{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:53:54Z","timestamp":1767920034409,"version":"3.49.0"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2019,7,29]],"date-time":"2019-07-29T00:00:00Z","timestamp":1564358400000},"content-version":"vor","delay-in-days":209,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Armed Forces Health Surveillance Center-Global Emerging Infections Surveillance and Response System"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,12,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>We conducted a comprehensive investigation to update our knowledge of traveler\u2019s diarrhea (TD) etiology and antimicrobial resistance (AMR) in Nepal.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A case\u2013control study of TD etiology was conducted at the CIWEC Clinic Travel Medicine Center in Kathmandu from 2012 to 2014. Stool samples were tested by microscopy, culture and molecular techniques for identification of bacterial, viral and parasitic enteric pathogens, and AMR. We analysed patient demographic data, pre-treatment information and clinical outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We enrolled 433 TD cases and 209 non-diarrhea controls. At least one of enteric pathogens was identified among 82% of cases and 44% of controls (P\u2009&amp;lt;\u20090.001). Multiple pathogens were observed among 35% of cases and 10% of controls. The most common pathogens significantly identified among cases in comparison with controls were Campylobacter (20%), norovirus (17%), enterotoxigenic E. coli (ETEC) (12%), rotavirus (9%) and Shigella (8%) (P\u2009&amp;lt;\u20090.001). We noted Campylobacter, Shigella and ETEC resistance to azithromycin at 8, 39 and 22% and to ciprofloxacin at 97, 78 and 23%, respectively.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Among travellers to Nepal with TD, viral pathogens were commonly found and norovirus was the second most common pathogen after campylobacter. We noted increased AMR to fluoroquinolones (FQs) and azithromycin (AZM). There is heightened concern for AZM treatment failures, though this continues to remain the drug of choice for TD treatment in our setting where FQs should not be used.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jtm\/taz054","type":"journal-article","created":{"date-parts":[[2019,7,24]],"date-time":"2019-07-24T07:11:21Z","timestamp":1563952281000},"source":"Crossref","is-referenced-by-count":22,"title":["Traveler\u2019s diarrhea in Nepal\u2014changes in etiology and antimicrobial resistance"],"prefix":"10.1093","volume":"26","author":[{"given":"Holly","family":"Murphy","sequence":"first","affiliation":[{"name":"IHA Infectious Diseases Consultants, 5333 McAuley Dr., Ypsilanti, MI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ladaporn","family":"Bodhidatta","sequence":"additional","affiliation":[{"name":"Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siriporn","family":"Sornsakrin","sequence":"additional","affiliation":[{"name":"Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bhawani","family":"Khadka","sequence":"additional","affiliation":[{"name":"CIWEC Clinic Travel Medicine Center, Kathmandu, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ananta","family":"Pokhrel","sequence":"additional","affiliation":[{"name":"CIWEC Clinic Travel Medicine Center, Kathmandu, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shristi","family":"Shakya","sequence":"additional","affiliation":[{"name":"CIWEC Clinic Travel Medicine Center, Kathmandu, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Umaporn","family":"Suksawad","sequence":"additional","affiliation":[{"name":"Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Boonchai","family":"Wongstitwilairoong","sequence":"additional","affiliation":[{"name":"Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanjaya","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Walter Reed\/AFRIMS Research Unit Nepal (WARUN), Kathmandu, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carl","family":"Mason","sequence":"additional","affiliation":[{"name":"Henry M. Jackson Foundation, Bethesda, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prativa","family":"Pandey","sequence":"additional","affiliation":[{"name":"CIWEC Clinic Travel Medicine Center, Kathmandu, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,7,29]]},"reference":[{"key":"2019122309080944100_ref1","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1001\/jama.1988.03410090077034","article-title":"Etiology of diarrhea among travelers and foreign residents in Nepal","volume":"260","author":"Taylor","year":"1988","journal-title":"JAMA"},{"key":"2019122309080944100_ref2","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1001\/jama.1996.03530310039030","article-title":"Epidemiology of diarrhea among expatriate residents living in a highly endemic 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