Carriage of multi-drug resistant bacteria among foreigners seeking medical care

Medical tourism has a potential of spreading multi-drug resistant bacteria (MDR). The Hadassah Medical Center serves as a referral center for global medical tourists and for Palestinian Authority residents. In order to assess whether patients of these groups are more likely to harbor MDR bacteria than local residents, we reviewed data from all patients admitted to our institution between 2009 and 2014. We compared MDR rates between countries of residency, controlling for gender, age, previous hospitalization and time from admission to MDR detection. Overall, among 111,577 patients with at least one microbiological specimen taken during hospitalization, there were 3,985 (3.5%) patients with at least one MDR-positive culture. Compared to Israeli patients, tourists and patients from the Palestinian Authority had increased rates of MDR positivity (OR, 95%CI): 2.3 (1.6 to 2.3) and 8.0 (6.3 to 10.1), respectively. Our data show that foreign patients seeking advanced medical care are more likely to carry MDR bacteria than the resident population. Strategies to minimize MDR spread, such as pre-admission screening or pre-emptive isolation should be considered in this population.