e., 48% Europe, 20% America, 15% Africa, 8.5% in Asia-Oceania,

and 6.6% in the Near and Middle East).7 The repatriation of French patients from foreign hospitals, but also health care provided to foreigners traveling in France, whatever their nationality, then expose the French population to highly resistant bacteria acquired in high resistance prevalent areas. The risk of the emergence and spread of highly resistant bacteria from migration has been recently evaluated in France because sporadic or limited epidemic situations have occurred in the recent past with pathogens such as Clostridium difficile ribotype 027,8,9 carbapenemase-producing Enterobacteriaceae (CPE),10–12 vancomycin-resistant Enterococcus (VRE),13,14 or multidrug-resistant Acinetobacter baumannii.15 French guidelines Fostamatinib ic50 to control the hospital spread of CPE and VRE from patients repatriated and travelers hospitalized in French hospitals were published in August 2010.16 They are so far available in French only but an official translation into English is under consideration. This article reviews the highly resistant bacteria at risk of importation from high prevalence foreign countries, having only spread to France mTOR inhibitor on sporadic or limited epidemic situations, and describes the recent French guidelines to control their

spread. The emergence of CPE since the early 1990s is alarming, and carries the risk for therapeutic failures.17 The carbapenems are now often used for the treatment of severe infections caused by Enterobacteriaceae producing extended-spectrum β-lactamases (ESBL). The large increase of ESBL prevalence and the exposure Obatoclax Mesylate (GX15-070) of hospitalized population

to carbapenems appear to be a major factor favoring the emergence of carbapenem-resistant bacteria via selective pressure, particularly in Klebsiella pneumoniae species, also in other species such as Escherichia coli.18 Resistance is due to carbapenemases, of which there are three types: K pneumoniae carbapenemases (KPC), metallo-β-lactamases, and oxacillinases.19 The production of metallo-β-lactamases has mostly been associated with Pseudomonas aeruginosa and Acinetobacter spp. and is rare in Enterobacteriaceae, except in isolates from Mediterranean Europe.20 New Delhi metallo-β-lactamase (NDM) 1 was identified in K pneumoniae and E coli recovered from a Swedish patient who was admitted in a hospital in New Delhi, India.21 The first CPE strain described was a Klebsiella isolate recovered in North Carolina, United States in 1996, and the enzyme was called KPC-1.22 Subsequently, other KPC-type enzymes have been described throughout the United States (KPC-2 to KPC-7) by sporadic or epidemic spread.23 The first outbreak of KPC outside the United States was reported in Israel, from passengers and/or patients having traveled between the two countries.24 Since then, many continents, such as South America and Asia, have reported the emergence of CPE.