Gastrointestinal illnesses are the most frequently diagnosed conditions among returning U.S. travelers. Although most episodes of travelers'
diarrhea do not require
antibiotic therapy,
fluoroquinolones (a type of
quinolone antibiotic) are recommended for treatment of moderate and severe travelers'
diarrhea as well as many other types of severe
infection. To assess associations between
quinolone susceptibility and international travel, we linked data about isolate susceptibility in NARMS to cases of enteric
infections reported to FoodNet. We categorized isolates as
quinolone-nonsusceptible (QNS) if they were resistant or had intermediate susceptibility to ≥1
quinolone. Among 1,726
travel-associated infections reported to FoodNet with antimicrobial susceptibility data in NARMS during 2004-2014, 56% of isolates were
quinolone-nonsusceptible, of which most (904/960) were Campylobacter. International travel was associated with >10-fold increased odds of
infection with
quinolone-nonsusceptible bacteria. Most QNS
infections were associated with travel to Latin America and the Caribbean (390/743; 52%); however, the greatest risk of QNS
infection was associated with travel to Africa (120 per 1,000,000 passenger journeys). Preventing acquisition and onward transmission of antimicrobial-resistant enteric
infections among travelers is critical.