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Objectives: Sexual transmission of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) is suspected. We aimed to identify clusters of sexual behavior associated with ESBL-E carriage among individuals at risk of sexually transmitted infections (STI). Methods: In this cross-sectional study, patients attending an STI-screening center and human immunodeficiency virus outpatient clinic in Paris, France between 2018 and 2019 were asked questions on the following sexual activities in the last 6 months: receptive/insertive anal intercourse, passive/active rimming, receptive/insertive fellatio, receptive/insertive fisting, receptive/insertive fingering, active/passive cunnilingus. ESBL-E carriage was determined from rectal swabs. Bayesian latent class analysis was used to identify clusters of sexual activity, which were then associated with ESBL-E carriage using logistic regression. Results: Among 1211 men who have sex with men (MSM), those belonging to two latent classes with higher prevalence of insertive fingering and active rimming (ESBL-E prevalence=15.3%, N = 124 and 16.0%, N = 100) and one class with higher proportions of all behaviors (24.3%, N = 70) had a higher risk of ESBL-E carriage compared to those in a class with few sexual behaviors (7.3%, N = 259) after adjustment. Among 439 other men and 479 women, no clear associations between sexual clusters and ESBL-E carriage were observed. Conclusions: Sexual behaviors are associated with varying degrees of ESBL-E carriage, particularly among MSM.

Objectives: Positive direct antiglobulin tests (DATs) have been reported in cases of post-artesunate delayed hemolysis (PADH), but the causal role of auto-immune hemolysis remains unclear. We aimed to analyze a cohort of patients with PADH and DAT during severe malaria.Methods: We describe PADH and DAT results in a 7-year multi-center retrospective cohort of patients receiving artesunate for severe imported malaria.Results: Of 337 patients treated with artesunate, 46 (13.6%) had at least one DAT result within 30 days of treatment initiation, and 25/46 (54.3%) had at least one positive DAT. Among 40 patients with available data, 17 (42.5%) experienced PADH. Patient characteristics were similar for patients with a positive or negative DAT, and DAT positivity was not associated with PADH occurrence (P = 0.36). Among patients, 5/13 (38.5%) with a positive DAT after day 7 experienced PADH, compared to 10/13 (76.9%) of those with a negative DAT after day 7 (P = 0.11). Overall, 41% of patients required blood transfusions, and outcome was favorable without corticosteroids, even in cases of PADH.Conclusions: DAT does not appear to be a marker of PADH, but rather an indirect marker of an immune-mediated mechanism. DAT positivity should not lead to the administration of systemic corticosteroids during PADH.