Travel-associated carbapenem-resistant organisms at a time of increasing geopolitical instability: a UK perspective
Pallett, Scott J C Boyd, Sara E Khanijau, Aakash Banerjee, Rishi Reec, Nicola Jawad, Sarah Daniel, Victoria Routledge, Matthew Navalan, Harin Ward, Christopher
Pallett, Scott J C
Boyd, Sara E
Khanijau, Aakash
Banerjee, Rishi
Reec, Nicola
Jawad, Sarah
Daniel, Victoria
Routledge, Matthew
Navalan, Harin
Ward, Christopher
Affiliation
Chelsea and Westminster Hospitals NHS Foundation Trust; University Hospitals Birmingham NHS Foundation Trust; University of Liverpool; St George's University Hospitals NHS Foundation Trust; Imperial College London; NHS University Hospitals of Liverpool Group; Barts Health NHS Trust; University Hospital Southampton NHS Foundation Trust; St George's University Hospitals NHS Foundation Trust; Public Health Wales Microbiology; Cambridge University Hospitals NHS Foundation Trust; Nottingham University Hospitals NHS Trust; Sherwood Forest Hospitals NHS Foundation Trust; Sheffield Teaching Hospitals NHS Foundation Trust; Lancashire Teaching Hospitals NHS Foundation Trust; University of Manchester; Northern Care Alliance NHS Foundation Trust; Hull University Teaching Hospitals NHS Trust; Liverpool University Hospitals NHS Foundation Trust; Liverpool School of Tropical Medicine; University of Birmingham
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Publication date
2025-12-16
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Abstract
Background: Conflict and catastrophe compromise multinational healthcare delivery and present risks for the spread of carbapenem-resistant organisms (CROs). UK risk and ability to detect travel-associated CROs remains unclear.
Methods: A 10-question survey was sent to microbiology/infection prevention & control (IPC) practitioners of 108 UK acute NHS Trusts/Regions/Boards, exploring recent experience and IPC practices for travel-associated CROs and approaches to extended-spectrum antimicrobial testing. Additionally, major trauma network centres were invited to review detected carbapenemase-producing organism (CPO) molecular data from March 2022-April 2024, comparing associated travel by WHO global region using one-way ANOVA.
Results: Seventy-three surveys were returned. IPC approaches were highly variable, with 19/73 (26.0%) centres requiring modification to national screening guidelines. 24/73 (32.8%) centres reported CROs associated with recent travel to major conflict areas. Twelve major trauma network centres contributed to review of detected CPOs, finding 297/1290 (23.0%) individuals with travel to 52 different countries. 227/297 (76.4%) were screening results; 279/297 (93.9%) were Enterobacterales. 112/297 (37.7%) had travelled to Europe, where carbapenemase diversity was greater than elsewhere (p<0.001).
Interpretation: A considerable range of UK centres are detecting CROs associated with travel to areas of current major conflict. A more didactic approach to travel history on first contact with healthcare services is required to stratify CPO risk at admission. These data should be collected prospectively in parallel with projects which successfully embed taking an effective travel history to assess risk of travel-associated infectious disease. This will allow clearer understanding of travel behaviours and trends, delineate risk and inform effective IPC.
Citation
Pallett SJC, Boyd SE, Khanijau A, Banerjee R, Reec N, Jawad S, Daniel V, Routledge M, Navalan H, Ward C, Saeed K, Lambourne J, Enoch DA, Shanks G, Cai J, Wild A, Mahida N, Hiles H, Parsons H, Tickell-Painter M, Shorten R, Srirathan V, Suich J, Wearmouth D, Dhillon R, Mughal N, Woolley SD, O'Shea MK, Moore LSP. Travel-associated carbapenem-resistant organisms at a time of increasing geopolitical instability: a UK perspective. J Hosp Infect. 2025 Dec 16:S0195-6701(25)00422-0. doi: 10.1016/j.jhin.2025.11.045. Epub ahead of print.
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Article