If at least one secondary case is detected, all carriers must then be cohorted in a dedicated area and cared for by a dedicated staff. If transferred to another ward or hospital, contact patients must be maintained under control measures in other wards or hospitals and must be screened every week. If remaining in the hospital, control measures must be maintained

until three negative Pexidartinib rectal swabs for CPE and VRE are obtained. The French Ministry of Health has endorsed and enforced these recommendations through a directive for all hospitals.49 Over the last 10 years, international health authorities observed the emergence and rapid spread throughout the world of new strains of the influenza virus, C difficile or multidrug-resistant tuberculosis.50 The modern transport and increased tourism, business travel, and migration population have contributed to the spread of these pathogens with high epidemic

impacts.51–55 Data on systematic screening of repatriated patients hospitalized in foreign hospitals are scarce and relatively old.56,57 Fifteen percent58 to sixty-four percent59 of travelers report health complaints during travel, and 5 of 1000 are admitted in foreign hospital during their travels.58 The global spread of resistance has not escaped this phenomenon. CPE and VRE have increasingly Interleukin-2 receptor been isolated worldwide. The spread of these highly resistant bacteria is alarming, from a public health point of view, because Everolimus this species is prone to be the source of many hospital-acquired infections in severely ill patients, and is well known for its ability to accumulate and transfer resistance determinants as illustrated with ESBLs. Current reports

indicate that CPE (mainly KPC-producing bacteria)60,61 and VRE34,36 are widespread in many continents or countries such as Asia, Israel, Greece, South America, Canada, and the United States. Fortunately, in western and northern Europe, CPE and VRE are still rare. So, why worry? Highly resistant and even pan drug-resistant (i.e., resistant to all available classes) CPE may be the source of therapeutic dead-ends, because novel anti-Gram-negative molecules are not expected in the near future.62 Careful and conservative use of antibiotics, combined with good infection control practices, is therefore mandatory.63 Little is known about the repatriates- or travelers-related risk factors other than hospitalization in foreign hospitals, but the description of outbreaks indicates that producer strains seem to benefit from selective advantages in hospitals where antimicrobial use is much higher and opportunities for transmission are more frequent than in the community.