A case series of infectious complications in medical tourists requiring hospital admission or outpatient home parenteral therapy

2021 ◽  
Author(s):  
Paul D Robinson ◽  
Stephen Vaughan ◽  
Bayan Missaghi ◽  
Bonnie Meatherall ◽  
Andrew Pattullo ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Cosmetic Surgery ◽  
Medical Tourism ◽  
Case Series ◽  
Infectious Complications ◽  
Prolonged Treatment ◽  
Cost Estimates ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Canadian Health ◽  
Fraser Institute

BACKGROUND: Travelling for medical care is increasing, and this medical tourism (MT) may have complications, notably infectious diseases (ID). We sought to identify MT-related infections (MTRIs) in a large Canadian health region and estimate resulting costs. METHODS: Retrospective and prospective capture of post-MT cases requiring hospital admission or outpatient parenteral antimicrobial therapy was completed by canvassing ID physicians practicing in Calgary, Alberta, from January 2017 to July 2019. Cost estimates for management were made with the Canadian Institute for Health Information’s (CIHI’s) patient cost estimator database tool applied to estimated rates of Canadians engaging in MT from a 2017 Fraser Institute report. RESULTS: We identified 12 cases of MT-related infectious syndromes. Eight had microbial aetiologies identified. MTs were young (mean = 40.3 y, SD = 12.2) and female ( n = 11) and pursued surgical treatment ( n = 11). Destination countries and surgical procedures varied but were largely cosmetic ( n = 5) and orthopaedic ( n = 3). Duration to organism identification (mean = 5.3 wk) and treatment courses (mean = 19 wk) appeared lengthy. CIHI cost estimates for management of relevant infectious complications of our cases ranged from $6,288 to $20,741, with total cost for cases with matching codes ( n = 8) totalling $94,290. CONCLUSIONS: In our series of MTRIs, etiologic organisms often found in Canadian-performed post-procedural infections were identified, and prolonged treatment durations were noted. Young women pursuing cosmetic surgery may be a population to target with public health measures to reduce the incidence of MTRIs and burden of disease.

Infectious complications related to medical tourism

2020 ◽  
Author(s):  
Androula Pavli ◽  
Helena C Maltezou
Keyword(s):  
Public Health ◽  
Organ Transplantation ◽  
Low Income ◽  
Cosmetic Surgery ◽  
Medical Tourism ◽  
The United States ◽  
Infectious Complications ◽  
Mycobacterium Fortuitum ◽  
Middle Income ◽  
Middle Income Countries

Abstract Background Medical tourism has been increasing dramatically globally, with people travelling from developed countries to low-income or middle-income countries, often to avoid high costs or long delays associated with seeking healthcare in their countries of origin. The current review summarizes healthcare-related infections associated with medical tourism, focusing on cosmetic surgery and organ transplantation. Methods A systematic MEDLINE and PubMed search from January 2010 to December 2019 yielded 80 relevant articles, including 49 articles on medical tourism-related infections focusing on cosmetic surgery and organ transplantation, which were included in this reviews. Results The literature reveals specific types of cross-border, healthcare-related infections depending on medical intervention. Destinations include low-income countries such as countries of Asia and the Indian subcontinent, middle-income countries including Central and South America, and high-income countries such as the United States and Europe. In terms of type of infections, in 36 (68%) and 15 (28.3%) studies, wound and blood-borne infections were documented, respectively, while in 21 studies (58.3%) non-tuberculous mycobacteria were isolated, including Mycobacterium abscessus, Mycobacterium chelonae, Mycobacterium senegalense and Mycobacterium fortuitum. The choices of medical tourists could have significant consequences for them and their home countries, including infectious complications and importation of pathogens, particularly antibiotic-resistant microorganisms, with public health implications. Conclusions There is a need for public health strategies in order to prevent morbidity and mortality as well as future management and education of patients engaging in medical tourism.

scholarly journals Emergency Department Visits During Outpatient Parenteral Antimicrobial Therapy: A Cohort Study

