ABSTRACT
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Subject(s)
Chlamydia Infections , Chlamydia trachomatis , Anti-Bacterial Agents , Azithromycin , Chlamydia Infections/diagnosis , Chlamydia Infections/drug therapy , HumansSubject(s)
Erysipelas/complications , Erysipelas/pathology , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/pathology , Vasculitis/complications , Vasculitis/pathology , Adult , Biopsy, Needle , Diagnosis, Differential , Disease Progression , Drug Therapy, Combination , Erysipelas/drug therapy , France , Humans , Immunohistochemistry , Lupus Erythematosus, Systemic/drug therapy , Male , Methotrexate/administration & dosage , Prednisone/administration & dosage , Risk Assessment , Severity of Illness Index , Treatment Outcome , Vasculitis/drug therapyABSTRACT
BACKGROUND: Extensively-drug-resistant bacteria (XDRB) have emerged as a major source of resistance. Hospitalization abroad seems to be the major risk factor associated with carriage, and numerous reports have warned about the risk of in-hospital transmission. However, little is known regarding possible community transmission. METHODS: A retrospective matched case-control study was conducted in a Parisian teaching hospital, which included patients admitted to hospital with a history of travel abroad over the preceding 12 months. Each XDRB carrier at admission (case) was matched with two non-carriers (controls) hospitalized in the same ward and admitted during the same month. AIM: To describe and identify risk factors associated with XDRB carriage at admission. FINDINGS: Forty-six cases and 92 controls were enrolled. The results of univariate and multi-variate analyses showed that health repatriation was the only factor associated with a higher risk of carrying XDRB (odds ratio 3.22, 95% confidence interval 1.23-7.84; P=0.01). Surprisingly, one-third of the study population had not been hospitalized abroad within the preceding 12 months. The most frequently identified XDRB species were Escherichia coli (36%), Enterococcus spp. (17%) and Klebsiella pneumoniae (9%), and the most frequently identified enzyme was OXA-48 (36%). CONCLUSION: In this retrospective study, health repatriation was the only risk factor for XDRB carriage identified at admission. Furthermore, the data suggest community-onset transmission. Therefore, there is an urgent need to conduct studies in high-risk countries to identify the risk factors associated with community carriage.