Kudos to this group of investigators from Holland who longitudinally followed a cohort of Dutch travelers for the acquisition of extended spectrum beta-lactamase (ESBL) bacteria. The findings were published in Lancet Infectious Diseases. Just completing the study was no small feat. The researchers obtain fecal cultures pre/post travel on 1847 individuals.Thirty four percent of returning travelers were ESBL enterobacteriaceae colonized with up to 11% exhibiting persistent colonization for up to one year. Transmission was observed in 7.7% of household members.
For the infectious diseases physician, the importance of obtaining a travel history cannot be overstated, particularly for diagnosis and clinical decision making.
The article's discussion goes so far as to raise the issue of screening patients with a significant travel history for ESBL carriage.
This is controversial and may be fraught with peril, a bacterial Pandora's Box. I am not sure that we are ready to launch into this strategy yet.
