February 2021 Update
Since July 2020, CDC has received eight reports of highly antibiotic-resistant Pseudomonas aeruginosa infections in patients who underwent surgery or other invasive procedures in Mexico. Among these, six occurred in patients who underwent medical procedures (bariatric surgery, plastic surgery, cholecystectomy, and cancer treatment) in Tijuana, Baja California, Mexico at different healthcare facilities. Two cases occurred in patients who underwent surgery in the state of Jalisco, Mexico. At this time there is no evidence of an ongoing outbreak linked to a particular facility or surgeon. CDC will continue to monitor reports of Pseudomonas aeruginosa infection linked to invasive procedures in Mexico.
Strain information for clinicians, laboratory scientists, and public health officials:
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 can cause infections that are difficult to treat. VIM-CRPA isolates associated with the initial outbreak in Tijuana have been extensively drug resistant (XDR).
Testing resources for Pseudomonas aeruginosa are available through the Antibiotic Resistance Laboratory Network which can be accessed through state health department healthcare-associated infections programs
Patients considering medical procedures abroad should be aware that receipt of health care abroad might increase the potential for infections caused by highly antibiotic-resistant organisms not commonly found in the United States.
CDC recommends that patients who underwent medical procedures (such as surgery or endoscopy) in Mexico and are experiencing signs of infection (e.g., redness, pus or swelling at the surgical incision site) seek medical care and inform their providers of their exposure to health care outside the United States (e.g., share the information on this webpage).
Healthcare providers caring for patients who underwent recent (within last year) invasive procedures in Mexico should follow the infection control recommendations listed below to prevent the potential spread of highly-resistant bacteria to other patients, as these highly resistant bacteria have the potential to spread rapidly in healthcare settings.
For individuals considering elective or non-urgent medical care outside of the United States, CDC’s Travelers’ Health website has information on risks of infection associated with medical tourism and getting health care abroad.
Recommendations on this website were updated to include patients who underwent surgery or invasive procedures at healthcare facilities anywhere in Mexico in response to recent cases which occurred in patients receiving care in areas other than Tijuana, Baja California, Mexico.
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 surgery or an invasive procedure in 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.
Highly antibiotic resistant Pseudomonas aeruginosa continue to be reported among travelers with infections who underwent surgery or invasive procedures at several healthcare facilities in 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.
- When caring for patients with a history of receiving surgery or an invasive procedure in 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.
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.
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 31, 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 31, 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.
- News Article: The San Diego Union-Tribune – CDC: Superbug involved in Tijuana bariatric surgery infectionsexternal icon
- News Article: The Washington Post – They went to Mexico for surgery. They came back with a deadly superbugexternal icon.
- World Health Organization – Carbapenem-resistant Pseudomonas aeruginosa infection – Mexicoexternal icon