The Travel Health and Vaccine Specialists

Drug-Resistant Infections in Patients Who Had Weight-Loss Surgery in Mexico

Alert – Level 2, Practice Enhanced PrecautionsWatch

Key Points

  • Some US residents returning from Tijuana, Baja California, Mexico, have been diagnosed with infections caused by an antibiotic-resistant form of Pseudomonas aeruginosa bacteria.
  • All of the travelers with this particular infection had surgery performed in Tijuana. Most (but not all) of them had weight-loss surgery. Over half of those infected had their procedure at the Grand View Hospital.
  • CDC is working with US state and local health departments to determine if any additional US residents were infected with the antibiotic-resistant form of Pseudomonas aeruginosa following surgery at Grand View Hospital. Until the investigation is complete, CDC recommends that travelers to Tijuana, Mexico, not have surgery (or other invasive medical procedures) at Grand View Hospital.
  • If you or someone you know had surgery or received medical care in Tijuana, Baja California, Mexico, see information about additional infectious risks.

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 aeruginosaPseudomonasinfections 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 surgery (primarily weight-loss surgery) in Tijuana, Mexico. Over half of those infected with drug-resistant Pseudomonas aeruginosa had surgery at Grand View Hospital, Tijuana. Others became infected after undergoing procedures at other hospitals and clinics in the city. Infections caused by this particular drug-resistant Pseudomonas are rare in the United States and are difficult to treat.

What can travelers to Mexico do to prevent drug-resistant infections?

Until CDC completes its investigation, we recommend that travelers to Mexico not have surgery (including weight-loss surgery) or other procedures at Grand View Hospital in Tijuana.

Additional information and advice for US residents planning to travel abroad for surgery or other medical care:

  • Some people who have traveled for medical care to countries outside the United States have been infected by hard-to-treat antibiotic-resistant strains of bacteria not commonly seen in the United States.
  • Medical and surgical procedures done anywhere (even in the United States) carry some risk and can result in complications.
  • See a travel medicine specialist in the United States at least a month before your trip. Travel medicine specialists can provide you with the guidance, vaccines, and medicines you may need for your travel.
  • Ask your doctor whether you are healthy enough to travel abroad for medical or surgical procedures.
  • Research the health care provider who will perform your procedure, as well as the clinic or hospital where you will receive care. Be aware that standards for providers and clinics abroad may be different from those in the United States.
  • Look for clinics and hospitals accredited by international organizations. Remember that using an internationally accredited facility is not a guarantee that your medical care will be free of complications.
  • Ask the clinic or hospital to provide you with copies of all of your medical records. If possible, these records should be in English. Bring them with you to any follow-up appointments you have.
  • Anytime you travel outside the country, consider the health and safety concerns at your destination. Also consider the additional risks posed by traveling after surgery:
    • Any prolonged travel after surgery increases your risk of developing blood clots in your legs. Avoid traveling for at least 10 days after surgery on your chest or abdomen (belly). The American Society of Plastic Surgeons recommends that patients fly no sooner than 7–10 days after having cosmetic procedures on the face or after laser treatments.
    • Consider the risks of participating in typical vacation activities after surgery. Avoid sunbathing, drinking alcohol, swimming, taking long tours, or participating in strenuous activities or exercise.

If you get sick during or after travel

If you think you have an infection or other complication, seek medical care immediately. Regardless of where you received care, tell your health care provider about your travel and any medical care or surgery you had abroad.

What can clinicians do?

  • US health care providers should be vigilant for the possibility of resistant infections occurring in patients who have traveled abroad for medical procedures. Take measures to control the spread of multidrug-resistant organisms in the United States.
  • 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 (CRPA). The resistance mechanism is a metallo-β-lactamase encoded by a mobile genetic element known as the Verona integron.
  • CRPA is drug-resistant and difficult to treat, requiring prolonged courses of complex antibacterial drug combinations. Consult with an infectious disease specialist.
  • When caring for patients who have undergone invasive procedures in Mexico, obtain cultures, perform antimicrobial susceptibility testing to guide treatment, and test any carbapenem-resistant bacteria for Verona integron and other plasmid-mediated carbapenemases. Report any CRPA surgical site infections in patients who had invasive procedures in Mexico to your local or state health department.
  • When admitting patients who have a history of overnight stays in health care facilities outside the United States, consider performing rectal screening for carbapenemase-producing organisms. This recommendation applies to patients hospitalized outside the United States at any time during the 6 months before their US hospital admission.
    • Consider placing such patients in isolation and contact precautions while awaiting screening results.
  • Mechanism testing for carbapenem-resistant bacteria and rectal screening for carbapenemases are available free of charge via the Antibiotic Resistance Laboratory Network, which can be accessed through state health department health care-associated infections programs.