title: Multidrug-resistant bacteria among patients treated in foreign hospitals: management considerations during medical repatriation.
abstract: BACKGROUND
  The repatriation of patients from foreign hospitals can foster the emergence and spread of multidrug-resistant bacteria (MRB). We aimed to evaluate the incidence of MRB in patients treated in foreign hospitals and repatriated by international inter-hospital air transport in order to better manage these patients and adjust our procedures.
  
  
  METHODS
  The records from all consecutive aeromedical evacuations and overseas repatriations carried out by Mondial Assistance France between December 2010 and November 2011 were reviewed for this study. Only inter-hospital transfers with inpatient destination of an acute care unit were considered. Patients were allocated to one of two groups: those identified as MRB carriers at their arrival in France and those who were not identified as such (either negative for MRB or not tested). Data were compared between the two groups.
  
  
  RESULTS
  Analysis was performed on 223 patients: 16 patients (7%) were identified as MRB carriers. Compared with confirmed non-MRB patients, MRB carriers came more frequently from a high-risk unit (88% vs 59%, p = 0.05) and had a longer foreign hospital stay [13 (3-20) vs 8 (6-14) d, p = 0.01].
  
  
  CONCLUSIONS
  The occurrence of MRB among patients repatriated from foreign hospitals is noted in a significant minority of such individuals transferred back to their home country. The typical MRB patient was admitted to a high-risk unit in a foreign hospital prior to repatriation with longer foreign hospital admissions. The prospective identification of these patients prior to transport is difficult. While these factors are associated with MRB presence, their absence does not rule out highly resistant bacterial colonization. A systematic review of this important medical issue is warranted with the development of guidelines.
authors.affiliation: Medical Department, Mondial Assistance France, Paris, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Josseaume
authors.forename: Laurent
authors.initials: L
authors.lastname: Verner
authors.forename: William J
authors.initials: WJ
authors.lastname: Brady
authors.forename: François-Xavier
authors.initials: FX
authors.lastname: Duchateau
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents; D001419:Bacteria / Q000187:drug effects / Q000472:pathogenicity; D002648:Child; D019091:Critical Pathways / Q000592:standards; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy / Q000635:transmission; D018432:Drug Resistance, Multiple; D005260:Female; D005602:France / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods; D007362:Intensive Care Units / Q000706:statistics & numerical data; D038622:Internationality; D007902:Length of Stay; D008297:Male; D010360:Patient Transfer / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D014164:Transfer Agreement / Q000592:standards
chemical_list: D000900:Anti-Bacterial Agents