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S333-S334
Author(s):  
So Lim Kim ◽  
Angela Everett ◽  
Susan J Rehm ◽  
Steven Gordon ◽  
Nabin Shrestha
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Hospital Admission ◽  
Vascular Access ◽  
Antimicrobial Therapy ◽  
Cleveland Clinic ◽  
Emergency Department Visits ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Ed Visits ◽  
Access Complications

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) carries risk of vascular access complications, antimicrobial adverse effects, and worsening of infection. Both OPAT-related and unrelated events may lead to emergency department (ED) visits. The purpose of this study was to describe adverse events that result in ED visits and risk factors associated with ED visits during OPAT. Methods OPAT courses between January 1, 2013 and December 31, 2016 at Cleveland Clinic were identified from the institution’s OPAT registry. ED visits within 30 days of OPAT initiation were reviewed. Reasons and potential risk factors for ED visits were sought in the medical record. Results Among 11,440 OPAT courses during the study period, 603 (5%) were associated with 1 or more ED visits within 30 days of OPAT initiation. Mean patient age was 58 years and 57% were males. 379 ED visits (49%) were OPAT-related; the most common visit reason was vascular access complication, which occurred in 211 (56%) of OPAT-related ED visits. The most common vascular access complications were occlusion and dislodgement, which occurred in 99 and 34 patients (47% and 16% of vascular access complications, respectively). In a multivariable logistic regression model, at least one prior ED visit in the preceding year (prior ED visit) was most strongly associated with one or more ED visits during an OPAT course (OR 2.96, 95% CI 2.38 – 3.71, p-value < 0.001). Other significant factors were younger age (p 0.01), female sex (p 0.01), home county residence (P < 0.001), and having a PICC (p 0.05). 549 ED visits (71%) resulted in discharge from the ED within 24 hours, 18 (2%) left against medical advice, 46 (6%) were observed up to 24 hours, and 150 ED visits (20%) led to hospital admission. Prior ED visit was not associated with hospital admission among patients who visited the ED during OPAT. Conclusion OPAT-related ED visits are most often due to vascular access complications, especially line occlusions. Patients with a prior ED visit in the preceding year have a 3-fold higher odds of at least one ED visit during OPAT compared with patients without a prior ED visit. A strategy of managing occlusions at home and a focus on patients with prior ED visits could potentially prevent a substantial proportion of OPAT-related ED visits. Disclosures All authors: No reported disclosures.

scholarly journals Treatment with a DPP-4 inhibitor at time of hospital admission for COVID-19 is not associated with improved clinical outcomes: data from the COVID-PREDICT cohort study in The Netherlands

2021 ◽  
Author(s):  
Rick I. Meijer ◽  
Trynke Hoekstra ◽  
Niels C. Gritters van den Oever ◽  
Suat Simsek ◽  
Joop P. van den Bergh ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cohort Study ◽  
Hospital Admission ◽  
Clinical Outcomes ◽  
Primary Outcome ◽  
Infectious Complications ◽  
Glucose Lowering ◽  
Diabetes Severity ◽  
Outcome Mortality

Abstract Purpose Inhibition of dipeptidyl peptidase (DPP-)4 could reduce coronavirus disease 2019 (COVID-19) severity by reducing inflammation and enhancing tissue repair beyond glucose lowering. We aimed to assess this in a prospective cohort study. Methods We studied in 565 patients with type 2 diabetes in the CovidPredict Clinical Course Cohort whether use of a DPP-4 inhibitor prior to hospital admission due to COVID-19 was associated with improved clinical outcomes. Using crude analyses and propensity score matching (on age, sex and BMI), 28 patients using a DPP-4 inhibitor were identified and compared to non-users. Results No differences were found in the primary outcome mortality (matched-analysis = odds-ratio: 0,94 [95% confidence interval: 0,69 – 1,28], p-value: 0,689) or any of the secondary outcomes (ICU admission, invasive ventilation, thrombotic events or infectious complications). Additional analyses comparing users of DPP-4 inhibitors with subgroups of non-users (subgroup 1: users of metformin and sulphonylurea; subgroup 2: users of any insulin combination), allowing to correct for diabetes severity, did not yield different results. Conclusions We conclude that outpatient use of a DPP-4 inhibitor does not affect the clinical outcomes of patients with type 2 diabetes who are hospitalized because of COVID-19 infection.

