Pascal Ralaimazava

High Rate of Acquisition but Short Duration of Carriage of Multidrug-Resistant Enterobacteriaceae After Travel to the Tropics

BACKGROUND Multidrug-resistant Enterobacteriaceae (MRE) are widespread in the community, especially in tropical regions. Travelers are at risk of acquiring MRE in these regions, but the precise extent of the problem is not known. METHODS From February 2012 to April 2013, travelers attending 6 international vaccination centers in the Paris area prior to traveling to tropical regions were asked to provide a fecal sample before and after their trip. Those found to have acquired MRE were asked to send fecal samples 1, 2, 3, 6, and 12 months after their return, or until MRE was no longer detected. The fecal relative abundance of MRE among all Enterobacteriaceae was determined in each carrier. RESULTS Among 824 participating travelers, 574 provided fecal samples before and after travel and were not MRE carriers before departure. Of these, 292 (50.9%) acquired an average of 1.8 MRE. Three travelers (0.5%) acquired carbapenemase-producing Enterobacteriaceae. The acquisition rate was higher in Asia (142/196 [72.4%]) than in sub-Saharan Africa (93/195 [47.7%]) or Latin America (57/183 [31.1%]). MRE acquisition was associated with the type of travel, diarrhea, and exposure to β-lactams during the travel. Three months after return, 4.7% of the travelers carried MRE. Carriage lasted longer in travelers returning from Asia and in travelers with a high relative abundance of MRE at return. CONCLUSIONS MRE acquisition is very frequent among travelers to tropical regions. Travel to these regions should be considered a risk factor of MRE carriage during the first 3 months after return, but not beyond. CLINICAL TRIALS REGISTRATION NCT01526187.

Plasmodium falciparum malaria and atovaquone-proguanil treatment failure.

We noticed overrepresentation of atovaquone-proguanil therapeutic failures among Plasmodium falciparum–infected travelers weighing >100 kg. We report here 1 of these cases, which was not due to resistant parasites or impaired drug bioavailability. The follow-up of such patients should be strengthened.

Perfil y evolución de la quimiosensibilidad al paludismo por P. falciparum importado en Francia en 2000

En 2000, la quimiosensibilidad al paludismo importado en Francia fue estable. Si se tienen en cuenta todos los paises de infeccion, la doble resistencia a la cloroquina y el cicloguanil no ha cambiado desde 1996 hasta 2000. La monoterapia a base de quinina o mefloquina sigue siendo el primer tratamiento contra el paludismo por P. falciparum. La resistencia a estos dos antipaludicos en Africa no es frecuente ni ha evolucionado durante los ultimos 15 anos.

Profil et évolution de la chimiosensibilité du paludisme d'importation à Plasmodium falciparum en France en 2000

En 2000, la chimiosensibilite du paludisme d’importation est restee stable en France. Tous pays d’infection confondus, la bi-resistance a la chloroquine et au cycloguanil n’a pas evolue de 1996 a 2000. La monotherapie par quinine ou mefloquine reste le traitement de premiere intention au paludisme a P. falciparum. Pour ces antipaludiques, la resistance est rare en Afrique et sans evolution au cours des 15 dernieres annees.