Medical tourists – a source of imported pathogens? – A review of Methicillin-Resistant Staphylococcus aureus (MRSA)-, Multiresistant Gram-negative bacteria (MRGN)-admission-screenings in Arab and Russian medical tourists at University Hospital Düsseldorf (UKD) from 2017 to 2021

Introduction

Many foreign patients travel to Germany solely for medical treatment (medical tourism), potentially carrying various pathogens. Saudi Arabia and Russia exhibit higher prevalence of multi-resistant bacteria compared to Germany. The Commission for Hospital Hygiene and Infection Prevention (KRINKO) recommends MRSA-admission-screenings for patients from such risk regions and MRGN-admission-screenings for patients with recent healthcare system exposure in regions with high MRGN-prevalence.

Goals

We aimed to investigate whether medical tourists from the Arabian Peninsula and Russia were routinely screened for MRSA and MRGN upon admission to UKD and whether the results comply with current screening recommendations.

Materials & Methods

We analysed MRSA- and MRGN-screening results of Arab and Russian patients admitted to UKD from 2017 to 2021.

Results

239 Arab and 135 Russian patients were admitted to UKD from 2017 to 2021, including 52% Arab and 21% Russian minors. While the gender distribution was similar, men were screened more frequently. MRSA-screening rates were higher (Arab 80%, Russia 70%) than MRGN-screenings rates (Arab 12%, Russia 24%). More Arab patients were positive for MRSA or MRGN (MRSA: Arab 7%, Russia 2%; MRGN: Arab 21%, Russia 6%). Notably, 72% of Arab MRSA- and 100% of Arab MRGN-positive patients were male. The proportion of MRSA- und MRGN-positive patients was comparable between Arab minors (MRSA 8%; MRGN 21%) and Arab adults (MRSA 7%; MRGN 20%). No Russian minors tested positive for MRSA or MRGN. Arab patients carried 11 (3x 4MRGN) and Russian 6 (1x 4MRGN) distinct MRGN species. Five MRGN species were detected in Arab minors and one MRGN in a Russian minor.

Summary

UKD implemented MRSA- and MRGN-screening recommendations. The respective KRINKO recommendations lead to variations in the proportions of MRSA- and MRGN-screened medical tourists. Arab patients showed higher rates of MRSA- and MRGN-positive screenings in adults and minors and a greater variety of MRGN species compared to Russian patients. Thus, our results underscore the importance of tailored screenings for multidrug-resistant bacteria based on the specific patient population.