Pseudomonas aeruginosa

Bacterial Infections in Patients Who Had Surgery in Tijuana, Mexico

Multiple states in the United States have reported infections with a highly resistant form of the bacteria known as Pseudomonas aeruginosa among travelers who had surgery at several hospitals in Tijuana, Mexico since August 1, 2018. Although an outbreak that primarily occurred at a single facility appears to be over, CDC continues to receive reports of antibiotic–resistant Pseudomonas aeruginosa infections in patients following surgery in Tijuana. CDC continues to recommend that patients who had surgery or invasive procedures at any hospital in Tijuana, Mexico and are experiencing signs of an infection—such as redness, pus or swelling at the surgical incision site, or fever—seek medical care immediately. Serious complications can result without prompt treatment. Healthcare providers caring for patients who underwent invasive procedures in Tijuana should follow infection control recommendations listed below to prevent transmission to other patients, as highly resistant bacteria have the potential to spread rapidly in healthcare settings.

See below for more information for individuals who underwent surgery at Grand View Hospital during August 1, 2018 to January 30, 2019.

Patient Information

Patients who had surgery or an invasive procedure in Tijuana, Mexico, and who think they have an infection or other complication should seek medical care immediately.

  • Patients who have had weight loss surgery in Tijuana, Mexico, should share the information on this webpage with their healthcare provider.
  • Patients who are considering invasive procedures outside of the United States can visit CDC’s Travelers’ Health website pages on medical tourism and getting health care abroad for more information.

Clinician Information

Highly antibiotic resistant Pseudomonas aeruginosa continue to be reported among travelers with infections who underwent surgery at several hospitals in Tijuana, Mexico. These infections highlight that resistant bacteria may be more common in other countries than in the United States. Most travelers with infections underwent weight loss surgery and most infections have been at the surgical incision site. The infections were caused by a strain of P. aeruginosa that expresses a carbapenemase called the Verona integron-encoded metallo-β-lactamase (VIM). P. aeruginosa expressing VIM (VIM-CRPA) are often resistant to all first-line antibiotics and difficult to treat, requiring complex antibacterial drug combinations and prolonged courses. Healthcare providers should consult with an infectious disease specialist to determine the best available treatment options.

See below for more information for individuals who underwent surgery at Grand View Hospital during August 1, 2018 to January 30, 2019.

  • When caring for patients with a history of receiving surgery in Tijuana Mexico, healthcare providers should obtain cultures of the presumably infected site(s), if clinically appropriate. If bacteria are identified from the culture, perform antimicrobial susceptibility testing to guide treatment, and test carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii, and Pseudomonas aeruginosa for VIM and other plasmid-mediated carbapenemases. Report surgical site infections in patients who had invasive procedures in Tijuana, Mexico, to your local or state health department.
  • When admitting patients who have a history of an overnight stay in a health care facility anywhere 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 U.S.-based hospital admission.
  • Consider placing such patients in isolation and use 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 healthcare-associated infections programs.
Grand View Hospital Outbreak – Message for Patients

In late 2018, CDC identified an outbreak of infections in people who had surgery at Grand View Hospital in Tijuana, Mexico. This outbreak appears to be over as of April 30, 2019. Mexican health officials (Baja California, Mexico, Public Health Services Sanitary Control Section) identified poor infection control practices at the hospital, including failure to follow recommended practices for assuring the quality of sterilization of medical devices and instruments. These practices put patients at risk for infections. As a precaution, CDC recommends that patients who had surgery at Grand View Hospital between August 1, 2018 and January 30, 2019, talk to their healthcare provider about getting tested for the bloodborne pathogens hepatitis B virus, hepatitis C virus, and human immunodeficiency virus (HIV), even though the risk for developing one of these infections is low. Individuals who had surgery at Grand View Hospital before August 2018 or after January 30, 2019, or had surgery at another hospital in Tijuana and are concerned about bacterial or bloodborne pathogen infection should talk to their healthcare provider. Decisions on testing should be made on a case-by-case basis.