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. 2017 May 1;24(3):10.1093/jtm/taw099.
doi: 10.1093/jtm/taw099.

Clostridium difficile infection in returning travellers

A Michal Stevens  1 , Douglas H Esposito  2 , Rhett J Stoney  2 , Davidson H Hamer  3   4 , Jose Flores-Figueroa  5 , Emmanuel Bottieau  6 , Bradley A Connor  7 , Effrossyni Gkrania-Klotsas  8   9 , Abraham Goorhuis  10 , Noreen A Hynes  11 , Michael Libman  12 , Rogelio Lopez-Velez  13 , Anne E McCarthy  14 , Frank von Sonnenburg  15 , Eli Schwartz  16 , Perry J J van Genderen  17 , L Scott Benson  1 , Daniel T Leung  1 ; GeoSentinel Surveillance Network
Affiliations

Clostridium difficile infection in returning travellers

A Michal Stevens et al. J Travel Med. .

Abstract

Background: There is increasing recognition of the contribution of community-acquired cases to the global burden of Clostridium difficile infection (CDI). The epidemiology of CDI among international travellers is poorly understood, and factors associated with international travel, such as antibiotic use and changes in gut microbiota, could potentially put travellers at higher risk.

Methods: We summarized demographic, travel-associated and geographic characteristics of travellers with CDI in the GeoSentinel database from 1997 to 2015. We also surveyed GeoSentinel sites to compare various testing indications, approaches, and diagnostic modalities.

Results: We identified 260 GeoSentinel records, including 187 that satisfied criteria for analysis (confirmed cases in non-immigrant travellers aged >2 years, seen <12 weeks post-travel). CDI was reported in all age groups and in travellers to all world regions; the largest proportions of cases having destinations in Asia (31%), Central/South America or the Caribbean (30%) and Africa (24%). Our site survey revealed substantial heterogeneity of testing approaches between sites; the most commonly used test was the C. difficile toxin gene PCR.

Conclusions: CDI is encountered in returning international travellers, although there is considerable variability in testing practices. These data underscore the importance of awareness of C. difficile as a potential cause of travel-associated diarrhoea.

Keywords: Clostridium difficile; diarrhoea; travellers.

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Conflict of interest statement

Conflict of interest

None declared.

Figures

Figure 1
Figure 1
Exclusion criteria for cases of travel-associated C. difficile-associated diarrhoea in GeoSentinel travellers, 1997–2015
Figure 2
Figure 2
Relative occurrence of C. difficile infection compared with giardiasis, cryptosporidiosis and campylobacteriosis, GeoSentinel 1997–2014
See this image and copyright information in PMC

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