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Volume 28, Number 1—January 2022

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

Ian Kracalik1Comments to Author , 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)

Main Article

Table 1

Characteristics for 38 confirmed and probable case-patients who had Verona integron‒encoded, metallo-β-lactamase‒producing Pseudomonas aeruginosa among US medical tourists traveling to Tijuana, Mexico, January 2018–December 2019

Characteristic No. (%)
Age, y
23–34 14 (37)
35–49 15 (40)
50–64 6 (16)
≥65 1 (3)
2 (5)
F 34 (90)
4 (10)
Surgical facility
Facility A 27 (71)
Facility B 1 (3)
Facility C 1 (3)
Facility D 1 (3)
Facility E* 2 (5)
Facility F 1 (3)
Facility G 1 (3)
Facility H 1 (3)
Facility I 2 (5)
Facility J 1 (3)
1 (3)
Surgeon who performed procedure
Surgeon 1 31 (82)
Surgeon 2 1 (3)
Surgeon 3 1 (3)
Surgeon 4 1 (3)
Surgeon 5 1 (3)
3 (8)
Surgical procedure†
Sleeve gastrectomy 34 (90)
Cholecystectomy 1 (3)
Laparoscopic adjustable gastric band 1 (3)
Sleeve gastrectomy revision 1 (3)
Unspecified bariatric surgery
3 (8)
Specimen source
Wound 31 (82)
Intraabdominal abscess 4 (11)
Abdominal fluid 1 (3)
Blood 1 (3)
Rectal swab specimen
1 (3)
Hospitalized in the United States after surgery 16 (42)
Patient died within 30 d of specimen collection 1 (3)

*Patient reported exposure to facilities E and D. †Four patients underwent >1 procedure: gastrectomy and cholecystectomy (n = 1), sleeve gastrectomy and bowel resection (1), sleeve gastrectomy and lap band removal (1), and sleeve gastrectomy, breast augmentation, and abdominoplasty (1).

Main Article

1These authors contributed equally to this article.

2Members of this team are listed at the end of this article.

Page created: October 28, 2021
Page updated: December 20, 2021
Page reviewed: December 20, 2021
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