Abstract
There is increasing evidence that human movement facilitates the global spread of resistant bacteria and antimicrobial resistance (AMR) genes. We systematically reviewed the literature on the impact of travel on the dissemination of AMR. We searched the databases Medline, EMBASE and SCOPUS from database inception until the end of June 2019. Of the 3052 titles identified, 2253 articles passed the initial screening, of which 238 met the inclusion criteria. The studies covered 30,060 drug-resistant isolates from 26 identified bacterial species. Most were enteric, accounting for 65% of the identified species and 92% of all documented isolates. High-income countries were more likely to be recipient nations for AMR originating from middle- and low-income countries. The most common origin of travellers with resistant bacteria was Asia, covering 36% of the total isolates. Beta-lactams and quinolones were the most documented drug-resistant organisms, accounting for 35% and 31% of the overall drug resistance, respectively. Medical tourism was twice as likely to be associated with multidrug-resistant organisms than general travel. International travel is a vehicle for the transmission of antimicrobial resistance globally. Health systems should identify recent travellers to ensure that adequate precautions are taken.
Highlights
Antimicrobial resistance (AMR) is a growing public health burden that is a serious threat to global health security [1]
A total of 30,060 AMR bacterial isolates associated with 17,470 instances of planned international travel was documented in the 238 studies [27,29–33,35,36,41–270] included in this analysis (Table 1)
As many of the travel-related quinolone-resistant enteric bacteria originated from Asia, we suggest that clinicians who see travellers from this region with GI-related illnesses should avoid empirically prescribing ciprofloxacin or any other quinolones
Summary
Antimicrobial resistance (AMR) is a growing public health burden that is a serious threat to global health security [1]. It has been estimated that this increase in the emergence of AMR organisms can increase the morbidity and mortality of infectious diseases, as it hampers the ability of antimicrobial drugs to cure infections [3,5]. AMR infections currently result in 700,000 global deaths every year, with associated mortality estimated to claim 10 million lives per year by 2050 [5]. These high mortality rates associated with AMR are expected to cause a cumulative loss of around US$100 trillion to the total world gross domestic product (GDP) in 2050 [5]
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