Abstract
BackgroundInternational travelers are at high risk of acquiring travelers’ diarrhea. Pre-travel consultation has been associated with lower rates of malaria, hepatitis, and human immunodeficiency virus (HIV) infections. The objective was to study the impact of pre-travel consultation on clinical management and outcomes of travelers’ diarrhea.MethodsThis retrospective cohort study analyzed 1160 patients diagnosed with travelers’ diarrhea at Mayo Clinic Rochester, MN from 1994 to 2017. Variables included high-risk activities, post-travel care utilization, antimicrobial prescriptions, hospitalizations, and complications. Travelers were divided into those who sought (n = 256) and did not seek (n = 904) pre-travel consultation. The two groups were compared using the Wilcoxon test for continuous variables and chi-square test for categorical variables. Multivariate logistic regression was used to adjust for differences in traveler characteristics.ResultsMore pre-travel consultation recipients were young Caucasians who had more post-travel infectious disease (ID) consultation [OR 3.1 (95% CI 1.9–5.3)], more stool sampling [OR 1.6 (95% CI 1.1–2.4)], and more antimicrobial prescriptions [OR 1.6 (95% CI 1.1–2.5)] for travelers’ diarrhea compared to the non-pre-travel consultation group. The pre-travel consultation group had shorter hospital stays (mean 1.8 days for pre-travel versus 3.3 days for non-pre-travel consultation group, p = 0.006) and reduced gastroenterology consultation rates [OR 0.4 (95% CI 0.2–0.9)]. 23 patients with positive stool cultures had Campylobacter susceptibilities performed; 65% (15/23) demonstrated intermediate susceptibility or resistance to ciprofloxacin.ConclusionPre-travel consultation was associated with higher rates of stool testing and antimicrobial prescriptions. The high rate of quinolone-resistant Campylobacter in our small sample suggests the need for judicious antimicrobial utilization. The pre-travel consultation group did have a shorter duration of hospitalization and reduced need for gastroenterology consultation for prolonged or severe symptoms, which are positive outcomes that reflect reduced morbidity of travelers’ diarrhea.
Highlights
International travelers are at high risk of acquiring travelers’ diarrhea
Travel itineraries The major destination for travelers returning with diarrhea was Central America, Mexico, of whom
The pre-travel consultation group had a shorter duration of hospitalization
Summary
International travelers are at high risk of acquiring travelers’ diarrhea. The objective was to study the impact of pre-travel consultation on clinical management and outcomes of travelers’ diarrhea. International travelers are at high risk of acquiring travel-related infections such as travelers’ diarrhea [3]. Pre-travel consultation may reduce the rate of malaria infection, it may not reduce the rate of travelers’ diarrhea. The objective of this study was to examine the impact of pre-travel consultation on clinical management and outcomes of travelers’ diarrhea. The hypothesis was that patients with travelers’ diarrhea who received pre-travel consultation would have improved clinical outcomes compared to those without pre-travel consultation. Specific aims included comparing high-risk travel behaviors as they relate to food and water consumption, itineraries, and hospitalization and complication rates for travelers with and without pre-travel consultation
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