Travel is easy, cheap (well, depending on your desire for luxury) and you get to meet some interesting characters on your way. Unfortunately, as this recent study from France just published in Clinical Infectious Diseases shows, some of the species that you interact with may have escaped your attention (unless you’re carrying agar plates or some fancy molecular kit with you).
The authors studied travellers attending five vaccination clinics in France prior to and post-travel looking for acquisition of MDR Enterobacteriaeceae. Over 50% came home with more than they bargained for, smuggling MDROs into France in their colons.
For those wishing to add some diversity to their microbiota, Asia seems to be the most fruitful destination, with 72% of travellers acquiring MDROs, with Sub-Saharan Africa in silver (48%) and Latin America in bronze (a mere 31%). Unsurprisingly the most significant risk factor was taking a β-lactam during the trip, whilst diarrhoea on the travels was also significant. The type of travel was also relevant, with backpacking and organised tours a higher risk and the all-inclusive trips a lower risk. I suspect the all-inclusives were regularly dosing their GI tract with a popular antimicrobial agent (Ethanol) due to the availability/no cost benefits of that type of holiday.
Fortunately the acquisitions appeared to be transient in nature, with less than 5% of carriers remaining positive at 3 months. MDR Gram negatives present a risk in healthcare settings and hospitalisation overseas is used as part of risk assessments during the admission process. Should we consider travel within the past 3 months to an areas of increased incidence a risk factor and not just hospitalisation? Possibly the approach of the local hairdresser should be followed when risk assessments are now undertaken; “Been anywhere nice on your holidays?”