scholarly journals Cardio-Pulmonary Sequelae in Recovered COVID-19 Patients: Considerations for Primary Care

2021 ◽  
Vol 12 ◽  
pp. 215013272110237
Author(s):  
Zouina Sarfraz ◽  
Azza Sarfraz ◽  
Alanna Barrios ◽  
Radhika Garimella ◽  
Asimina Dominari ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Infection ◽  
Clinical Laboratory ◽  
Point Of Care ◽  
Case Reports ◽  
Case Series ◽  
Infectious Complications ◽  
Care Physician ◽  
Cross Sectional ◽  
Infection Period

Background: Current literature lacks characterization of the post-recovery sequelae among COVID-19 patients. This review characterizes the course of clinical, laboratory, radiological findings during the primary infection period, and the complications post-recovery. Primary care findings are presented for long-COVID care. Methods: Adhering to PRISMA guidelines, 4 databases were searched (PubMed, Embase, CINAHL Plus, Scopus) through December 5, 2020, using the keywords “COVID-19 and/or recovered and/or cardiovascular and/or long-term and/or sequelae and/or sub-acute and/or complication.” We included published peer-reviewed case reports, case series, and cross-sectional studies providing the clinical course of COVID-19 infection, and cardiopulmonary complications of patients who recovered from COVID-19, while making healthcare considerations for primary care workers. Results: We identified 29 studies across 9 countries including 37.9% Chinese and 24.1% U.S. studies, comprising 655 patients (Mean Age = 45) with various ethnical backgrounds including Asian and European. Based on the WHO COVID-19 severity classification scale, initial disease severity was mild for 377 patients and severe for 52 patients. Treatments during primary infection included corticosteroids, oxygen support, and antivirals. The mean value (in days) for complication onset after acute recovery was 28 days. Complete blood counts and RT-PCR tests were the most common laboratory results described. In 22 of the studies, patients showed signs of clinical improvement and were prescribed medications such as anticoagulants or corticosteroids. Conclusion: Post-recovery infectious complications are common in long-COVID-19 patients ranging from mild infections to life-threatening conditions. International thoracic and cardiovascular societies need to develop guidelines for patients recovering from COVID-19 pneumonia, while focused patient care by the primary care physician is crucial to curb preventable adverse events. Recommendations for real-time and lab-quality diagnostic tests are warranted to establish point-of-care testing, detect early complications, and provide timely treatment.

Spinal Surgery During COVID-19 Pandemic in Saudi Arabia

2021 ◽  
pp. 12
Author(s):  
Faisal Konbaz ◽  
Taif Alqahtani ◽  
Nada Alharthi ◽  
Mohammad Baraja ◽  
Nazish Masud ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Tertiary Care ◽  
Case Series ◽  
Medical Intervention ◽  
Care Hospital ◽  
Hospital Data ◽  
Chi Square ◽  
Chi Square Test ◽  
The Mean ◽  
American Society

Introduction: The COVID-19 pandemic has challenged the healthcare system’s capacities around the world. Due to the alarming situation, medical activities have been restricted to allocate resources to treat COVID-19-infected patients. However, medical emergencies still need urgent medical intervention. Considering the lack of reliable data regarding spinal surgeries during the COVID-19 pandemic, the present study sought to analyze the pattern of spinal surgeries in KSA. Methodology: A case series of patients who had urgent spine surgeries during COVID-19 pandemic was conducted in a tertiary care hospital. Data on patients’ demographics, COVID-19 test result, American Society of Anesthesia Score, SSS grade, diagnosis, and data related to surgery and postoperative findings were collected. All collected data were then processed and analyzed. Surgical outcomes based on source of admission were compared using Chi-square test. Result: A total of 63 patients who underwent spine surgery during the COVID-19 pandemic were included. The mean age of the patients was 53 ± 18 years and males were predominant (59%). The positive COVID-19 patients were 3%. Almost half of the patients were classified into ASA II. The majority were categorized into grade B (65%) according to SSS. The frequently diagnosed condition was fracture (33%), followed by spinal stenosis (18%) and metastatic (10%), while the most mentioned location was lumbar (61%). Postoperative complications were found in 11% of the patients. The readmission rate within 30 days, unplanned return to OR and ICU admission were 19%, 13%, and 11%, respectively. While the mean duration between admission and surgery was 8 ± 20 days, the mean duration of length of stay was 20 ± 29 days. Further, a significant association was seen between the admission source and the surgical procedure performed and surgical indication. Conclusion: It has been demonstrated that the surgical intervention was only provided to patients requiring immediate or urgent spinal management. However, the length of hospitalization and duration between hospital admission and surgery was substantially prolonged. Further studies are warranted to determine the factors leading to prolonged hospitalization and time between hospital admission and surgery.

