From the Division of Plastic Surgery, Department of Surgery, University of Texas Medical Branch.
Plast Reconstr Surg. 2018 Dec;142(6):1644-1651. doi: 10.1097/PRS.0000000000005014.
Medical tourism has become increasingly globalized as individuals travel abroad to receive medical care. Cosmetic patients in particular are more likely to seek surgery abroad to defray costs. Unfortunately, not all procedures performed abroad adhere to strict hygienic regulations, and bacterial flora vary. As a result, it is not uncommon for consumers to return home with difficult-to-treat postoperative infections.
A systematic literature review of PubMed, Ovid, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases was performed to assess the microbiology patterns and medical management of patients with postoperative infections after undergoing elective surgery abroad.
Forty-two cases of postoperative infections were reported among patients who underwent elective surgery abroad. Most cases were reported from the Dominican Republic, and the most common elective procedures were abdominoplasty, mastopexy, and liposuction. Rapidly growing mycobacteria such as Mycobacterium abscessus, Mycobacterium fortuitum, and Mycobacterium chelonae were among the most common causes of postoperative infection, with M. abscessus involving 74 percent of cases. Most cases were treated with surgical débridement and a combination of antibiotics. Clarithromycin, amikacin, and moxifloxacin were the most common drugs used for long-term treatment.
When encountering a patient with a history of medical tourism and treatment-refractory infection, rapidly growing mycobacteria must be considered. To increase the likelihood of yielding a diagnostic organism, multiple acid-fast bacilli cultures from fluid and débridement content should be performed. There has been reported success in treating rapidly growing mycobacterial infections with a combination of antibiotics including clarithromycin, amikacin, and moxifloxacin.
随着个人出国接受医疗服务，医疗旅游变得越来越全球化。特别是美容患者更有可能到国外寻求手术以降低成本。不幸的是，并非所有在国外进行的手术都符合严格的卫生规定，细菌菌群也不同。因此，消费者在术后出现难以治疗的感染后回国的情况并不少见。
对 PubMed、Ovid、Web of Science 和 Cumulative Index to Nursing and Allied Health Literature 数据库进行了系统的文献回顾，以评估在国外接受择期手术的患者术后感染的微生物学模式和医疗管理。
在国外接受择期手术的患者中报告了 42 例术后感染病例。大多数病例报告来自多米尼加共和国，最常见的择期手术是腹部整形术、乳房提升术和抽脂术。快速生长的分枝杆菌，如脓肿分枝杆菌、偶然分枝杆菌和溃疡分枝杆菌，是术后感染的最常见原因，其中脓肿分枝杆菌占 74%。大多数病例采用手术清创术和联合抗生素治疗。克拉霉素、阿米卡星和莫西沙星是长期治疗最常用的药物。
当遇到有医疗旅游史和治疗抵抗性感染的患者时，必须考虑快速生长的分枝杆菌。为了增加获得诊断性生物体的可能性，应从液体和清创内容物中进行多次抗酸杆菌培养。使用包括克拉霉素、阿米卡星和莫西沙星在内的抗生素联合治疗快速生长的分枝杆菌感染已被报道取得成功。
