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Drug-Resistant Surgical Infections in Mexico Fuel 'Medical Tourism' Fears in US

JAN 16, 2019 | ALEXANDRA WARD
The US Centers for Disease Control and Prevention (CDC) has issued a level 2 travel notice on drug-resistant infections in Mexico caused by an antibiotic-resistant strain of Pseudomonas aeruginosa.

United States residents who underwent invasive medical procedures, primarily weight-loss surgery, at facilities in Tijuana, Mexico, are being diagnosed with serious infections caused by drug-resistant Pseudomonas aeruginosa. Such infections are not common in the United States and are particular difficult to treat, the CDC said in a statement.

Roughly half of the infected individuals had surgery at Grand View Hospital in Tijuana, while others had procedures at other facilities. The Mexican government has closed Grand View until it can confirm the strain of bacteria is no longer present.

Pseudomonas is typically an environmental organism and we tend to see it associated with environmental contamination,” Saskia Popescu, MPH, MA, CIC, an infection preventionist and Contagion® contributor, said. “Outbreaks are normally involving those with compromised immune systems, but in a surgical environmental, it’s likely related to one or two things (or even both)—poor environmental disinfection of the operating room or breaches in sterilization processes in their central sterile processing department.”

This sort of “medical tourism”—where people travel to other countries for medical procedures—poses serious public health risks in situations such as this when individuals become infected with a hard-to-treat, antibiotic-resistant pathogen that is rare in their native country.

“This outbreak is truly a big deal,” Popescu told Contagion®. “It highlights the concerns with medical tourism and how it feeds antimicrobial resistance. While patients may think they’re saving money, they put themselves at a bigger risk for surgical site infections and resistant organisms that can be costly and dangerous.”

The CDC urges US residents traveling to Mexico not to have surgery at Grand View Hospital until it is cleared. Health care providers should perform antimicrobial susceptibility testing to guide treatment and take steps to report any surgical site infections in patients who had invasive procedures in Mexico to the local or state health departments.

“Providers caring for patients with a history of invasive procedures in Mexico should be aware of the potential for infections caused by resistant pathogens. The pathogen implicated in the current cluster of infections is carbapenem-resistant Pseudomonas aeruginosa,” the CDC said in a statement. “The resistance mechanism is a metallo-β-lactamase encoded by a mobile genetic element known as the Verona integron. Carbapenem-resistant Pseudomonas aeruginosa are drug-resistant and difficult to treat, requiring protracted and complex antibacterial drug combinations and courses. Consult with an infectious disease specialist.”
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