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

Scott J.C. Pallett; Sara E. Boyd; Aakash Khanijau; Rishi Banerjee; Nicola Reece; Sarah Jawad; Victoria Daniel; Matthew Routledge; Harin Navalan; Christopher Ward; Kordo Saeed; Jonathan Lambourne; David A. Enoch; Gabriella Shanks; James Cai; Anna Wild; Nikunj Mahida; Heather Hiles; Helena Parsons; Maya Tickell-Painter; Robert Shorten; Vino Srirathan; Joe Suich; Deborah Wearmouth; Rishi Dhillon; Nabeela Mughal; Stephen D. Woolley; Matthew K. O'Shea; Luke 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

Scott J.C. Pallett^*
, Sara E. Boyd
, Aakash Khanijau
, Rishi Banerjee
, Nicola Reece
, Sarah Jawad
, Victoria Daniel
, Matthew Routledge
, Harin Navalan
, Christopher Ward
, Kordo Saeed
, Jonathan Lambourne
, David A. Enoch
, Gabriella Shanks
, James Cai
, Anna Wild
, Nikunj Mahida
, Heather Hiles
, Helena Parsons
, Maya Tickell-Painter

Robert Shorten, Vino Srirathan, Joe Suich, Deborah Wearmouth, Rishi Dhillon, Nabeela Mughal, Stephen D. Woolley, Matthew K. O'Shea, Luke S.P. Moore

^*Corresponding author for this work

Immunology and Immunotherapy

Research output: Contribution to journal › Article › peer-review

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.

Original language	English
Journal	The Journal of Hospital Infection
Early online date	16 Dec 2025
DOIs	https://doi.org/10.1016/j.jhin.2025.11.045
Publication status	E-pub ahead of print - 16 Dec 2025

Bibliographical note

Keywords

Antimicrobial resistance
infection prevention and control
surveillance
screening
global health security

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jhin.2025.11.045Licence: Creative Commons: Attribution-NonCommercial-NoDerivs (CC BY-NC-ND)

Cite this

Pallett, S. J. C., Boyd, S. E., Khanijau, A., Banerjee, R., Reece, N., Jawad, S., Daniel, V., Routledge, M., Navalan, H., Ward, C., Saeed, K., Lambourne, J., Enoch, D. A., Shanks, G., Cai, J., Wild, A., Mahida, N., Hiles, H., Parsons, H., ... Moore, L. S. P. (2025). Travel-associated carbapenem-resistant organisms at a time of increasing geopolitical instability: a UK perspective. The Journal of Hospital Infection. Advance online publication. https://doi.org/10.1016/j.jhin.2025.11.045

@article{fe4cf79df9884dc78b15a4ebbfb04ca6,

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

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.",

keywords = "Antimicrobial resistance, infection prevention and control, surveillance, screening, global health security",

author = "Pallett, \{Scott J.C.\} and Boyd, \{Sara E.\} and Aakash Khanijau and Rishi Banerjee and Nicola Reece and Sarah Jawad and Victoria Daniel and Matthew Routledge and Harin Navalan and Christopher Ward and Kordo Saeed and Jonathan Lambourne and Enoch, \{David A.\} and Gabriella Shanks and James Cai and Anna Wild and Nikunj Mahida and Heather Hiles and Helena Parsons and Maya Tickell-Painter and Robert Shorten and Vino Srirathan and Joe Suich and Deborah Wearmouth and Rishi Dhillon and Nabeela Mughal and Woolley, \{Stephen D.\} and O'Shea, \{Matthew K.\} and Moore, \{Luke S.P.\}",

note = "Copyright {\textcopyright} 2025 The Author(s). Published by Elsevier Ltd.",

year = "2025",

month = dec,

day = "16",

doi = "10.1016/j.jhin.2025.11.045",

language = "English",

journal = "The Journal of Hospital Infection",

issn = "0195-6701",

publisher = "Elsevier",

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Pallett, SJC, Boyd, SE, Khanijau, A, Banerjee, R, Reece, N, Jawad, S, Daniel, V, Routledge, M, Navalan, H, Ward, C, Saeed, K, Lambourne, J, Enoch, DA, Shanks, G, Cai, J, Wild, A, Mahida, N, Hiles, H, Parsons, H, Tickell-Painter, M, Shorten, R, Srirathan, V, Suich, J, Wearmouth, D, Dhillon, R, Mughal, N, Woolley, SD, O'Shea, MK & Moore, LSP 2025, 'Travel-associated carbapenem-resistant organisms at a time of increasing geopolitical instability: a UK perspective', The Journal of Hospital Infection. https://doi.org/10.1016/j.jhin.2025.11.045

TY - JOUR

T1 - Travel-associated carbapenem-resistant organisms at a time of increasing geopolitical instability

T2 - a UK perspective

AU - Pallett, Scott J.C.

AU - Boyd, Sara E.

AU - Khanijau, Aakash

AU - Banerjee, Rishi

AU - Reece, Nicola

AU - Jawad, Sarah

AU - Daniel, Victoria

AU - Routledge, Matthew

AU - Navalan, Harin

AU - Ward, Christopher

AU - Saeed, Kordo

AU - Lambourne, Jonathan

AU - Enoch, David A.

AU - Shanks, Gabriella

AU - Cai, James

AU - Wild, Anna

AU - Mahida, Nikunj

AU - Hiles, Heather

AU - Parsons, Helena

AU - Tickell-Painter, Maya

AU - Shorten, Robert

AU - Srirathan, Vino

AU - Suich, Joe

AU - Wearmouth, Deborah

AU - Dhillon, Rishi

AU - Mughal, Nabeela

AU - Woolley, Stephen D.

AU - O'Shea, Matthew K.

AU - Moore, Luke S.P.

PY - 2025/12/16

Y1 - 2025/12/16

N2 - 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.

AB - 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.

KW - Antimicrobial resistance

KW - infection prevention and control

KW - surveillance

KW - screening

KW - global health security

U2 - 10.1016/j.jhin.2025.11.045

DO - 10.1016/j.jhin.2025.11.045

M3 - Article

C2 - 41412384

SN - 0195-6701

JO - The Journal of Hospital Infection

JF - The Journal of Hospital Infection

ER -

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

Abstract

Bibliographical note

Keywords

UN SDGs

Access to Document

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Cite this