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Medical Tourism and Postoperative Infections: A Systematic Literature Review of Causative Organisms and Empiric Treatment

Padilla, Pablo, M.D.; Ly, Priscilla, B.S.; Dillard, Rachel, B.S.; Boukovalas, Stefanos, M.D.; Zapata-Sirvent, Ramon, M.D.; Phillips, Linda G., M.D.

Plastic and Reconstructive Surgery: December 2018 - Volume 142 - Issue 6 - p 1644-1651
doi: 10.1097/PRS.0000000000005014
Plastic Surgery Focus: Special Topics
Patient Safety CME

Background: Medical tourism has become increasingly globalized as individuals travel abroad to receive medical care. Cosmetic patients in particular are more likely to seek surgery abroad to defray costs. Unfortunately, not all procedures performed abroad adhere to strict hygienic regulations, and bacterial flora vary. As a result, it is not uncommon for consumers to return home with difficult-to-treat postoperative infections.

Methods: A systematic literature review of PubMed, Ovid, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases was performed to assess the microbiology patterns and medical management of patients with postoperative infections after undergoing elective surgery abroad.

Results: Forty-two cases of postoperative infections were reported among patients who underwent elective surgery abroad. Most cases were reported from the Dominican Republic, and the most common elective procedures were abdominoplasty, mastopexy, and liposuction. Rapidly growing mycobacteria such as Mycobacterium abscessus, Mycobacterium fortuitum, and Mycobacterium chelonae were among the most common causes of postoperative infection, with M. abscessus involving 74 percent of cases. Most cases were treated with surgical débridement and a combination of antibiotics. Clarithromycin, amikacin, and moxifloxacin were the most common drugs used for long-term treatment.

Conclusions: When encountering a patient with a history of medical tourism and treatment-refractory infection, rapidly growing mycobacteria must be considered. To increase the likelihood of yielding a diagnostic organism, multiple acid-fast bacilli cultures from fluid and débridement content should be performed. There has been reported success in treating rapidly growing mycobacterial infections with a combination of antibiotics including clarithromycin, amikacin, and moxifloxacin.

Patient Safety CME.

Galveston, Texas

From the Division of Plastic Surgery, Department of Surgery, University of Texas Medical Branch.

Received for publication January 24, 2018; accepted May 9, 2018.

Disclosure:The authors have no financial interest to declare in relation to the content of this article. This work received no financial support or funding.

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Linda G. Phillips, M.D., Division of Plastic Surgery, Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, Texas 77555,

Copyright © 2018 by the American Society of Plastic Surgeons