Colonization with Multidrug-resistant bacteria among children hospitalized abroad—A Study from Finland 

International travel, particularly hospitalization abroad, plays a significant role in the global spread of antimicrobial resistance (AMR) among children. In this long-term study (2010–2024) at Helsinki University Hospital, one-third (34.4%) of paediatric patients previously hospitalized abroad were colonized with multidrug-resistant organisms (MDROs). The most frequently detected MDROs were extended-spectrum β-lactamase–producing Enterobacterales (ESBL-PE) and methicillin-resistant Staphylococcus aureus (MRSA), with carbapenemase-producing Enterobacterales (CPE) identified in a smaller but clinically important proportion (3.1%).

Independent risk factors for MDRO colonization included recent antibiotic use, type of travel, and—most prominently—the income level of the country where hospitalization occurred. Colonization rates increased markedly with decreasing country income, ranging from 13.5% after hospitalization in high-income countries to 87.5% in low-income countries. Although only a small proportion of colonized children developed clinical infection (3.2%), the high carriage rates underscore the importance of systematic screening and infection control following healthcare exposure abroad, especially for children hospitalized in low- and middle-income countries or those with additional risk factors such as visiting friends and relatives (VFR) travel, foreign residence, or recent antibiotic use.