Rogers BA, Aminzadeh Z, Hayashi Y, Paterson DL.
Clinical Infectious Diseases 2011;53(1):49–56
This review outlines how increasing modalities of travel, such as aeromedical evacuation of civilians and of military personnel, medical tourism and any shared healthcare across countries, are risks for the transmission of multidrug-resistant organisms via the patient, from country to country.
The authors performed a systematic search of the literature looking at inter-country transfer of multiresistant bacterial pathogens like Acinetobacter spp. and Enterobacteriaceae that produce carbapenemases (e.g. Klebsiella pneumoniae carbapenemase (KPC) and the novel New Delhi metallo-β-lactamase (NDM), meticillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and hypervirulent Clostridium difficile. The authors highlight the increasing potential for travellers and migrants to act as vectors (and victims) of healthcare-associated infections, and outbreaks with these multidrug-resistant bacteria.
In order to prevent the importation and to decrease the spread of these multidrug-resistant bacteria to and within receiving healthcare institutions and countries, the authors propose certain screening recommendations to be implemented. Suggestions are also made regarding how to target therapy based on microbiological results from clinical and screening cultures from these patients.
ECDC comment: This review underscores the risk of transfer of multidrug-resistant bacteria through increasing patient mobility. Caution and vigilance need to be implemented to correctly evaluate the at-risk-patient and to implement infection prevention measures correctly to prevent the importation and spread of these multidrug-resistant bacteria in the healthcare system in the destination country. It is of paramount importance to have a good infection prevention infrastructure to support the necessary infection prevention methods that need to be implemented.
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