• A Michal Stevens, Douglas H Esposito, Rhett J Stoney, Davidson H Hamer, Jose Flores-Figueroa, Emmanuel Bottieau, Bradley A Connor, Effrossyni Gkrania-Klotsas, Abraham Goorhuis, Noreen A Hynes, Michael Libman, Rogelio Lopez-Velez, Anne E McCarthy, Frank von Sonnenburg, Eli Schwartz, Perry J J van Genderen, L Scott Benson, Daniel T Leung, and GeoSentinel Surveillance Network.
• International Travel Clinic, Division of Infectious Diseases, University of Utah School of Medicine, 30 North 1900 East, Salt Lake City, UT, USA.
• J Travel Med. 2017 May 1; 24 (3).

BackgroundThere is increasing recognition of the contribution of community-acquired cases to the global burden of Clostridium difficile infection (CDI). The epidemiology of CDI among international travellers is poorly understood, and factors associated with international travel, such as antibiotic use and changes in gut microbiota, could potentially put travellers at higher risk.MethodsWe summarized demographic, travel-associated and geographic characteristics of travellers with CDI in the GeoSentinel database from 1997 to 2015. We also surveyed GeoSentinel sites to compare various testing indications, approaches, and diagnostic modalities.ResultsWe identified 260 GeoSentinel records, including 187 that satisfied criteria for analysis (confirmed cases in non-immigrant travellers aged >2 years, seen <12 weeks post-travel). CDI was reported in all age groups and in travellers to all world regions; the largest proportions of cases having destinations in Asia (31%), Central/South America or the Caribbean (30%) and Africa (24%). Our site survey revealed substantial heterogeneity of testing approaches between sites; the most commonly used test was the C. difficile toxin gene PCR.ConclusionsCDI is encountered in returning international travellers, although there is considerable variability in testing practices. These data underscore the importance of awareness of C. difficile as a potential cause of travel-associated diarrhoea.© International Society of Travel Medicine, 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

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