The Ethics of Medical Tourism

2015 ◽  
pp. 79-88
Author(s):  
Nader Ghotbi
Keyword(s):  
Cosmetic Surgery ◽  
Assisted Suicide ◽  
Common Ground ◽  
Medical Tourism ◽  
Ethical Decision Making ◽  
Ethical Issues ◽  
Moral Issues ◽  
Therapeutic Massage ◽  
Life Saving ◽  
Almost All

Medical tourism is rapidly growing. There are various reasons for this form of travel; from having life-saving surgery, receiving organ transplants and other vital operations, to therapeutic massage, using hot spas, and cosmetic surgery, and from receiving assistance with infertility to assisted suicide services at particular destinations. Some forms of medical tourism have strong ethical issues attached to them, but there are also ethical issues that may apply to almost all cases, and these can be discussed in a general way. This chapter discusses fundamental definitions of the concepts and general ethical issues in medical tourism, and then explains in more detail some of the moral issues in medical tourism that need to be examined from an ethical standpoint. The chapter establishes common ground for discussion based on broadly accepted principles that can be used almost universally as general guidelines for ethical decision-making in medical tourism activities.

Medical Tourism Patient Mortality

2022 ◽  
pp. 143-162
Author(s):  
Alicia Mason ◽  
Sakshi Bhati ◽  
Ran Jiang ◽  
Elizabeth A. Spencer
Keyword(s):  
News Media ◽  
Cosmetic Surgery ◽  
Medical Tourism ◽  
Qualitative Content Analysis ◽  
The United States ◽  
Media Representations ◽  
Patient Death ◽  
Bereavement Counseling ◽  
Media Reports ◽  
Social Support Systems

Medical tourism is a process in which a consumer travels from one's place of residence and receives medical treatment, thus becoming a patient. Patients Beyond Borders (PBB) forecasts some 1.9 million Americans will travel outside the United States for medical care in 2019. This chapter explores media representations of patient mortality associated with medical tourism within the global news media occurring between 2009-2019. A qualitative content analysis of 50 patient mortality cases found that (1) a majority of media representations of medical tourism patient death are of middle-class, minority females between 25-55 years of age who seek cosmetic surgery internationally; (2) sudden death, grief, and bereavement counseling is noticeably absent from medical tourism providers (MTPs); and (3) risk information from authority figures within the media reports is often vague and abstract. A detailed list of health communication recommendations and considerations for future medical tourists and their social support systems are provided.

scholarly journals Variability in Opioid Prescription Following Primary Single-Level Lumbar Microdiscectomy

2020 ◽  
pp. 219256822095067
Author(s):  
Hai Le ◽  
Eileen Phan ◽  
Lauren Agatstein ◽  
Joshua Barber ◽  
Eric Klineberg ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Case Series ◽  
Postoperative Pain Management ◽  
Prolonged Hospital Stay ◽  
Inclusion Criteria ◽  
Retrospective Case ◽  
Opioid Prescription ◽  
Single Level ◽  
Lumbar Microdiscectomy ◽  
Prolonged Hospital

