Abstract
Medical tourism has a potential of spreading multi-drug resistant bacteria (MDR). The Hadassah Medical Center serves as a referral center for global medical tourists and for Palestinian Authority residents. In order to assess whether patients of these groups are more likely to harbor MDR bacteria than local residents, we reviewed data from all patients admitted to our institution between 2009 and 2014. We compared MDR rates between countries of residency, controlling for gender, age, previous hospitalization and time from admission to MDR detection. Overall, among 111,577 patients with at least one microbiological specimen taken during hospitalization, there were 3,985 (3.5%) patients with at least one MDR-positive culture. Compared to Israeli patients, tourists and patients from the Palestinian Authority had increased rates of MDR positivity (OR, 95%CI): 2.3 (1.6 to 2.3) and 8.0 (6.3 to 10.1), respectively. Our data show that foreign patients seeking advanced medical care are more likely to carry MDR bacteria than the resident population. Strategies to minimize MDR spread, such as pre-admission screening or pre-emptive isolation should be considered in this population.
Highlights
Multi-drug resistant (MDR) organisms are a global threat[1,2], leading to prolonged hospital stay, treatment failure, excess in-hospital death, and increased economic costs[3,4,5]
There is an increased risk that medical tourism could lead to geographically dispersed outbreaks of communicable diseases, including the spread of multi-drug resistant bacteria (MDR) bacteria to non-endemic facilities[7,8]
Most of the evidence regarding the potential threat of spreading resistant bacteria was based on single source epidemics associated with one traceable pathogen, or a resistance mechanism which was newly introduced to a country
Summary
Multi-drug resistant (MDR) organisms are a global threat[1,2], leading to prolonged hospital stay, treatment failure, excess in-hospital death, and increased economic costs[3,4,5]. Medical tourism is not new; as a result of the shrinking global village, far more people seeking expert medical care travel between countries. There is an increased risk that medical tourism could lead to geographically dispersed outbreaks of communicable diseases, including the spread of MDR bacteria to non-endemic facilities[7,8]. Traditional risk factors for carriage of MDR bacteria include previous carriage, recent hospital stay, recent exposure to antibiotics and long-term care facility residence[14]. Medical tourists are not considered a separate group that might require pre-emptive contact isolation[15]. We sought to assess whether these patient populations are more likely to harbor resistant bacteria than local patients and may necessitate pre-emptive isolation until carriage status is determined
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