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Mil Med. 2017 Sep;182(S2):26-33. doi: 10.7205/MILMED-D-17-00067.

Acquisition of Multidrug-Resistant Gram-Negative Organisms During Travel.

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Deputy Medical Corps Chief, Medical Corps Specific Branch Proponent Office, Infectious Disease Consultant to the Army Surgeon General, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234.
Infectious Disease Service, San Antonio Military Medical Center, JBSA Fort Sam Houston, TX 78234.


The rate of multidrug resistance has continued to increase worldwide, presenting clinicians with further challenges related to patient care. In this article, we review information related to the acquisition of multidrug-resistant (MDR) Gram-negative organisms among travelers, including deployed personnel, as well as the potential impact on wound microbiology and travelers' diarrhea. Travel to Asia, experiencing travelers' diarrhea, and use of antibiotics, whereas abroad have been associated with an increased risk of acquiring MDR Enterobacteriaceae colonization. Acquisition of new pathogens (MDR and non-MDR) through travel may result in microbiome changes (both gastrointestinal and nongastrointestinal), which may lead to alterations in the gastrointestinal flora and antimicrobial resistance. Although the long-term impact of MDR Enterobacteriaceae is unknown, host colonization changes may occur, which could lead to infectious outcomes. In particular, a well-recognized complication is urinary tract infections (UTIs), whereas MDR wound infections, pneumonia, and travelers' diarrhea are also potential outcomes relevant to military health.

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