{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T05:53:12Z","timestamp":1790661192432,"version":"4.1.0"},"reference-count":29,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Diarrheal disease causes substantial morbidity in international travelers. Knowledge of antibiotic resistance of causative pathogens helps guide empiric treatment decisions.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n \n To characterize antimicrobial nonsusceptibility patterns of culture-confirmed\n Campylobacter<\/jats:italic>\n species, nontyphoidal\n Salmonella<\/jats:italic>\n (NTS) species,\n Shigella<\/jats:italic>\n species, and diarrheagenic\n Escherichia coli<\/jats:italic>\n isolated from international travelers with diarrhea identified by the GeoSentinel Surveillance Network.\n <\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This is a retrospective cross-sectional analysis of antimicrobial susceptibility data for 4 major pathogens causing travel-associated diarrhea, reported from April 14, 2015, to December 19, 2022, at 58 of 71 international GeoSentinel sites. Participants included a convenience sample of international travelers with acute diarrhea seen during or after travel presenting at the GeoSentinel sites.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n \n The main outcomes were demographics, clinical characteristics, and antimicrobial susceptibility profiles of patients with culture-confirmed\n Campylobacter<\/jats:italic>\n species, NTS species,\n Shigella<\/jats:italic>\n species, and diarrheagenic\n E coli<\/jats:italic>\n species. Routinely collected antimicrobial susceptibility data with intermediate susceptibility and resistant were defined as nonsusceptible. The antimicrobial susceptibility test results were described as numbers and percentages, and binomial 95% CIs were calculated for the proportions.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 859 total cases, the median (IQR) age was 30 (23-43) years, and 440 travelers (51%) were male. Among\n Campylobacter<\/jats:italic>\n isolates, nonsusceptibility to fluoroquinolones was found in 206 of 274 isolates (75%; 95% CI, 70%-80%), and nonsusceptibility to macrolides was found in 30 of 255 isolates (12%; 95% CI, 8%-16%) and was highest in travelers to South Central Asia (45 of 51 isolates; 88%; 95% CI, 76%-96%). Among NTS species, 96 of 302 isolates (32%; 95% CI, 27%-37%) were nonsusceptible to fluoroquinolones, 18 of 111 isolates (16%; 95% CI, 10%-24%) were nonsusceptible to macrolides, and 15 of 273 isolates (5%; 95% CI, 3%-9%) were nonsusceptible to third-generation cephalosporins. For\n Shigella<\/jats:italic>\n species, 44 of 196 isolates (22%; 95% CI, 17%-29%) were nonsusceptible to fluoroquinolones, and 36 of 103 isolates (35%; 95% CI, 26%-45%) were nonsusceptible to macrolides. For\n E coli<\/jats:italic>\n , fluoroquinolone nonsusceptibility was 18% (12 of 66 isolates; 95% CI, 10%-30%). Of note, 19 of 24\n Shigella<\/jats:italic>\n isolates (79%; 95% CI, 58%-93%) were nonsusceptible to fluoroquinolones among travelers to South Central Asia, and 29 of 37\n Shigella<\/jats:italic>\n isolates (78%; 95% CI, 62%-90%) were nonsusceptible to macrolides among travelers to South America.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cross-sectional study of travelers\u2019 diarrhea antimicrobial resistance patterns, there was marked variability of nonsusceptibility to 2 major classes of antibiotics commonly used for treating travelers\u2019 diarrhea among global regions. Antimicrobial susceptibility from culture should be obtained when possible, including after pathogen detection by culture-independent methods. These findings may help inform strategies for self-treatment and clinician management of travelers\u2019 diarrhea.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.51089","type":"journal-article","created":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T16:31:10Z","timestamp":1766421070000},"page":"e2551089","source":"Crossref","is-referenced-by-count":4,"title":["GeoSentinel Analysis of Travelers\u2019 Diarrhea Antimicrobial Resistance Patterns"],"prefix":"10.1001","volume":"8","author":[{"given":"Bhawana","family":"Amatya","sequence":"first","affiliation":[{"name":"CIWEC Hospital and Travel Medicine Center, Lainchaur, Kathmandu, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prativa","family":"Pandey","sequence":"additional","affiliation":[{"name":"CIWEC Hospital and Travel Medicine Center, Lainchaur, Kathmandu, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah 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