title: Management of infections in critically ill returning travellers in the intensive care unit-I: considerations on infection control and transmission of resistance.
abstract: Depending on their destinations and activities, international travellers are at a significant risk of contracting both communicable and non-communicable diseases. On return to their home countries, such travellers may require intensive care. The emergence of severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), and more recently Ebola haemorrhagic fever, has highlighted the risks. Other well-known communicable pathogens such as methicillin-resistant Staphylococcus aureus and carbapenemase-producing Enterobacteriaceae have been described previously. However, malaria remains by far the most important cause of death. The issues related to imported antibiotic resistance and protection from highly contagious diseases are reviewed here. Surveillance strategies based on epidemiological data (country visited, duration of travel, and time elapsed since return) and clinical syndromes, together with systematic search policies, are usually mandatory to limit the risk of an outbreak. Single-bed hospital rooms and isolation according to symptoms should be the rule while awaiting laboratory test results. Because person-to-person contact is the main route of transmission, healthcare workers should implement specific prevention strategies.
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University Medical School, Samsun, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Leblebicioglu
authors.affiliation: Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia.
authors.forename: Alfonso J
authors.initials: AJ
authors.lastname: Rodriguez-Morales
authors.affiliation: Department of Medical Biotechnologies, University of Siena, Siena, Italy; Department of Experimental and Clinical Medicine, University of Florence, and Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy.
authors.forename: Gian Maria
authors.initials: GM
authors.lastname: Rossolini
authors.affiliation: National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, Madrid, Spain.
authors.forename: Rogelio
authors.initials: R
authors.lastname: López-Vélez
authors.affiliation: Infection Control Unit, Université d'Angers, Centre Hospitalier Universitaire d'Angers, Angers, France.
authors.forename: Jean-Ralph
authors.initials: JR
authors.lastname: Zahar
authors.affiliation: CIBERES, Vall Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain. Electronic address: jrello@crips.es.
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
mesh_terms: D016638:Critical Illness / Q000453:epidemiology; D004196:Disease Outbreaks; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007239:Infections / Q000628:therapy* / Q000635:transmission; D007362:Intensive Care Units; D014195:Travel
keywords: ICU; Infection control; Migrant; Resistance; Traveller