Epidemiological and Clinical Characteristics of International Travelers with Enteric Fever and Antibiotic Resistance Profiles of Their Isolates: a GeoSentinel Analysis

Stefan H.F. Hagmann, Kristina M. Angelo, Ralph Huits, Katherine Plewes, Gilles Eperon, Martin P. Grobusch, Anne McCarthy, Michael Libman, Eric Caumes, Daniel T. Leung, Hilmir Asgeirsson, Mogens Jensenius, Eli Schwartz, Adrian Sánchez-Montalvá, Paul Kelly, Prativa Pandey, Karin Leder, Daniel L. Bourque, Yukihiro Yoshimura, Frank P. MockenhauptPerry J.J. van Genderen, Silvia Odolini, Patricia Schlagenhauf, Bradley A. Connor, Davidson H. Hamer

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Enteric fever, caused by Salmonella enterica serovar Typhi (S Typhi) and S. enterica serovar Paratyphi (S Paratyphi), is a common travel-related illness. Limited data are available on the antimicrobial resistance (AMR) patterns of these serovars among travelers. Records of travelers with a culture-confirmed diagnosis seen during or after travel from January 2007 to December 2018 were obtained from GeoSentinel. Traveler demographics and antimicrobial susceptibility data were analyzed. Isolates were classified as nonsusceptible if intermediate or resistant or as susceptible in accordance with the participating site's national guidelines. A total of 889 travelers (S Typhi infections, n = 474; S Paratyphi infections, n = 414; coinfection, n = 1) were included; 114 (13%) were children of <18 years old. Most individuals (41%) traveled to visit friends and relatives (VFRs) and acquired the infection in South Asia (71%). Child travelers with S Typhi infection were most frequently VFRs (77%). The median trip duration was 31 days (interquartile range, 18 to 61 days), and 448 of 691 travelers (65%) had no pretravel consultation. Of 143 S Typhi and 75 S Paratyphi isolates for which there were susceptibility data, nonsusceptibility to antibiotics varied (fluoroquinolones, 65% and 56%, respectively; co-trimoxazole, 13% and 0%; macrolides, 8% and 16%). Two S Typhi isolates (1.5%) from India were nonsusceptible to third-generation cephalosporins. S Typhi fluoroquinolone nonsusceptibility was highest when infection was acquired in South Asia (70 of 90 isolates; 78%) and sub-Saharan Africa (6 of 10 isolates; 60%). Enteric fever is an important travel-associated illness complicated by AMR. Our data contribute to a better understanding of region-specific AMR, helping to inform empirical treatment options. Prevention measures need to focus on high-risk travelers including VFRs and children.

Original languageEnglish
Article numbere01084-20
Number of pages10
JournalAntimicrobial Agents and Chemotherapy
Issue number11
Publication statusPublished - Nov 2020


  • antimicrobial resistance
  • enteric fever
  • paratyphoid
  • travel
  • typhoid

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