Extensively Drug-Resistant Carbapenemase-Producing Pseudomonas aeruginosa and Medical Tourism from the United States to Mexico, 2018–2019
, D. Cal Ham1
, 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, and for the Verona Integron-Encoded Metallo-β-Lactamase–Producing Carbapenem-Resistant Pseudomonas aeruginosa Medical Tourism Investigation Team2
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (I. Kracalik, D. Cal Ham, G. McAllister, R.J. Stoney, K. Moser, M.E. Villarino, A. Bhatnagar, E. Sula, R.A. Stanton, A.C. Brown, A.L. Halpin, L. Epstein, M. Spalding Walters); Utah Department of Health, Salt Lake City, Utah, USA (A.R. Smith, M. Vowles); Washington State Department of Health, Olympia, Washington, USA (K. Kauber); Texas Department of State Health Services, Austin, Texas, USA (M. Zambrano, G. Rodriguez); Arkansas Department of Health, Little Rock, Arkansas, USA (K. Garner); Arizona Department of Health Services, Phoenix, Arizona, USA (K. Chorbi); Oregon Health Authority, Portland, Oregon, USA (P.M. Cassidy); West Virginia Department of Health and Human Resources, Charleston, West Virginia, USA (S. McBee); Secretaría de Salud de Baja California, Mexicali, Mexico (O.E. Zazueta)
Figure 3. Whole-genome sequencing analysis and selected epidemiologic data for 22 Verona-integron-encoded metallo-β-lactamase-producing carbapenem-resistant Pseudomonas aeruginosa clinical isolates from US medical tourists who underwent surgery in Tijuana, Mexico, August 2018–December 2019. Phylogenetic tree includes an outlier isolate from Arkansas. On the right, the first group of 8 columns indicates facilities (A, B,C, E, F, G, I, and unknown), and the second group of 4 columns indicates surgeons (1, 2, 3, and unknown). Scale bar indicates nucleotide substitutions per site.
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