changes, modulation and future directions.

    PubMed  Google Scholar 

  54. Kim S, Covington A, Pamer EG. The intestinal microbiota: antibiotics, colonization resistance, and enteric pathogens. Immunol Rev. 2017;279(1):90–105.

    CAS  PubMed  PubMed Central  Google Scholar 

  55. Pires J, Kraemer JG, Kuenzli E, Kasraian S, Tinguely R, Hatz C, et al. Gut microbiota dynamics in travelers returning from India colonized with extended-spectrum cephalosporin-resistant Enterobacteriaceae: a longitudinal study. Travel Med Infect Dis. 2019;27:72–80.

    PubMed  Google Scholar 

  56. Bengtsson-Palme J, Angelin M, Huss M, Kjellqvist S, Kristiansson E, Palmgren H, et al. The human gut microbiome as a transporter of antibiotic resistance genes between continents. Antimicrob Agents Chemother. 2015;59(10):6551–60.

    CAS  PubMed  PubMed Central  Google Scholar 

  57. Langelier C, Graves M, Kalantar K, Caldera S, Durrant R, Fisher M, et al. Microbiome and antimicrobial resistance gene dynamics in international travelers. Emerg Infect Dis. 2019;25(7):1380–3.

    CAS  PubMed  PubMed Central  Google Scholar 

  58. Gargiullo L, Del Chierico F, D'Argenio P, Putignani L. Gut microbiota modulation for multidrug-resistant organism decolonization: present and future perspectives. Front Microbiol. 2019;10:1704.

    PubMed  PubMed Central  Google Scholar 

  59. • Dall LB, Lausch KR, Gedebjerg A, Fuursted K, Storgaard M, Larsen CS. Do probiotics prevent colonization with multi-resistant Enterobacteriaceae during travel? A randomized controlled trial. Travel Med Infect Dis. 2019;27:81–6 Small and moderate quality randomized controlled trial which demonstrated no effect of a probiotic in reduction of colonization by MDR bacteria.

    PubMed  Google Scholar 

  60. Vogt SL, Finlay BB. Gut microbiota-mediated protection against diarrheal infections. J Travel Med. 2017;24(suppl_1):S39–43.

    PubMed  PubMed Central  Google Scholar 

  61. Lalani T, Tisdale MD, Liu J, Mitra I, Philip C, Odundo E, et al. Comparison of stool collection and storage on Whatman FTA elute cards versus frozen stool for enteropathogen detection using the TaqMan Array card PCR assay. PLoS One. 2018;13(8):e0202178.

    PubMed  PubMed Central  Google Scholar 

  62. Tisdale MD, Tribble DR, Telu K, Fraser JA, Connor P, Philip C, et al. A comparison of stool enteropathogen detection by semiquantitative PCR in adults with acute travelers’ diarrhea before and 3 weeks after successful antibiotic treatment. Open Forum Infect Dis. 2019;6(5):ofz187.

    PubMed  PubMed Central  Google Scholar 

  63. Pholwat S, Liu J, Taniuchi M, Chinli R, Pongpan T, Thaipisutikul I, et al. Genotypic antimicrobial resistance assays for use on E. coli isolates and stool specimens. PloS one. 2019;14(5):e0216747.

    PubMed  PubMed Central  Google Scholar 

  64. •• Riddle MS, Connor BA, Beeching NJ, DuPont HL, Hamer DH, Kozarsky P, et al. Guidelines for the prevention and treatment of travelers' diarrhea: a graded expert panel report. J Travel Med. 2017;24(suppl_1):S57–74 Current guidelines developed by the International Society of Travel Medicine which provide best evidence to support treatment of acute TD and prevention as well as recommendations on pre-travel counseling on the issue of MDR acquisition.

    PubMed  Google Scholar 

  65. Hitch G, Fleming N. Antibiotic resistance in travellers’ diarrhoeal disease, an external perspective. J Travel Med. 2018;25(suppl_1):S27–37.

    PubMed  Google Scholar 

  66. Riddle MS, Chen WH, Kirkwood CD, MacLennan CA. Update on vaccines for enteric pathogens. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 2018;24(10):1039–45.

    CAS  Google Scholar 

  67. Kantele A, Mero S, Kirveskari J, Laaveri T. Increased risk for ESBL-producing bacteria from co-administration of Loperamide and antimicrobial drugs for travelers’ diarrhea. Emerg Infect Dis. 2016;22(1):117–20.

