TY - JOUR
T1 - Impact of pre-travel consultation on clinical management and outcomes of travelers' diarrhea
T2 - A retrospective cohort study 11 Medical and Health Sciences 1117 Public Health and Health Services 11 Medical and Health Sciences 1103 Clinical Sciences
AU - Tan, Eugene M.
AU - St Sauver, Jennifer L.
AU - Sia, Irene G.
N1 - Publisher Copyright:
© 2018 The Author(s).
PY - 2018/12/4
Y1 - 2018/12/4
N2 - Background: International travelers are at high risk of acquiring travelers' diarrhea. Pre-travel consultation has been associated with lower rates of malaria, hepatitis, and human immunodeficiency virus (HIV) infections. The objective was to study the impact of pre-travel consultation on clinical management and outcomes of travelers' diarrhea. Methods: This retrospective cohort study analyzed 1160 patients diagnosed with travelers' diarrhea at Mayo Clinic Rochester, MN from 1994 to 2017. Variables included high-risk activities, post-travel care utilization, antimicrobial prescriptions, hospitalizations, and complications. Travelers were divided into those who sought (n = 256) and did not seek (n = 904) pre-travel consultation. The two groups were compared using the Wilcoxon test for continuous variables and chi-square test for categorical variables. Multivariate logistic regression was used to adjust for differences in traveler characteristics. Results: More pre-travel consultation recipients were young Caucasians who had more post-travel infectious disease (ID) consultation [OR 3.1 (95% CI 1.9-5.3)], more stool sampling [OR 1.6 (95% CI 1.1-2.4)], and more antimicrobial prescriptions [OR 1.6 (95% CI 1.1-2.5)] for travelers' diarrhea compared to the non-pre-travel consultation group. The pre-travel consultation group had shorter hospital stays (mean 1.8 days for pre-travel versus 3.3 days for non-pre-travel consultation group, p = 0.006) and reduced gastroenterology consultation rates [OR 0.4 (95% CI 0.2-0.9)]. 23 patients with positive stool cultures had Campylobacter susceptibilities performed; 65% (15/23) demonstrated intermediate susceptibility or resistance to ciprofloxacin. Conclusion: Pre-travel consultation was associated with higher rates of stool testing and antimicrobial prescriptions. The high rate of quinolone-resistant Campylobacter in our small sample suggests the need for judicious antimicrobial utilization. The pre-travel consultation group did have a shorter duration of hospitalization and reduced need for gastroenterology consultation for prolonged or severe symptoms, which are positive outcomes that reflect reduced morbidity of travelers' diarrhea.
AB - Background: International travelers are at high risk of acquiring travelers' diarrhea. Pre-travel consultation has been associated with lower rates of malaria, hepatitis, and human immunodeficiency virus (HIV) infections. The objective was to study the impact of pre-travel consultation on clinical management and outcomes of travelers' diarrhea. Methods: This retrospective cohort study analyzed 1160 patients diagnosed with travelers' diarrhea at Mayo Clinic Rochester, MN from 1994 to 2017. Variables included high-risk activities, post-travel care utilization, antimicrobial prescriptions, hospitalizations, and complications. Travelers were divided into those who sought (n = 256) and did not seek (n = 904) pre-travel consultation. The two groups were compared using the Wilcoxon test for continuous variables and chi-square test for categorical variables. Multivariate logistic regression was used to adjust for differences in traveler characteristics. Results: More pre-travel consultation recipients were young Caucasians who had more post-travel infectious disease (ID) consultation [OR 3.1 (95% CI 1.9-5.3)], more stool sampling [OR 1.6 (95% CI 1.1-2.4)], and more antimicrobial prescriptions [OR 1.6 (95% CI 1.1-2.5)] for travelers' diarrhea compared to the non-pre-travel consultation group. The pre-travel consultation group had shorter hospital stays (mean 1.8 days for pre-travel versus 3.3 days for non-pre-travel consultation group, p = 0.006) and reduced gastroenterology consultation rates [OR 0.4 (95% CI 0.2-0.9)]. 23 patients with positive stool cultures had Campylobacter susceptibilities performed; 65% (15/23) demonstrated intermediate susceptibility or resistance to ciprofloxacin. Conclusion: Pre-travel consultation was associated with higher rates of stool testing and antimicrobial prescriptions. The high rate of quinolone-resistant Campylobacter in our small sample suggests the need for judicious antimicrobial utilization. The pre-travel consultation group did have a shorter duration of hospitalization and reduced need for gastroenterology consultation for prolonged or severe symptoms, which are positive outcomes that reflect reduced morbidity of travelers' diarrhea.
KW - Infectious disease
KW - Pre-travel consultation
KW - Travelers' diarrhea
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U2 - 10.1186/s40794-018-0076-2
DO - 10.1186/s40794-018-0076-2
M3 - Article
AN - SCOPUS:85080023837
SN - 2055-0936
VL - 4
JO - Tropical Diseases, Travel Medicine and Vaccines
JF - Tropical Diseases, Travel Medicine and Vaccines
IS - 1
M1 - 16
ER -