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

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

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.

Antimicrobial resistance, Global health security, Infection prevention and control, Screening, Surveillance
0195-6701
143-150
Pallett, S.J.C.
eb80d6b3-9cc1-4efa-8f75-4b2a6f16abfc
Boyd, S.E.
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Khanijau, A.
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Banerjee, R.
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Reec, N.
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Jawad, S.
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Daniel, V.
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Routledge, M.
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Navalan, H.
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Saeed, K.
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Lambourne, J.
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Enoch, D.A.
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Shanks, G.
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Cai, J.
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Wild, A.
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Mahida, N.
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Hiles, H.
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Parsons, H.
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Tickell-Painter, M.
48122845-b649-4aea-98e6-6ed44f8c1335
Shorten, R.
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Srirathan, V.
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Suich, J.
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Wearmouth, D.
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Dhillon, R.
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Mughal, N.
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Woolley, S.D.
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O'Shea, M.K.
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Moore, L.S.P.
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et al.
Pallett, S.J.C.
eb80d6b3-9cc1-4efa-8f75-4b2a6f16abfc
Boyd, S.E.
de338bfd-55a0-4c3b-99eb-44702750cab7
Khanijau, A.
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Banerjee, R.
06517d0f-9be4-49c4-a2ac-00cf495e2a52
Reec, N.
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Jawad, S.
d15da0c8-7bab-46d8-bbd6-a9b6442a278c
Daniel, V.
a8a7d6fd-9fa8-4915-940c-4ed0a33de969
Routledge, M.
876186d4-ab3e-4edb-beb7-4caf0792af67
Navalan, H.
44fcc95b-96db-46fb-a65c-9a7fa2e91dc8
Saeed, K.
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Lambourne, J.
bbdf9dd7-d524-405f-a643-d0b01687c1ef
Enoch, D.A.
758483d3-a8b0-45a6-88b3-c11289bc7c75
Shanks, G.
4373ac85-2756-4ce2-998f-e4fcaa5b9a2a
Cai, J.
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Wild, A.
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Mahida, N.
512ab4af-1f99-4194-aeb1-cb1302fdb680
Hiles, H.
a7d52ab5-6bf6-4bf3-b111-d3c65c8623c2
Parsons, H.
694189a1-8e0f-493a-b973-a38caad49365
Tickell-Painter, M.
48122845-b649-4aea-98e6-6ed44f8c1335
Shorten, R.
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Srirathan, V.
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Suich, J.
1e13867f-e450-4194-ac36-8fe9ae25f6e2
Wearmouth, D.
47702f3d-419c-4270-acfa-4604a54e87e0
Dhillon, R.
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Mughal, N.
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Woolley, S.D.
b046534f-18f3-4942-ace6-61e17bc34450
O'Shea, M.K.
5371d186-3291-4b54-8dfd-ec3b71601311
Moore, L.S.P.
6645b537-50ac-4189-b270-55301bce3d64

Pallett, S.J.C., Boyd, S.E. and Khanijau, A. , et al. (2026) Travel-associated carbapenem-resistant organisms at a time of increasing geopolitical instability: a UK perspective. The Journal of hospital infection, 169, 143-150. (doi:10.1016/j.jhin.2025.11.045).

Record type: Article

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.

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Accepted/In Press date: 21 November 2025
e-pub ahead of print date: 16 December 2025
Published date: 27 January 2026
Keywords: Antimicrobial resistance, Global health security, Infection prevention and control, Screening, Surveillance

Identifiers

Local EPrints ID: 508712
URI: http://eprints.soton.ac.uk/id/eprint/508712
DOI: doi:10.1016/j.jhin.2025.11.045
ISSN: 0195-6701
PURE UUID: 3d8b9404-ad7b-498e-8abc-3c50e8ad4d7f
ORCID for K. Saeed: ORCID iD orcid.org/0000-0003-0123-0302

Catalogue record

Date deposited: 30 Jan 2026 17:50
Last modified: 06 Feb 2026 02:57

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Contributors

Author: S.J.C. Pallett
Author: S.E. Boyd
Author: A. Khanijau
Author: R. Banerjee
Author: N. Reec
Author: S. Jawad
Author: V. Daniel
Author: M. Routledge
Author: H. Navalan
Author: K. Saeed ORCID iD
Author: J. Lambourne
Author: D.A. Enoch
Author: G. Shanks
Author: J. Cai
Author: A. Wild
Author: N. Mahida
Author: H. Hiles
Author: H. Parsons
Author: M. Tickell-Painter
Author: R. Shorten
Author: V. Srirathan
Author: J. Suich
Author: D. Wearmouth
Author: R. Dhillon
Author: N. Mughal
Author: S.D. Woolley
Author: M.K. O'Shea
Author: L.S.P. Moore
Corporate Author: et al.

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