Clostridium difficile infection in returning travellers

A. Michal Stevens, Douglas H. Esposito, Rhett J. Stoney, Davidson H. Hamer, Jose Flores-Figueroa, Emmanuel Bottieau, Bradley A. Connor, Effrossyni Gkrania-Klotsas, Abraham Goorhuis, Noreen A. Hynes, Michael Libman, Rogelio Lopez-Velez, Anne E. McCarthy, Frank von Sonnenburg, Eli Schwartz, Perry J.J. van Genderen, L. Scott Benson, Daniel T. Leung, for the GeoSentinel Surveillance Network

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19 Citations (Scopus)


Background There is increasing recognition of the contribution of community-acquired cases to the global burden of Clostridium difficile infection (CDI). The epidemiology of CDI among international travellers is poorly understood, and factors associated with international travel, such as antibiotic use and changes in gut microbiota, could potentially put travellers at higher risk. Methods We summarized demographic, travel-associated and geographic characteristics of travellers with CDI in the GeoSentinel database from 1997 to 2015. We also surveyed GeoSentinel sites to compare various testing indications, approaches, and diagnostic modalities. Results We identified 260 GeoSentinel records, including 187 that satisfied criteria for analysis (confirmed cases in non-immigrant travellers aged > 2 years, seen < 12 weeks post-travel). CDI was reported in all age groups and in travellers to all world regions; the largest proportions of cases having destinations in Asia (31%), Central/South America or the Caribbean (30%) and Africa (24%). Our site survey revealed substantial heterogeneity of testing approaches between sites; the most commonly used test was the C. difficile toxin gene PCR. Conclusions CDI is encountered in returning international travellers, although there is considerable variability in testing practices. These data underscore the importance of awareness of C. difficile as a potential cause of travelassociated diarrhoea.

Original languageEnglish
Article numbertaw099
Pages (from-to)1-6
Number of pages6
JournalJournal of Travel Medicine
Issue number3
Publication statusPublished - 1 May 2017
Externally publishedYes


  • Clostridium difficile
  • Diarrhoea
  • Travellers

Cite this

Michal Stevens, A., Esposito, D. H., Stoney, R. J., Hamer, D. H., Flores-Figueroa, J., Bottieau, E., Connor, B. A., Gkrania-Klotsas, E., Goorhuis, A., Hynes, N. A., Libman, M., Lopez-Velez, R., McCarthy, A. E., von Sonnenburg, F., Schwartz, E., van Genderen, P. J. J., Scott Benson, L., Leung, D. T., & for the GeoSentinel Surveillance Network (2017). Clostridium difficile infection in returning travellers. Journal of Travel Medicine, 24(3), 1-6. [taw099].