Traveler's Diarrhea and the Acquisition of Multidrug Resistance

Segment Description: Mark Riddle, MD, DrPH, associate dean of clinical research, University of Nevada, Reno, and associate chief of staff for research, VA Sierra Nevada Healthcare System, speaks about his research on travelers’ diarrhea and multidrug resistance at ACG 2019.

Interview transcript: (modified slightly for readability)

Over the past few years, in the areas of travel medicine, infectious disease control, and gastrointestinal health, we've realized that when travelers like you I go to Mexico or Africa or somewhere, we have the potential to be colonized with multidrug-resistant organisms. There's a certain type, extended-spectrum and beta-lactamase-producing Enterobacteriaceae, that are acquired. More and more studies showing that there are certain risk factors for going to a region like India or Southeast Asia, risk factors of just getting diarrhea when you travel. And then certainly the highest risk factor is if you have any antibiotics. Commonly before you travel, your doctor will provide you with an antibiotic to take if you get sick while you're traveling. So there's a lot of diarrhea and use of antibiotics in the travel setting, and they work really well in reducing your disease and ability to have your full itinerary.

But they come with consequences. And one of the consequences we're understanding is this emergence of acquisition.

So the impetus was trying to understand: are there any microbiome effects that suggest that someone is at higher risk and, and what are the disturbances that might be associated with that? Our impetus for this particular study was because we just completed a large, randomized, controlled trial where we looked at single-dose antibiotics—so just one pill of antibiotics versus the standard of care, which is multi-day multi-dose. We thought that there would be less acquisition, less disturbance because we're just giving a single dose versus a multi-day, multi-dose. And so this was a study that was taking advantage of a large clinical trial that was done globally in, in my former job as as a military, navy physician.

The study, Travelers' Diarrhea, Single Dose Antibiotics, Acquisition of Multi-Drug Resistance and Associations With Functional Microbiome Characterization: Is There Any There There?, was presented on Monday, October 28, 2019, at the American College of Gastroenterology Annual Scientific Meeting in San Antonio, Texas.