Thursday, January 10, 2019

CDC Traveler's Advisory: Drug-Resistant Pseudomonas aeruginosa Infections In Mexico

Credit CDC


While medical tourism often offers an attractive price for elective surgery it has occasionally been linked to the acquisition - and importation - of resistant bacterial infections.   A few journal articles on point include:
The Globalization of Healthcare: Implications of Medical Tourism for the Infectious Disease Clinician- Lin H. Chen Mary E. Wilson

Multistate US Outbreak of Rapidly Growing Mycobacterial Infections Associated With Medical Tourism to the Dominican Republic, 2013–2014 - EID Journal
Medical Tourism and Postoperative Infections: A Systematic Literature Review of Causative Organisms and Empiric Treatment - 2018 Dec 

With the rise of carbapenen-resistant bacteria, these types of infections become more difficult to treat, and their importation - and spread - a greater threat.  Late yesterday the CDC released a Level 2 Travel notice on Drug Resistant Pseudomonas aeruginosa Infections - most apparently acquired through invasive weight loss surgery in Tijuana, Mexico.

Drug-Resistant Infections in Mexico

Alert - Level 2, Practice Enhanced Precautions

Key Points
Recently, some US residents returning from Tijuana, Baja California, Mexico, were diagnosed with infections caused by an antibiotic-resistant form of Pseudomonas aeruginosa bacteria.
All of the travelers with this particular infection had an invasive medical procedure performed in Tijuana. Most (but not all) of them had weight-loss surgery. About half of those infected had their surgery done at the Grand View Hospital.
Based on information provided by the CDC, the Mexican government has closed the Grand View Hospital until further notice.
CDC recommends that travelers to Tijuana, Mexico, not have surgery at the Grand View Hospital until the Mexican government can confirm that the drug-resistant form of Pseudomonas aeruginosa bacteria is no longer there.

What is drug-resistant Pseudomonas?

Pseudomonas is a kind of bacteria found widely in the environment. The most common type of Pseudomonas that infects humans is called Pseudomonas aeruginosa. Pseudomonas infections of the blood, lungs (pneumonia), and after surgery can lead to severe illness and death.

Unfortunately, bacteria (including Pseudomonas) are becoming more resistant to antibiotics. Infections with bacteria that are resistant to antibiotics are much harder to treat. Bacteria that cause infections that doctors cannot treat easily with antibiotics are called “drug-resistant.” Drug-resistant Pseudomonas bacteria do not respond to most commonly available antibiotics.
What is the current situation?

CDC has received reports of serious drug-resistant Pseudomonas aeruginosa infections in US residents who had invasive medical procedures (primarily weight-loss surgery) in Tijuana, Mexico. About half of those infected with these bacteria had surgery at Grand View Hospital, Tijuana. The others became infected after surgery at other hospitals and clinics. Infections caused by this particular drug-resistant Pseudomonas are rare in the United States and difficult to treat.
What can travelers to Mexico do to prevent drug-resistant infections?

CDC recommends that travelers to Mexico not have surgery (including weight-loss surgery) at Grand View Hospital in Tijuana, until the Mexican government can confirm that the drug-resistant form of Pseudomonas aeruginosa bacteria is no longer there.
       (Continue . . . )

While it is certainly possible to acquire a Pseudomonas infection in a U.S. hospital (see below), your odds of encountering a drug-resistant version are much higher in a lot of countries outside of the United States.

This from the CDC's  Pseudomonas aeruginosa in Healthcare Settings

Multidrug-resistant Pseudomonas can be deadly for patients in critical care.  An estimated 51,000 healthcare-associated P. aeruginosa infections occur in the United States each year. More than 6,000 (13%) of these are multidrug-resistant, with roughly 400 deaths per year attributed to these infections.  Multidrug-resistant Pseudomonas was given a threat level of serious threat in the CDC AR Threat report.

While we are always alert for the next potential severe pandemic, the rise of antimicrobial resistance is arguably the great public health challenge the world will face in the foreseeable future.  The prospects of entering a `post-antibiotic' era are both real, and quite grim.

While I cover AMR topics occasionally in this blog, I can heartily recommend CIDRAP's Antimicrobial Stewardship Project as the best place to learn about the growing global threat of AMR.
You'll also want to check out the CIDRAP-ASP Youtube Channel, which has more than 24 hours of lectures and webinars on Antimicrobial stewardship.
Some of my more recent blogs on the threat of antibiotic resistance include:
WHO Report: Wide Differences In Antibiotic Use Between Countries

The Lancet: Attributable Deaths & Disability Due To Infections With Antibiotic-Resistant Bacteria - EU 2015

Pakistan Media Reports: Scores Of `Counterfeit' Drugs Removed From Punjab Hospitals

mBio: The Gathering Storm: Is Untreatable Typhoid Fever on the Way?
Global AMR Threat: Centrally Approved & Unapproved Antibiotic Formulations Sold In India
WHO: First Global Antimicrobial Surveillance System (GLASS) Report

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