Two Arkansas residents and four Utahans are among a cluster of American patients who traveled to Tijuana, Mexico, for an invasive surgical procedure only to return with an antibiotic-resistant infection. Both states’ health departments and the Centers for Disease Control and Prevention (CDC) are urging anyone who had surgery at Grand View Hospital in Tijuana during or after August 2018 to undergo screening for hepatitis C, hepatitis C and HIV.

“October of last year is when Utah learned of their first case,” Rebecca Ward, health educator with the Utah Department of Health and Epidemiology, told Fox 13. “Utah’s actually looking for more of these cases so we may be able to find more than other states simply because it is reportable.”

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According to the CDC, most of the affected patients had weight loss surgery at the hospital and were exposed to Pseudomonas aeruginosa bacteria. The bacteria causes difficult-to-treat infections of the blood and lungs and can lead to severe illness or even death. Patients who may have undergone procedures at Grand View Hospital or nearby centers and may be experiencing side effects such as redness, pus or swelling at the surgical incision site are encouraged to seek medical care immediately.

Mexican officials reportedly found poor infection control practices at Grand View Hospital, including failure to follow proper sterilization procedures, and ordered it closed until it rid of the bacteria, but the Washington Post reported that the center has reopened and is performing surgeries.

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“If people continue to travel out of the country to particular places like Mexico, it’s likely we can see more cases,” Ward told Fox 13.

The CDC recommends Americans see a travel medicine specialist before traveling abroad for health care, and consulting with a physician about potential risks. It recommends health care providers be vigilant for the possibility of resistant infections occurring in patients who have traveled abroad for medical procedures, and to take appropriate infection control measures.

The agency estimates that thousands of Americans travel abroad for procedures each year due to lower cost or availability, and lists antibiotic-resistant infections as a risk of doing so.

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“Antibiotic resistance is a global problem, and resistant bacteria may be more common in other countries than in the United States,” the CDC said.