Background Diarrhea remains a major public health problem for both civilian and military populations. This study describes the prevalence of acute diarrheal illness etiological agents, their antibiotic resistance distribution patterns, the resulting impact upon military force health protection, and potential prevention and treatment strategies. Results Forty-eight acute diarrhea stool samples from US military personnel deployed to Thailand from 2013-2017 were screened for enteric pathogens using ELISA, the TaqMan Array Card (TAC), and conventional microbiological methods. These isolates were also evaluated using antimicrobial susceptibility testing (AST) against ampicillin (AMP), azithromycin (AZM), ceftriaxone (CRO), ciprofloxacin (CIP), nalidixic acid (NA), erythromycin (ERY), and trimethoprim-sulfamethoxazole (SXT) using commercial methodology. Susceptibility results were interpreted following the CLSI and NARM guidelines. Questionnaire data obtained from 47/48 volunteers indicated that 89.4% (42/47) reported eating local food and the most common clinical symptoms were nausea and abdominal pain (51%; 24/47). Multiple bacterial species were identified from the 48 stool samples with diarrhea etiological agents being detected in 79% (38/48) of the samples distributed as follows: 43.8% (21/48) Campylobacter jejuni and Campylobacter species, 42% (20/48) diarrheagenic Escherichia coli, and 23% (11/48) Salmonella. Co-infections were detected in 46% (22/48) of the samples. All C. jejuni isolates were resistant to CIP and NA. One C. jejuni isolate exhibited resistance to both AZM and ERY. Lastly, an association between exposure to poultry and subsequent detection of the diarrhea-associated pathogens E. coli and P. shigelloides was significant (p < 0.05). Conclusion The detection of Campylobacter isolates with CIP, AZM and ERY resistance has critical force health protection and public health implications, as these data should guide effective Campylobacteriosis treatment options for deployed military members and travelers to Southeast Asia. Additional research efforts are recommended to determine the association of pathogen co-infections and/or other contributing factors towards diarrheal disease in military and traveler populations. Ongoing surveillance and AST profiling of potential disease-causing bacteria is required for effective disease prevention efforts and treatment strategies.

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2013-2017 年在泰国部署的美国军人急性腹泻粪便的肠道病原学监测。

背景 腹泻仍然是平民和军人的主要公共卫生问题。本研究描述了急性腹泻病病原体的流行情况、其抗生素耐药性分布模式、对军队健康保护的影响以及潜在的预防和治疗策略。结果 使用 ELISA、TaqMan 阵列卡 (TAC) 和常规微生物学方法对 2013-2017 年部署到泰国的美军人员的 48 份急性腹泻粪便样本进行了肠道病原体筛查。还使用针对氨苄青霉素 (AMP)、阿奇霉素 (AZM)、头孢曲松 (CRO)、环丙沙星 (CIP)、萘啶酸 (NA)、红霉素 (ERY) 和甲氧苄啶-磺胺甲恶唑 (SXT) 的抗菌药敏试验 (AST) 对这些分离株进行了评估) 使用商业方法。敏感性结果按照 CLSI 和 NARM 指南进行解释。从 47/48 名志愿者获得的问卷调查数据表明，89.4% (42/47) 报告吃当地食物，最常见的临床症状是恶心和腹痛 (51%; 24/47)。从 48 份粪便样本中鉴定出多种细菌种类，其中 79% (38/48) 的样本中检测到腹泻病原体，分布如下：43.8% (21/48) 空肠弯曲杆菌和弯曲杆菌种类，42% (20/48 ) 引起腹泻的大肠杆菌和 23% (11/48) 沙门氏菌。在 46% (22/48) 的样本中检测到合并感染。所有 C. jejuni 分离株都对 CIP 和 NA 具有抗性。一种空肠弯曲菌分离株对 AZM 和 ERY 均表现出抗性。最后，接触家禽与随后检测到与腹泻相关的病原体大肠杆菌和志贺氏杆菌之间存在显着关联（p < 0.05）。结论 检测具有 CIP、AZM 和 ERY 耐药性的弯曲杆菌分离株具有关键的部队健康保护和公共卫生意义，因为这些数据应为部署的军人和前往东南亚的旅行者提供有效的弯曲杆菌治疗选择。建议进行额外的研究，以确定病原体合并感染和/或其他促成军事和旅行者人群腹泻病的因素之间的关系。有效的疾病预防工作和治疗策略需要对潜在的致病细菌进行持续的监测和 AST 分析。志贺氏菌属显着（p < 0.05）。结论 检测具有 CIP、AZM 和 ERY 耐药性的弯曲杆菌分离株具有关键的部队健康保护和公共卫生意义，因为这些数据应为部署的军人和前往东南亚的旅行者提供有效的弯曲杆菌治疗选择。建议进行额外的研究，以确定病原体合并感染和/或其他促成军事和旅行者人群腹泻病的因素之间的关系。有效的疾病预防工作和治疗策略需要对潜在的致病细菌进行持续的监测和 AST 分析。志贺氏菌属显着（p < 0.05）。结论 检测具有 CIP、AZM 和 ERY 耐药性的弯曲杆菌分离株具有关键的部队健康保护和公共卫生意义，因为这些数据应为部署的军人和前往东南亚的旅行者提供有效的弯曲杆菌治疗选择。建议进行额外的研究，以确定病原体合并感染和/或其他促成军事和旅行者人群腹泻病的因素之间的关系。有效的疾病预防工作和治疗策略需要对潜在的致病细菌进行持续的监测和 AST 分析。因为这些数据应该为部署的军人和前往东南亚的旅行者提供有效的弯曲杆菌病治疗方案。建议进行额外的研究，以确定病原体合并感染和/或其他促成军事和旅行者人群腹泻病的因素之间的关系。有效的疾病预防工作和治疗策略需要对潜在的致病细菌进行持续的监测和 AST 分析。因为这些数据应该为部署的军人和前往东南亚的旅行者提供有效的弯曲杆菌病治疗方案。建议进行额外的研究，以确定病原体合并感染和/或其他促成军事和旅行者人群腹泻病的因素之间的关系。有效的疾病预防工作和治疗策略需要对潜在的致病细菌进行持续的监测和 AST 分析。