Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Towards Learning Structure via Consensus for Face Segmentation and Parsing

Face segmentation is the task of densely labeling pixels on the face according to their semantics. While current methods place an emphasis on developing sophisticated architectures, use conditional random fields for smoothness, or rather employ adversarial training, we follow an alternative path towards robust face segmentation and parsing. Occlusions, along with other parts of the face, have a proper structure that needs to be propagated in the model during training. Unlike state-of-the-art methods that treat face segmentation as an independent pixel prediction problem, we argue instead that it should hold highly correlated outputs within the same object pixels. We thereby offer a novel learning mechanism to enforce structure in the prediction via consensus, guided by a robust loss function that forces pixel objects to be consistent with each other. Our face parser is trained by transferring knowledge from another model, yet it encourages spatial consistency while fitting the labels. Different than current practice, our method enjoys pixel-wise predictions, yet paves the way for fewer artifacts, less sparse masks, and spatially coherent outputs

RoPAD: Robust Presentation Attack Detection through Unsupervised Adversarial Invariance

For enterprise, personal and societal applications, there is now an increasing demand for automated authentication of identity from images using computer vision. However, current authentication technologies are still vulnerable to presentation attacks. We present RoPAD, an end-to-end deep learning model for presentation attack detection that employs unsupervised adversarial invariance to ignore visual distractors in images for increased robustness and reduced overfitting. Experiments show that the proposed framework exhibits state-of-the-art performance on presentation attack detection on several benchmark datasets

Does Generative Face Completion Help Face Recognition?

Face occlusions, covering either the majority or discriminative parts of the face, can break facial perception and produce a drastic loss of information. Biometric systems such as recent deep face recognition models are not immune to obstructions or other objects covering parts of the face. While most of the current face recognition methods are not optimized to handle occlusions, there have been a few attempts to improve robustness directly in the training stage. Unlike those, we propose to study the effect of generative face completion on the recognition. We offer a face completion encoder-decoder, based on a convolutional operator with a gating mechanism, trained with an ample set of face occlusions. To systematically evaluate the impact of realistic occlusions on recognition, we propose to play the occlusion game: we render 3D objects onto different face parts, providing precious knowledge of what the impact is o

AIRD: Adversarial Learning Framework for Image Repurposing Detection

Image repurposing is a commonly used method for spreading misinformation on social media and online forums, which involves publishing untampered images with modified metadata to create rumors and further propaganda. While manual verification is possible, given vast amounts of verified knowledge available on the internet, the increasing prevalence and ease of this form of semantic manipulation call for the development of robust automatic ways of assessing the semantic integrity of multimedia data. In this paper, we present a novel method for image repurposing detection that is based on the real-world adversarial interplay between a bad actor who repurposes images with counterfeit metadata and a watchdog who verifies the semantic consistency between images and their accompanying metadata, where both players have access to a reference dataset of verified content, which they can use to achieve their goals. The proposed method exhibits state-of-the-art performance on location-identity, subject-identity and painting-artist verification, showing its efficacy across a diverse set of scenarios

Recurrent Convolutional Strategies for Face Manipulation Detection in Videos

The spread of misinformation through synthetically generated yet realistic images and videos has become a significant problem, calling for robust manipulation detection methods. Despite the predominant effort of detecting face manipulation in still images, less attention has been paid to the identification of tampered faces in videos by taking advantage of the temporal information present in the stream. Recurrent convolutional models are a class of deep learning models which have proven effective at exploiting the temporal information from image streams across domains. We thereby distill the best strategy for combining variations in these models along with domain specific face preprocessing techniques through extensive experimentation to obtain state-of-the-art performance on publicly available videobased facial manipulation benchmarks. Specifically, we attempt to detect Deepfake, Face2Face and FaceSwap tampered faces in video streams. Evaluation is performed on the recently introduced FaceForensics++ dataset, improving the previous state-of-the-art by up to 4.55% in accuracy

Two-Branch Recurrent Network for Isolating Deepfakes in Videos

The current spike of hyper-realistic faces artificially generated using deepfakes calls for media forensics solutions that are tailored to video streams and work reliably with a low false alarm rate at the video level. We present a method for deepfake detection based on a two-branch network structure that isolates digitally manipulated faces by learning to amplify artifacts while suppressing the high-level face content. Unlike current methods that extract spatial frequencies as a preprocessing step, we propose a two-branch structure: one branch propagates the original information, while the other branch suppresses the face content yet amplifies multi-band frequencies using a Laplacian of Gaussian (LoG) as a bottleneck layer. To better isolate manipulated faces, we derive a novel cost function that, unlike regular classification, compresses the variability of natural faces and pushes away the unrealistic facial samples in the feature space. Our two novel components show promising results on the FaceForensics+ +, Celeb-DF, and Facebook’s DFDC preview benchmarks, when compared to prior work. We then offer a full, detailed ablation study of our network architecture and cost function. Finally, although the bar is still high to get very remarkable figures at a very low false alarm rate, our study shows that we can achieve good video-level performance when cross-testing in terms of video-level AUC

Learning Pose-Aware Models for Pose-Invariant Face Recognition in the Wild

We propose a method designed to push the frontiers of unconstrained face recognition in the wild with an emphasis on extreme out-of-plane pose variations. Existing methods either expect a single model to learn pose invariance by training on massive amounts of data or else normalize images by aligning faces to a single frontal pose. Contrary to these, our method is designed to explicitly tackle pose variations. Our proposed Pose-Aware Models (PAM) process a face image using several pose-specific, deep convolutional neural networks (CNN). 3D rendering is used to synthesize multiple face poses from input images to both train these models and to provide additional robustness to pose variations at test time. Our paper presents an extensive analysis of the IARPA Janus Benchmark A (IJB-A), evaluating the effects that landmark detection accuracy, CNN layer selection, and pose model selection all have on the performance of the recognition pipeline. It further provides comparative evaluations on IJB-A and the PIPA dataset. These tests show that our approach outperforms existing methods, even surprisingly matching the accuracy of methods that were specifically fine-tuned to the target dataset. Parts of this work previously appeared in [1] and [2]