One of the many things that bugs me (pun intended) is the suggestion that medical tourism, where people travel to other countries for lower-cost procedures, should be seriously considered as a solution to the U.S.’s inability to provide affordable healthcare. Why? The importation of highly antibiotic resistant bacteria from hospitals in countries with significant resistance problems. Now Scary Disease Lady (like ‘Maryn McKenna’ is her real name…) discuss a recent report in which three of 574 France travellers to India returned with carbapenemase-producing organisms (in the paper, there’s no discussion of MICs, so it’s unclear if these organisms were resistant to carbapenems):

A team of French researchers reports that healthy travelers who had no contact with foreign medical systems brought back extremely drug-resistant bacteria, probably just from drinking water, and that the bacteria persisted in their guts for at least two months after they came home….

Most of the people who have returned to the West carrying these highly resistant bacteria had the misfortune to be injured, or otherwise need medical care, while they were traveling. Since hospitals even in the industrialized world tend to be places where problematic infections lurk, that made sense….

The French team asked 574 travelers going to sub-tropical areas to donate stool samples before they left and after they returned, to see what they had picked up during their time abroad. In three of them — all from the 57 out of the 574 who had gone to India — they found E. coli that was carrying this resistance-conferring DNA and that had not been present when the travelers left.

For the cognoscenti, each of these three patients appeared to have multiple carbapenem-producing organisms, and these strains persisted for two months after they returned. Unfortunately, there was no detailed genotyping reported so we don’t know much else about the organisms. Still, this is how resistance evolves and spreads.

Have a nice day!

Cited article: Ruppé E, Armand-Lefèvre L, Estellat C, El-Mniai A, Boussadia Y, Consigny PH, Girard PM, Vittecoq D, Bouchaud O, Pialoux G, Esposito-Farèse M, Coignard B, Lucet JC, Andremont A, Matheron S. Acquisition of carbapenemase-producing Enterobacteriaceae by healthy travellers to India, France, February 2012 to March 2013 . Euro Surveill. 2014;19(14):pii=20768. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20768