Evaluation of a programme for ‘Rapid Assessment of Febrile Travelers’ (RAFT): a clinic-based quality improvement initiative

Jazuli, Farah; Lynd, Terence; Mah, Jordan; Klowak, Michael; Jechel, Dale; Klowak, Stefanie; Ovens, Howard; Sabbah, Sam; Boggild, Andrea K

In single-centre and multicentre analyses, TD is the most common cause of non-malarial fever in the returned traveller. 6 8-13 Invasive bacterial gastroenteritides (eg, Campylobacter, Salmonella) are common specific causes of fever in the returned traveller, but a specific aetiological confirmation is unlikely due to the insensitivity of stool culture. Of 33 febrile returned travellers with presumed bacterial TD in this study, only six had stool culture positivity for a typical bacterial enteropathogen, despite >80% of TD being bacterial. 15 This lack of aetiological confirmation among individuals with TD has led to widespread implementation of empiric treatment strategies (eg, 3 days of ciprofloxacin 15 ); however, this approach may foster increased fluoroquinolone resistance among endogenous flora, and is counter to the tenets of antimicrobial stewardship. High-sensitivity, multiplex stool pathogen detection assays, now even commercially available, 16 17 have the potential to better direct antimicrobial treatment decisions in returned travellers with TD.