Travel-associated carbapenem-resistant organisms at a time of increasing geopolitical instability: a UK perspective

S J C Pallett; S E Boyd; A Khanijau; R Banerjee; N Reece; S Jawad; V Daniel; M Routledge; H Navalan; C Ward; K Saeed; J Lambourne; D A Enoch; G Shanks; J Cai; A Wild; N Mahida; H Hiles; H Parsons; M Tickell-Painter; R Shorten; V Srirathan; J Suich; D Wearmouth; R Dhillon; N Mughal; S D Woolley; M K O'Shea; L S P Moore

doi:10.1016/j.jhin.2025.11.045

Travel-associated carbapenem-resistant organisms at a time of increasing geopolitical instability: a UK perspective

J Hosp Infect. 2025 Dec 16:169:143-150. doi: 10.1016/j.jhin.2025.11.045. Online ahead of print.

Authors

S J C Pallett¹, S E Boyd², A Khanijau³, R Banerjee⁴, N Reece⁵, S Jawad⁶, V Daniel⁷, M Routledge⁸, H Navalan⁹, C Ward⁶, K Saeed¹⁰, J Lambourne⁴, D A Enoch⁸, G Shanks⁴, J Cai⁴, A Wild¹¹, N Mahida¹², H Hiles¹³, H Parsons¹³, M Tickell-Painter¹⁴, R Shorten¹⁵, V Srirathan¹⁶, J Suich¹⁷, D Wearmouth¹⁷, R Dhillon⁷, N Mughal⁹, S D Woolley¹⁸, M K O'Shea¹⁹, L S P Moore²⁰

Affiliations

¹ Clinical Infection Department, Chelsea and Westminster Hospitals NHS Foundation Trust, London, UK; Centre of Defence Pathology, Royal Centre of Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK. Electronic address: scott.pallett@nhs.net.
² David Price Evans Global Health and Infectious Disease Research Group, University of Liverpool, Institute of Systems, Molecular & Integrative Biology, William Henry Duncan Building, Liverpool, UK; Infection Clinical Academic Group, St George's University Hospitals NHS Foundation Trust, London, UK.
³ Liverpool Clinical Laboratories, NHS University Hospitals of Liverpool Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK.
⁴ Department of Microbiology, Royal London Hospital, Barts Health NHS Trust, London, UK.
⁵ Centre of Defence Pathology, Royal Centre of Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK; Department of Microbiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
⁶ Infection Clinical Academic Group, St George's University Hospitals NHS Foundation Trust, London, UK.
⁷ Public Health Wales Microbiology, Cardiff, Wales, UK.
⁸ Clinical Microbiology & Public Health Laboratory, United Kingdom Health Security Agency (UKHSA), Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
⁹ Clinical Infection Department, Chelsea and Westminster Hospitals NHS Foundation Trust, London, UK.
¹⁰ Department of Microbiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Clinical and Experimental Sciences, University of Southampton, Southampton, UK.
¹¹ Department of Microbiology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
¹² Department of Microbiology, Sherwood Forest Hospitals NHS Foundation Trust, Nottingham, UK.
¹³ Department of Microbiology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
¹⁴ Department of Microbiology, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.
¹⁵ Department of Microbiology, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK; Department of Medical Education, University of Manchester, Manchester, UK.
¹⁶ Department of Microbiology, Northern Care Alliance NHS Foundation Trust, UK.
¹⁷ Department of Microbiology, Hull University Teaching Hospitals NHS Trust, Hull, UK.
¹⁸ Centre of Defence Pathology, Royal Centre of Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK; Liverpool Clinical Laboratories, NHS University Hospitals of Liverpool Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, Merseyside, UK.
¹⁹ Centre of Defence Pathology, Royal Centre of Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK; Department of Microbiology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Immunology and Immunotherapy, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK.
²⁰ Clinical Infection Department, Chelsea and Westminster Hospitals NHS Foundation Trust, London, UK; National Institute for Health Research Imperial Biomedical Research Centre, Imperial College London, Hammersmith Campus, London, UK.

PMID: 41412384
DOI: 10.1016/j.jhin.2025.11.045

Abstract

Background: Conflict and catastrophe compromise multi-national healthcare delivery and present risks for the spread of carbapenem-resistant organisms (CROs). The risk of and ability to detect travel-associated CROs in the UK remain unclear.

Methods: A 10-question survey was sent to microbiology/infection prevention and 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 to April 2024, comparing associated travel by the World Health Organization global region using one-way analysis of variance.

Results: Seventy-three surveys were returned. IPC approaches were highly variable, with 19 of 73 (26.0%) centres requiring modification to national screening guidelines. Twenty-four of 73 (32.9%) centres reported CROs associated with recent travel to major conflict areas. Twelve major trauma network centres contributed to review of detected CPOs, finding 297 of 1290 (23.0%) individuals with travel to 52 different countries. In total, 227 of 297 (76.4%) were screening results; 279 of 297 (93.9%) were Enterobacterales. A total of 112 of 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 the 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 the risk of travel-associated infectious disease. This will allow clearer understanding of travel behaviours and trends, delineate risk and inform effective IPC.

Keywords: Antimicrobial resistance; Global health security; Infection prevention and control; Screening; Surveillance.