Related Experiment Video
Updated: Jul 26, 2025
Author Spotlight: Advancing Pathogen Detection and Disease Assessment in Real-Time Using M-ROSE
Published on: March 1, 2024
Preventing empirical antibiotic treatment failure in migrant populations: screening by infection risk, not ethnic
Steven L Taylor1, Lito E Papanicolas1, Erin Flynn2
1South Australian Health and Medical Research Institute, Adelaide, Australia; College of Medicine and Public Health, Flinders University, Adelaide, Australia.
Abstract:
Multidrug-resistant organisms (MDROs) are a major international health threat. In many low and middle-income countries poorly regulated antibiotic use, limited surveillance, and inadequate sanitation give rise to high rates of antibiotic resistance. A resulting reliance on last-line antibiotic options further contributes to the emergence of MDROs. The potential for these pathogens to spread across international borders is a matter of considerable concern. However, this problem is commonly framed as primarily a threat to the health security of countries where resistance is not yet endemic. In fact, it is little acknowledged that those at greatest risk from antibiotic treatment failure are individuals who move from regions of high MDRO prevalence to settings where standard empirical treatment options remain largely effective. In this perspective, we highlight the poor treatment outcomes for disseminated bacterial infections in individuals who have moved from settings in which MDROs are common to those where MDROs are currently less common. We discuss MDRO screening strategies that could avoid stigmatizing vulnerable populations by focusing on future risk of disseminated infection, rather than past risk of acquisition. In practical terms, this means screening individuals before childbirth, immunosuppressive treatments, major surgery, or other events associated with disseminated infection risk, rather than prioritizing screening for individuals from regions with high carriage rates. We argue that such measures would reduce antibiotic treatment failure and improve outcomes while protecting migrant populations from the divisive consequences of targeted screening programs.
Insights
Multidrug-resistant organisms (MDROs) pose a global health risk. Individuals traveling from high-prevalence areas to low-prevalence areas face higher risks of treatment failure, necessitating proactive screening strategies.
Area of Science:
- Global Health
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Multidrug-resistant organisms (MDROs) represent a significant international health threat, exacerbated by antibiotic misuse and inadequate sanitation in low- and middle-income countries.
- The spread of MDROs is a global concern, often perceived as a threat to developed nations, overlooking the heightened risk faced by travelers from high-prevalence regions.
- Individuals migrating from areas with high MDRO prevalence to regions with effective standard treatments are at increased risk of antibiotic treatment failure.
Purpose of the Study:
- To highlight the poor treatment outcomes for disseminated bacterial infections in individuals moving between regions with differing MDRO prevalence.
- To propose revised MDRO screening strategies that focus on future risk rather than past acquisition, avoiding stigmatization.
- To advocate for pre-emptive screening before high-risk medical events to improve patient outcomes and protect vulnerable populations.
Main Methods:
- This perspective analyzes the implications of MDRO prevalence on treatment outcomes for mobile populations.
- It discusses the limitations of current screening approaches and proposes an alternative strategy based on future risk assessment.
- The authors advocate for a shift in screening focus from geographical origin to individual risk factors for disseminated infection.
Main Results:
- Individuals traveling from high MDRO prevalence areas to low prevalence areas experience poorer outcomes from disseminated bacterial infections.
- Current screening methods risk stigmatizing mobile populations by focusing on past exposure.
- A proactive screening approach, targeting individuals before high-risk medical interventions, can mitigate treatment failures.
Conclusions:
- Screening for multidrug-resistant organisms should be based on an individual's future risk of disseminated infection, not their region of origin.
- Proactive screening before childbirth, surgery, or immunosuppression can significantly reduce antibiotic treatment failure.
- Implementing risk-based screening strategies will improve patient outcomes and prevent the marginalization of migrant populations.
More Related Videos
09:59Application of the Intelligent High-Throughput Antimicrobial Sensitivity Testing/Phage Screening System and Lar Index of Antimicrobial Resistance
Published on: July 21, 2023
19:57An Affordable HIV-1 Drug Resistance Monitoring Method for Resource Limited Settings
Published on: March 30, 2014
Related Concept Videos
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:26Urine Studies II: Urine Culture and Sensitivity Test
01:20Infection
The chain begins with pathogens: bacteria, viruses, fungi, prions, or parasites such as protozoa helminths. These can be present on the skin as transient or resident flora, or they can be acquired from the environment. Identifying and treating the type of infection and...
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:17Transmission-based Precautions I: Contact, Enteric, and Droplets
Contact Precautions:
Contact precautions are the measures taken to prevent the transmission of infectious agents, especially epidemiologically important microorganisms such as MRSA or influenza, primarily transmitted through direct or indirect contact with an...
01:28Acute Pyelonephritis II: Diagnostic Studies and Management