Medical tourism: first report of multiresistant bacteria after elective surgery in India

A PATIENT who returned to Australia with an untreatable multiresistant gram-negative bacterium following elective surgery in India has highlighted the risks associated with medical tourism.

Concerns about the growing multibillion dollar industry have been backed by the Royal Australasian College of Surgeons (RACS) which says surgeons are increasingly performing corrective operations following cheap surgery performed overseas.

The first Australian case of a multiresistant strain of the gram-negative organism Providencia rettgeri was reported in a letter published in the MJA this week.

The patient, a Canberra man, had elective plastic surgery in India last September but suffered a hypoxic brain injury leading to a month long stay in intensive care. He was subsequently transferred to a Canberra hospital, where heavy growth of the resistant organism was found in a urinary catheter specimen.

The organism was resistant to all beta-lactam antibiotics, all aminoglycosides, ciprofloxacin, tigecycline and colistin. A second pathogen, Pseudomonas aeruginosa, also detected from the catheter specimen, was sensitive only to colistin.

The patient cleared the organism after two months; however,  letter co-author, Professor Peter Collignon, Director of Infectious Diseases and Microbiology at Canberra Hospital, told InSight the case was a warning about why antibiotic resistance needed to be taken so seriously.

“No antibiotic may be available to treat patients who develop serious infection with such organisms, and there is the added concern regarding cross-infection in health care facilities,” Professor Collignon and colleagues wrote in the Journal.

RACS Executive Director of Surgical Affairs, Dr John Quinn, said doctors in Australia were mopping up problems following medical tourism trips, including postoperative infections following overseas hip or knee replacements.

“If the replacement gets infected and needs to be removed, not only is that a danger for the patient because they might lose a limb, but it is a very costly exercise for the Australian public because most end up in public hospitals,” Dr Quinn said.

The College was against people travelling overseas for medical treatment because of the risks associated with low-quality prosthetics, implants and surgical skills. The number of Australians who travel overseas for surgery is unknown.

Med J Aust 2010; 193: 59.

Posted: 5 July, 2010