Study Design: Retrospective case series. Objectives: To evaluate the variability in opioid prescription following primary single-level lumbar microdiscectomy. Methods: We retrospectively reviewed consecutive patients who underwent primary single-level lumbar microdiscectomy. Only opioid-naïve patients ≥18 years old were included. Patients who had revision microdiscectomy, multilevel decompression, and/or any complication requiring prolonged hospital stay (>2 days) were excluded. The primary outcomes were the maximum daily dosage of opioids prescribed in morphine milligram equivalents (MME) and the number of pills prescribed (equivalent to 5 mg hydrocodone). Results: Between 2014 and 2019, 169 patients (90 men, 79 women) met inclusion criteria, with a mean age of 46.9 years. Surgery resulted in a statistically significant improvement in VAS (Visual Analogue Scale) score (6.4 to 2.5, P < .01). At discharge, 8 patients (4.7%) did not receive any opioid prescription. Of the remaining 161 patients, 1 patient (0.01%) received hydromorphone, 30 (18.6%) Percocet, 43 (26.7%) oxycodone, and 87 Norco (54.0%). The length of opioid prescription was 6.7 days. The maximum daily dosage of opioids prescribed was 70.4 MME (SD 32.1). The total number of pills prescribed was 89.4 (SD 54.7). Twenty-five patients (15.5%) received a refill prescription. Multivariate analysis demonstrated the operating service, prescriber, and hospital admission were statistically significant predictors of maximum daily MME. The prescriber and hospital admission were statistically significant predictors of total number of pills prescribed. Conclusions: We found significant variability in opioid prescription following primary single-level lumbar microdiscectomy. For standard spinal procedures like lumbar microdiscectomy, opioid-prescribing guidelines should be established to standardize postoperative pain management.

P22 Using an elastomeric pump to administer continuous infusions of antibiotics as part of an outpatient parenteral antimicrobial therapy (opat) programme

2018 ◽  
Vol 103 (2) ◽  
pp. e2.25-e2
Author(s):  
David Sharpe ◽  
Claire Crouch ◽  
David Porter ◽  
Stephane Paulus
Keyword(s):  
Respiratory Tract ◽  
Central Venous Access ◽  
Good Practice ◽  
Mode Of Delivery ◽  
Case Series ◽  
British Society ◽  
List Type ◽  
Retrospective Case ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Tract Infections

AimsContinuous intravenous infusion using an elastomeric pump is an alternative delivery method in paediatric patients who need intravenous antibiotics (IVAB) which would otherwise need to be administered three times daily, such as piperacillin/tazobactam or ceftazidime.1 We describe our experience using elastomeric pumps in the OPAT setting.MethodsA retrospective case series of 5 children (aged 5–17 years) discharged home on IVAB continuous infusion administered via an elastomeric pump. One child received this mode of delivery twice therefore 6 patient-episodes are described in this case series. Outcomes were assessed using the BSAC p-OPAT (British Society of Antimicrobial Chemotherapy Paediatric-OPAT) criteria. Ethics approval was not required because the information was gathered retrospectively and patient data has been anonymised.ResultsIn 5 of the episodes the indication was lower respiratory tract infection treated with continuous IV piperacillin/tazobactam. All patients had a background of neurodisability, recurrent respiratory tract infections and Pseudomonas aeruginosa carriage. The remaining patient was treated for an infective exacerbation of cystic fibrosis with a regimen that included continuous IV ceftazidime. All episodes had an outcome defined as ‘Success’ according to the BSAC p-OPAT criteria; having an infection outcome of ‘improved’ or ‘cured’ with no adverse events reported.ConclusionsThe successful outcomes in this case series suggest that elastomeric pumps are a safe and effective option for administering selected antibiotics by continuous IV infusion to children, although central venous access is a requirement. This option should be considered to facilitate the early discharge of patients to be treated with IVAB such as piperacillin/tazobactam under the guidance of an OPAT service.ReferencePatel S, Abrahamson E, Goldring S, Green H, Wickens H, Laundy M. Good practice recommendations for paediatric outpatient parenteral antibiotic therapy (p-OPAT) in the UK: A consensus statement. J Antimicrob Chemother2015;70(2):360–73.

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