Travel-associated Staphylococcus aureus infections: a global perspective from the GeoSentinel Surveillance Network

Antimicrobial resistance (AMR) is a major global health threat, and Staphylococcus aureus is among the leading contributors to the global AMR-attributable disease burden. Data on the clinical presentation and antimicrobial susceptibility patterns of Staphylococcus aureus infections in returning travellers remain scarce.

We described the clinical presentation, travel characteristics, and antimicrobial susceptibility of travellers and migrants diagnosed with Staphylococcus aureus infection through the GeoSentinel network between January 2014 and December 2022. Because no consensus definition exists for travel-associated infections, we included all cases recorded in the GeoSentinel database as travel-associated. We evaluated patients during travel or after return. Antimicrobial susceptibility testing (AST) was performed according to routine laboratory practice at participating sites.

We retrieved 740 travellers and migrants with Staphylococcus aureus infection diagnosed at 50 GeoSentinel sites. Four hundred thirty-eight (59.2%) were male, and the median age was 32 years (IQR 23-48). The most frequently visited regions were Southeast Asia, sub-Saharan Africa, and South-Central Asia. Most patients presented after travel (576/740; 77.8%). Skin and soft tissue infections were the predominant diagnosis (670/740; 90.5%), and most patients were managed as outpatients (579/740; 78.2%). Overall, 406/740 (54.9%) isolates showed resistance or reduced susceptibility to at least one antimicrobial class, including methicillin (224/656; 34.1%), lincosamides (144/627; 23.0%), and trimethoprim-sulfamethoxazole (129/597; 21.6%). Demographic characteristics and hospitalization frequency were similar between patients with MSSA and MRSA infections.

Most Staphylococcus aureus infections in international travellers presented as skin and soft tissue infections and were managed in outpatient settings. Resistance or reduced susceptibility to at least one antimicrobial class was common, with one-third of isolates identified as methicillin-resistant. These findings support the importance of AST to guide management of skin and soft tissue infections in internationally mobile populations and reinforce the need for standardized definitions of travel-associated bacterial infections and continued global surveillance.