    CAS  PubMed  PubMed Central  Google Scholar 

  68. Ericsson CD, Riddle MS. Should travel medicine practitioners prescribe antibiotics for self-treatment of travelers' diarrhea? J Travel Med. 2018;25(1). https://doi.org/10.1093/jtm/tay081.

  69. Corbellino M, Kieffer N, Kutateladze M, Balarjishvili N, Leshkasheli L, Askilashvili L, et al. Eradication of a multi-drug resistant, carbapenemase-producing Klebsiella pneumoniae isolate following oral and intra-rectal therapy with a custom-made, lytic bacteriophage preparation. Clin Infect Dis. 2019. https://doi.org/10.1093/cid/ciz782.

  70. Palmer JD, Piattelli E, McCormick BA, Silby MW, Brigham CJ, Bucci V. Engineered probiotic for the inhibition of salmonella via tetrathionate-induced production of Microcin H47. ACS Infect Dis. 2018;4(1):39–45.

    CAS  PubMed  Google Scholar 

  71. Riddle MS, Connor BA. Faecal microbiota transplantation: what is the role in travellers' diarrhoea? J Travel Med. 2019;26(1). https://doi.org/10.1093/jtm/tay129.

  72. Lee DS, Ryu JA, Chung CR, Yang J, Jeon K, Suh GY, et al. Risk factors for acquisition of multidrug-resistant bacteria in patients with anastomotic leakage after colorectal cancer surgery. Int J Color Dis. 2015;30(4):497–504.

    Google Scholar 

  73. Lew KY, Ng TM, Tan M, Tan SH, Lew EL, Ling LM, et al. Safety and clinical outcomes of carbapenem de-escalation as part of an antimicrobial stewardship programme in an ESBL-endemic setting. J Antimicrob Chemother. 2015;70(4):1219–25.

    CAS  PubMed  Google Scholar 

  74. Ma X, Wu Y, Li L, Xu Q, Hu B, Ni Y, et al. First multicenter study on multidrug resistant bacteria carriage in Chinese ICUs. BMC Infect Dis. 2015;15:358.

    PubMed  PubMed Central  Google Scholar 

  75. Pano Pardo JR, Serrano Villar S, Ramos Ramos JC, Pintado V. Infections caused by carbapenemase-producing Enterobacteriaceae: risk factors, clinical features and prognosis. Enferm Infecc Microbiol Clin. 2014;32(Suppl 4):41–8.

    PubMed  Google Scholar 

  76. Tu B, Bi J, Wu D, Zhao P, Shi L, Xie Y, et al. Bloodstream infection due to Escherichia coli in liver cirrhosis patients: clinical features and outcomes. Oncotarget. 2018;9(87):35780–9.

    PubMed  Google Scholar 

  77. Wares JR, Lawson B, Shemin D, D'Agata EM. Evaluating infection prevention strategies in out-patient dialysis units using agent-based modeling. PLoS One. 2016;11(5):e0153820.

    PubMed  PubMed Central  Google Scholar 

  78. Ruppé E, Chappuis F. What and how should we tell travellers about antimicrobial resistance? J Travel Med. 2017;24(2). https://doi.org/10.1093/jtm/taw089.

  79. Wiklund S, Fagerberg I, Ortqvist A, Vading M, Giske CG, Broliden K, et al. Knowledge and understanding of antibiotic resistance and the risk of becoming a carrier when travelling abroad: a qualitative study of Swedish travellers. Scandinavian J Public Health. 2015;43(3):302–8.

    CAS  Google Scholar 

  80. Migault C, Kanagaratnam L, Nguyen Y, Lebrun D, Giltat A, Hentzien M, et al. Poor knowledge among French travellers of the risk of acquiring multidrug-resistant bacteria during travel. J Travel Med. 2016;24(1).

  81. Kantele A. A call to restrict prescribing antibiotics for travellers’ diarrhea--travel medicine practitioners can play an active role in preventing the spread of antimicrobial resistance. Travel Med Infect Dis. 2015;13(3):213–4.

    PubMed  Google Scholar 

  82. McGrath CM, Leder K. Travellers' diarrhoea-a survey of practice. J Travel Med. 2017;24(2). https://doi.org/10.1093/jtm/taw085.

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    Mark S. Riddle

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Riddle, M.S. Travel, Diarrhea, Antibiotics, Antimicrobial Resistance and Practice Guidelines—a Holistic Approach to a Health Conundrum. Curr Infect Dis Rep 22, 8 (2020). https://doi.org/10.1007/s11908-020-0717-2

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