CDPH Advisory: Ongoing Risk of Highly Drug-Resistant Infections in Patients Following Hospitalization or Invasive Procedures in Mexico February 16, 2021 General California Department of Public Health (CDPH), public health, VIM-CRPA 0 DOWNLOAD CDPH ADVISORY HERE Ongoing Risk of Highly Drug-Resistant Infections in Patients Following Hospitalization or Invasive Procedures in Mexico February 2021 The California Department of Public Health (CDPH) and local public health partners are alerting healthcare providers of a recent increase in reports of VIM-producing carbapenem-resistant Pseudomonas aeruginosa (VIM-CRPA) in patients following hospitalization or invasive medical procedures in Mexico for routine healthcare visits, medical emergencies, and medical tourism. Since our November 2019 Health Advisory describing an initial cluster of five VIM-CRPA cases with similar exposure from August to October 2019, there have been three additional reports of VIM-CRPA identified in California from August to December 2020. These patients reported undergoing invasive procedures in Guadalajara and Tijuana, Mexico. The most recent case was identified in December 2020; the patient reported having plastic surgery at a Tijuana-area healthcare facility in October 2020. The CDPH Healthcare-Associated Infections (HAI) Program recommends healthcare providers be vigilant for the possibility of VIM-CRPA and other multidrug-resistant organisms (MDRO) in patients following hospitalization or invasive procedures in Mexico. To identify and control the spread of these pathogens in California, the HAI Program recommends the following strategies to healthcare facilities: When caring for patients who have a history of hospitalization or invasive procedures in Mexico, obtain cultures, perform antimicrobial susceptibility testing to guide treatment, and test any carbapenem-resistant bacteria for VIM and other plasmid-mediated carbapenemases. VIM-CRPA are highly resistant and difficult to treat, requiring protracted and complex antibacterial drug combinations and courses; consult with an infectious disease specialist for treatment guidance. Consider colonization screening for patients who have reported receiving healthcare outside of the United States during the 12 months prior to their hospitalization in the US. For patients identified with VIM-CRPA, inquire about receipt of healthcare in Mexico or anywhere outside of the United States, including hospitalization or invasive procedures in the prior 12 months Implement important containment strategies for VIM-CRPA and other MDRO: Place patients on Contact precautions and in a single-bed room, whenever possible. Perform hand hygiene before donning personal protective equipment (PPE), after doffing PPE, and before and after patient contact. Routinely clean and disinfect healthcare surfaces and shared medical equipment using an Environmental Protection Agency (EPA)-approved hospital-grade disinfectant. Perform colonization screening on any epidemiologically-linked patients (e.g., roommates prior to implementation of transmission-based precautions or patients exposed to common medical device or instrument) Monitor adherence to infection prevention practices (https://www.cdph.ca.gov/Programs/CHCQ/HAI/Pages/MonitoringAdherenceToHCPracticesThatPreventInfection.aspx) Communicate VIM-CRPA or other MDRO status to a receiving healthcare facility at time of patient transfer. Report any cases of VIM-CRPA and other healthcare-associated unusual or highly-resistant organisms to your local health department and the CDPH HAI Program at HAIProgram@cdph.ca.gov. Carbapenemase mechanism testing for CRPA and other carbapenem-resistant organisms is available through some local public health laboratories and the CDPH Microbial Diseases Laboratory. To prioritize testing of CRPA isolates for carbapenemase testing, please submit CRPA resistant to imipenem, meropenem, or doripenem by standard antimicrobial susceptibility methods and non-susceptible to cefepime, ceftazidime, or ceftolozane/tazobactam. Colonization testing (screening) for carbapenemase-producing (CP) organisms, including CP-CRPA, is available at no cost through the CDC Antibiotic Resistance Laboratory Network. These services can be accessed through your local health department in consultation with the CDPH HAI Program by contacting HAIProgram@cdph.ca.gov. For more information about VIM-CRPA and investigation and response measures, please visit: https://www.cdph.ca.gov/Programs/CHCQ/HAI/CDPH%20Document%20Library/CRO_Quicksheet_Oct2020.pdf. For more information about MDROs, please visit: https://www.cdph.ca.gov/Programs/CHCQ/HAI/Pages/AntimicrobialResistanceLandingPage.aspx. Comments are closed.
