Medical Tourism and Postoperative Infections

A Systematic Literature Review of Causative Organisms and Empiric Treatment

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


Plast Reconstr Surg. 2018;142(6):1644-1651. 

In This Article


The initial search of the PubMed, Ovid, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases identified 242 articles. Review of titles and abstracts reduced this number to 94 articles. A final review of the remaining articles narrowed the results to 20 articles that met all inclusion and exclusion criteria. The results of this review process are depicted in Table 1.

The articles included in this review were case reports and case series published between 2003 and 2017. A total of 42 cases of postoperative infections were reported among patients who underwent elective surgery abroad. Most reported cases were from the Dominican Republic, whereas others came from Mexico, Thailand, China, Vietnam, India, Ecuador, Panama, Venezuela, Turkey, and the Caribbean (Figure 1). Ninety-eight percent of the reported cases were female patients, with ages ranging from 19 to 69 years. The most frequent elective procedures include abdominoplasty (33 percent), mammaplasty (27 percent), and liposuction (24 percent), with many medical tourists undergoing a combination of these procedures (Figure 2). Other operations included gluteal augmentation, mastopexy, liposculpture, and scar excision. Rapidly growing mycobacteria including M. abscessus, M. fortuitum, and M. chelonae were shown to be the most common causes of infection among medical tourists, involving 91 percent of the cases (Figure 3). M. abscessus was the most commonly reported microorganism, involving 74 percent of cases. Most patients were treated with immediate surgical débridement or incision and drainage. Several antimicrobials were then started and discontinued because of treatment failure or intolerable side effects of nephrotoxicity, ototoxicity, or hypersensitivity reaction. Clarithromycin, amikacin, and moxifloxacin were the most commonly used drugs used for long-term treatment, with regimens lasting weeks to months (Table 2).

Figure 1.

Destination of surgery, showing the countries where patients underwent various medical procedures.

Figure 2.

Types of operations, showing the procedures patients underwent abroad.

Figure 3.

Causative microorganisms, showing the common microorganisms that grew on cultures when patients were treated in the United States or respective home country.