Unwanted Souvenirs: Travel and Multi‐Resistant Bacteria

Abstract

Antibiotics have been used in clinical practice for about 80 years and, throughout that period, the problems posed by resistant bacteria have escalated at a pace that has forced near‐continuous development of new antibacterial drugs. We now face an immediate future in which pharmaceutical companies can offer few options for some of the multi‐drug‐resistant bacteria encountered ever more frequently by the clinicians and microbiologists of the 21st century. Travelers have aided the international spread of infectious diseases since antiquity. Though it is a more recent pairing, travel is also inextricably linked with antibiotic resistance. Importation of resistant strains of Neisseria gonorrhoeae , for example, has for many years been associated with travel to countries in the Far East. Indeed, the two original penicillinase plasmids of this species were described as “Asian” and “African” to reflect their epidemiological associations. 1 Moreover, international surveillance systems often illustrate dramatic differences between countries in the prevalence of resistance for many clinical pathogens and hospital opportunists. Countries of high prevalence have the potential to serve as reservoirs for further dissemination. Much recent attention has been focused on Escherichia coli , which is a normal component of our gut flora, but also a major cause of … Corresponding Author: Neil Woodford, BSc, PhD, FRCPath, Antibiotic Resistance Monitoring and Reference Laboratory, HPA Microbiology Services—Colindale, 61 Colindale Avenue, London NW9 5EQ, UK. E‐mail: neil.woodford{at}hpa.org.uk