title: Enteric pathogen sampling of tourist restaurants in Bangkok, Thailand.
abstract: BACKGROUND
  Travelers' diarrhea (TD) is the most prevalent disorder affecting travelers to developing countries. Thailand is considered "moderately risky" for TD acquisition, but the risk by city visited or behavior of the visitor has yet to be definitely defined. Restaurant eating is consistently associated with the acquisition of diarrhea while traveling, and pathogen-free meals serve as a marker of public health success. This study seeks to ascertain a traveler's risk of exposure to certain bacterial gastric pathogens while eating at Bangkok restaurants recommended in popular tourist guide books.
  
  
  METHODS
  A cross-sectional tourist restaurant survey was conducted. Thirty-five restaurants recommended in the two top selling Bangkok guidebooks on Amazon.com were sampled for bacterial pathogens known to cause diarrhea in Thailand, namely Salmonella, Campylobacter, and Arcobacter (a Campylobacter-like organism). A total of 70 samples from two meals at each restaurant were obtained. Suspected bacterial pathogens were isolated by differential culture and tested for antibiotic resistance.
  
  
  RESULTS
  Salmonella group E was isolated from one meal (2%), and Arcobacter butzleri from nine meals (13%). Campylobacter spp. were not found. The large majority of A butzleri isolates were resistant to azithromycin but susceptible to ciprofloxacin and an aminoglycoside.
  
  
  CONCLUSIONS
  A traveler's risk of exposure to established bacterial pathogens, Salmonella and Campylobacter, by eating in recommended restaurants is small. Arcobacter butzleri exposure risk is 13% per meal eaten, and rises to 75% when 10 meals are eaten. All restaurants, regardless of price, appear to be equally "risky." Current evidence points to Arcobacter being pathogenic in humans; however, further research is needed to conclusively define pathogenicity. Routine prophylaxis for diarrhea is not recommended; however, travelers should be aware of the risk and come prepared with adequate and appropriate self-treatment medications.
authors.affiliation: Department of Preventive Medicine, Madigan Army Medical Center, Ft Lewis, WA 98431, USA. nathan.teague@us.army.mil
authors.forename: Nathan S
authors.initials: NS
authors.lastname: Teague
authors.forename: Apichai
authors.initials: A
authors.lastname: Srijan
authors.forename: Boonchai
authors.initials: B
authors.lastname: Wongstitwilairoong
authors.forename: Kamonporn
authors.initials: K
authors.lastname: Poramathikul
authors.forename: Thanaporn
authors.initials: T
authors.lastname: Champathai
authors.forename: Supaporn
authors.initials: S
authors.lastname: Ruksasiri
authors.forename: Julie
authors.initials: J
authors.lastname: Pavlin
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Mason
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D020640:Arcobacter / Q000302:isolation & purification; D002167:Campylobacter / Q000302:isolation & purification; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000382:microbiology*; D005506:Food Contamination; D006801:Humans; D008826:Microbial Sensitivity Tests; D012147:Restaurants; D012307:Risk Factors; D012475:Salmonella / Q000302:isolation & purification; D013785:Thailand; D014195:Travel
chemical_list: D000900:Anti-Bacterial Agents