ArticleJAMA network open2025
GeoSentinel Analysis of Travelers' Diarrhea Antimicrobial Resistance Patterns.
Article in JAMA network open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- Errors in Byline, Abstract, and Methods.JAMA network open · 2026Article
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Authors and funding
21 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Importance: Diarrheal disease causes substantial morbidity in international travelers. Knowledge of antibiotic resistance of causative pathogens helps guide empiric treatment decisions. Objective: To characterize antimicrobial nonsusceptibility patterns of culture-confirmed Campylobacter species, nontyphoidal Salmonella (NTS) species, Shigella species, and diarrheagenic Escherichia coli isolated from international travelers with diarrhea identified by the GeoSentinel Surveillance Network. Design, Setting, and Participants: This is a retrospective cross-sectional analysis of antimicrobial susceptibility data for 4 major pathogens causing travel-associated diarrhea, reported from April 14, 2015, to December 19, 2022, at 58 of 71 international GeoSentinel sites. Participants included a convenience sample of international travelers with acute diarrhea seen during or after travel presenting at the GeoSentinel sites. Main Outcomes and Measures: The main outcomes were demographics, clinical characteristics, and antimicrobial susceptibility profiles of patients with culture-confirmed Campylobacter species, NTS species, Shigella species, and diarrheagenic E coli species. Routinely collected antimicrobial susceptibility data with intermediate susceptibility and resistant were defined as nonsusceptible. The antimicrobial susceptibility test results were described as numbers and percentages, and binomial 95% CIs were calculated for the proportions. Results: Of 859 total cases, the median (IQR) age was 30 (23-43) years, and 440 travelers (51%) were male. Among Campylobacter isolates, nonsusceptibility to fluoroquinolones was found in 206 of 274 isolates (75%; 95% CI, 70%-80%), and nonsusceptibility to macrolides was found in 30 of 255 isolates (12%; 95% CI, 8%-16%) and was highest in travelers to South Central Asia (45 of 51 isolates; 88%; 95% CI, 76%-96%). Among NTS species, 96 of 302 isolates (32%; 95% CI, 27%-37%) were nonsusceptible to fluoroquinolones, 18 of 111 isolates (16%; 95% CI, 10%-24%) were nonsusceptible to macrolides, and 15 of 273 isolates (5%; 95% CI, 3%-9%) were nonsusceptible to third-generation cephalosporins. For Shigella species, 44 of 196 isolates (22%; 95% CI, 17%-29%) were nonsusceptible to fluoroquinolones, and 36 of 103 isolates (35%; 95% CI, 26%-45%) were nonsusceptible to macrolides. For E coli, fluoroquinolone nonsusceptibility was 18% (12 of 66 isolates; 95% CI, 10%-30%). Of note, 19 of 24 Shigella isolates (79%; 95% CI, 58%-93%) were nonsusceptible to fluoroquinolones among travelers to South Central Asia, and 29 of 37 Shigella isolates (78%; 95% CI, 62%-90%) were nonsusceptible to macrolides among travelers to South America. Conclusions and Relevance: In this cross-sectional study of travelers' diarrhea antimicrobial resistance patterns, there was marked variability of nonsusceptibility to 2 major classes of antibiotics commonly used for treating travelers' diarrhea among global regions. Antimicrobial susceptibility from culture should be obtained when possible, including after pathogen detection by culture-independent methods. These findings may help inform strategies for self-treatment and clinician management of travelers' diarrhea.
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