GeoSentinel Analysis of Travelers’ Diarrhea Antimicrobial Resistance Patterns
Bibliographic 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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".