Emerging Infectious Diseases (Jan 2022)

Extensively Drug-Resistant Carbapenemase-Producing Pseudomonas aeruginosa and Medical Tourism from the United States to Mexico, 2018–2019

  • Ian Kracalik,
  • D. Cal Ham,
  • Gillian McAllister,
  • Amanda R. Smith,
  • Maureen Vowles,
  • Kelly Kauber,
  • Melba Zambrano,
  • Gretchen Rodriguez,
  • Kelley Garner,
  • Kaitlyn Chorbi,
  • P. Maureen Cassidy,
  • Shannon McBee,
  • Rhett J. Stoney,
  • Kathleen Moser,
  • Margarita E. Villarino,
  • Oscar E. Zazueta,
  • Amelia Bhatnagar,
  • Erisa Sula,
  • Richard A. Stanton,
  • Allison C. Brown,
  • Alison L. Halpin,
  • Lauren Epstein,
  • Maroya Spalding Walters

DOI
https://doi.org/10.3201/eid2801.211880
Journal volume & issue
Vol. 28, no. 1
pp. 51 – 61

Abstract

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Carbapenem-resistant Pseudomonas aeruginosa (CRPA) producing the Verona integron‒encoded metallo-β-lactamase (VIM) are highly antimicrobial drug-resistant pathogens that are uncommon in the United States. We investigated the source of VIM-CRPA among US medical tourists who underwent bariatric surgery in Tijuana, Mexico. Cases were defined as isolation of VIM-CRPA or CRPA from a patient who had an elective invasive medical procedure in Mexico during January 2018‒December 2019 and within 45 days before specimen collection. Whole-genome sequencing of isolates was performed. Thirty-eight case-patients were identified in 18 states; 31 were operated on by surgeon 1, most frequently at facility A (27/31 patients). Whole-genome sequencing identified isolates linked to surgeon 1 were closely related and distinct from isolates linked to other surgeons in Tijuana. Facility A closed in March 2019. US patients and providers should acknowledge the risk for colonization or infection after medical tourism with highly drug-resistant pathogens uncommon in the United States.

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