Impact of pre-travel consultation on clinical management and outcomes of travelers' diarrhea: A retrospective cohort study 11 Medical and Health Sciences 1117 Public Health and Health Services 11 Medical and Health Sciences 1103 Clinical Sciences

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2 Scopus citations

Abstract

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.

Original languageEnglish (US)
Article number16
JournalTropical Diseases, Travel Medicine and Vaccines
Volume4
Issue number1
DOIs
StatePublished - Dec 4 2018

Keywords

  • Infectious disease
  • Pre-travel consultation
  • Travelers' diarrhea

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

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