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CDPH Health Advisory:
Ongoing Risk of Highly Drug-Resistant Infections in Patients Following Hospitalization or Invasive Procedures in Tijuana, Mexico

KEY MESSAGES
  • The California Department of Public Health (CDPH) is alerting healthcare providers to the ongoing risk of infections caused by Verona integron-encoded metallo-beta-lactamase (VIM)-producing carbapenem-resistant Pseudomonas aeruginosa (VIM-CRPA) in patients following hospitalization or invasive procedures in Tijuana, Mexico.
  • The Long Beach Department of Health and Human Services (Health Department) is requesting that clinicians call the Communicable Disease Control Program at 562.570.4302 to report any cases of VIM-CRPA or other unusual or highly resistant organisms.
  • Mechanism testing to confirm carbapenemase-producing bacteria can also be requested through the Long Beach Health Department.
  • The CDPH Health Advisory below summarizes the current situation and provides guidance on screening, testing, and infection control measures.
Health Advisory: Ongoing Risk of Highly Drug-Resistant Infections in Patients Following Hospitalization or Invasive Procedures in Tijuana, Mexico
November 2019
 
CDPH and local public health partners are alerting healthcare providers to the ongoing risk of highly drug-resistant infections in patients following hospitalization or invasive procedures in Tijuana, Mexico, not limited to medical tourism. A previous outbreak of surgical site infections with VIM-producing carbapenem-resistant Pseudomonas aeruginosa (VIM-CRPA) primarily associated with bariatric surgery at Grand View Hospital (https://www.cdc.gov/hai/outbreaks/pseudomonas-aeruginosa.html) was deemed over and CDC removed its travel advisory. However, CDC and multiple state and local health departments continue to receive reports of VIM-CRPA infections in patients following surgeries and invasive procedures at several different hospitals in Tijuana. Five cases of VIM-CRPA infections have been identified in patients with healthcare exposures in Tijuana-area hospitals and subsequently hospitalized in San Diego. The most recent case had a surgery in a Tijuana-area hospital in August 2019.

The CDPH Healthcare-Associated Infections (HAI) Program recommends healthcare providers be vigilant for the possibility of VIM-CRPA and other resistant infections in patients following hospitalization or invasive procedures in Tijuana, not limited to medical tourism. The need for vigilance applies to anywhere in California where binational patients or medical tourists might return and seek care. The CDPH HAI Program recommends the following measures to identify and control the spread of resistant organisms in California:
  • When caring for patients who have a history of hospitalization or invasive procedure in Mexico, obtain cultures, perform antimicrobial susceptibility testing to guide treatment, and test any carbapenem-resistant bacteria for VIM and other plasmid-mediated carbapenemases. VIM-CRPA are highly resistant and difficult to treat, requiring protracted and complex antibacterial drug combinations and courses; consult with an infectious disease specialist for treatment guidance.
  • Perform rectal screening for carbapenemase-producing organisms when admitting patients who have a history of overnight stays in healthcare facilities outside the United States during the 12 months before their US-based hospital admission. Consider placing such patients in isolation and Contact precautions while awaiting screening results.
  • Place patients from whom VIM-CRPA is isolated (regardless of specimen source) in isolation on Contact precautions, and ask about receipt of healthcare in Mexico or anywhere outside the U.S., including medical tourism, in the 12 months prior to positive culture. Note that infection control measures including Contact precautions may still be required for patients with highly resistant organisms that test negative for carbapenemase.
  • Report any cases of VIM-CRPA or other unusual or highly resistant organisms to your local health department and the CDPH HAI Program at HAIprogram@cdph.ca.gov.
Carbapenemase mechanism testing for carbapenem-resistant bacteria is available via some local public health laboratories and the CDPH Microbial Diseases Laboratory. Rectal screening for carbapenemases is available free of charge via the CDC Antibiotic Resistance Laboratory Network and can be accessed through your local health department in consultation with the CDPH HAI Program by contacting HAIprogram@cdph.ca.gov. The California AR Lab-Epi Alliance website (https://www.cdph.ca.gov/Programs/CHCQ/HAI/Pages/CA_ARLN.aspx) includes information about these testing resources.
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