Clinical characteristics and risk factors for multidrug-resistant bacterial isolation in patients with international travel history

Published:August 28, 2022DOI:


      • We identified the risk factors for MDRO isolation among returned travelers.
      • ESBL E. coli (ESBLEC) was detected in about 90% of all MDRO screened patients.
      • The risk factors for detection were different between ESBLEC and non-ESBLEC MDRO.



      International travelers are at risk of carrying resistant bacteria. It is critical to identify risk factors associated with multidrug-resistant organism (MDRO) colonization in travelers.


      A retrospective chart review observational study was conducted at two tertiary centers in Japan for inpatients who had been hospitalized or visited an outpatient clinic overseas within the previous 12 months. These patients underwent MDRO screening upon admission. To identify independent predictors for the isolation of MDROs, multivariable analyses were performed using logistic regression.


      In total, 77 (36%) of the 216 patients were positive for MDROs at admission. The majority of bacteria detected in stool samples were extended-spectrum beta-lactamase-producing Escherichia coli (ESBLEC) (n = 67 [89%]). ESBLEC was detected in nearly 40% of patients who traveled to Asia. Travel to Asia was an independent risk factor for any MDRO and ESBLEC isolation. For non-ESBLEC MDRO isolation, a history of surgery abroad was an independent risk factor for detection.

      Discussion and conclusions

      A history of hospitalization abroad has previously been found to be associated with MDRO colonization in travelers, which was not identified as a risk factor in this study. The risk factors for MDRO colonization were different between ESBLEC and non-ESBLEC MDROs.

      Key Words

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