Travelling Abroad? Reduce Your Risk of Bringing Home Antibiotic-Resistant Bacteria


15 March 2019

For many travelers, a vacation ends with a few gifts for family and friends, some loose change in foreign currency and fond memories of adventure and relaxation; however, antibiotic resistant bacteria are an unexpected, but increasingly common unwelcome souvenir.

Antibiotic resistance is a growing problem both in Ontario and across the world. Bacterial resistance to antibiotics has been fueled by antibiotic overuse in humans and animals and has led to one of the greatest public health threats of the 21st century. Many bacteria have now become tolerant to the effects of antibiotics, leading to worsening infections and in many cases, death. If bacterial resistance continues to increase, medical advances such as organ transplantation, cancer chemotherapy and care of premature newborns will become too risky to undertake, jeopardizing healthcare as we know it. Across the globe, there are 700,000 annual deaths due to drug-resistant infections and this number is expected to surpass 10 million by the year 2050 if we do not act quickly.

Rates of antibiotic resistance are seen disproportionately across the globe, so the risk of picking up these organisms depends a lot on the region of travel. Extended spectrum beta-lactamase producing Enterobacteriaceae bacteria are so common in parts of India and Asia that travelers have a greater than 60% chance of bringing one of these highly resistant bacteria back to Canada with them, simply by visiting these regions. Less common, but increasing in incidence, is one of the most-dreaded types of antibiotic resistant organisms, carbapenem-resistant Enterobacteriaceae, which are bacteria that are resistant to last-line antibiotic treatment. More than half of patients infected with these extremely resistant bacteria will die.

Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL PE) are bacteria that produce enzymes that can hydrolyze most beta-lactam antibiotics, rendering them ineffective 
Carbapenem resistant Enterobacteriaceae (CRE) are bacteria that are resistant to carbapenem antibiotics, a last line treatment for gram-negative infections. Included in this category are carbapenemase-producing Enterobacteriacae (CPE), bacteria that produce enzymes that can break down carbapenem antibiotics. There are very few antibiotic treatment options to manage infections caused by these organisms.

Traveler’s diarrhea, the result of ingesting contaminated food or beverages containing pathogenic organisms, is a common travel-associated infection. Traveler’s diarrhea is burdensome enough on its own, but also comes along with the added risk of becoming colonized with bacteria resistant to antibiotics. Taking antibiotics to prevent or treat traveler’s diarrhea further increases this risk. As a result, recent guidelines suggest avoiding antibiotics for treatment of mild traveler’s diarrhea and for prevention of diarrhea in most travelers.

As alarming as this may sound, there are things that can be done to avoid being the next vector for a drug-resistant pathogen. Here are some take home messages to avoid taking home antibiotic resistant bacteria:

  1. Before travelling, it is important to visit a general practitioner or travel clinic. They will advise of necessary vaccinations and provide region-specific advice on how to reduce your risk.
  2. To prevent traveler’s diarrhea and acquiring resistant organisms, practicing good hand hygiene is essential, travellers should be advised to drink bottled water and consider the following words of wisdom when thinking about food, “boil it, peel it, cook it or forget it.”
  3. Avoid antibiotics to prevent traveler’s diarrhea. Mild traveler’s diarrhea that does not interfere with travel plans will usually resolve without antibiotics.

For more information, visit this article authored by PHO’s Infection Prevention and Control Clinicians. Also check out our visual abstract on this topic.

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Updated 15 March 2019