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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Psychiatric Evaluation of Organ Donor Candidates in a University Hospital and Their Anxiety, Depression and Quality of Life Levels

WOS: 000418008800007Objective: The aim of this study was to conduct a psychiatric evaluation of organ donor candidates and to investigate their levels of anxiety, depression and quality of life. Material and Methods: This study was performed between May 2015 and February 2016. It included 102 volunteers. The socio-demographic Data Collection Form, DSM-IV Clinical Interview Form - Clinical Version Structured for Axis Diagnoses (SCID-I/CV), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Symptom Checklist (SCL-90-R), and SF-36 Quality of Life Survey (SF-36) were administered to the patients. Results: The average age of the applicants was found to be 41.64 +/- 12.02, 42.2% (n=43) being male and 57.8% (n=59) being female. When it comes to the degree of affinity between potential donors and recipients, 57.8% (n=59) were first-degree relatives, 19.6% (n=20) were spouses, and 22.5% (n=23) were other relatives and/or close relations. By dividing donor candidates into groups by the degree of their affinity to recipients, there were statistically significant differences revealed between BDI, BAI and SCL-90-R total scores and interpersonal sensitivity subscale scores. Conclusion: As compared to the global average, the number of living donors is higher than cadaver donors; and donor candidates mostly comprise spouses and first-degree relatives. Therefore, family members and first-degree relatives who are affected directly or indirectly by the transplant process are exposed to social and psychological effects more as the donor candidates/donors. It is of crucial importance to evaluate the psychosocial states of donors, in addition to recipients, in order to manage the long-lasting transplant process, a treatment- and care-demanding one in a more appropriate way

THE USE OF HAND ASSISTED RETROPERITONEOSCOPIC NEPHRECTOMY TECHNIQUE FOR SINGLE INCISION SIMULTANEOUS NATIVE NEPHRECTOMY AND LIVING DONOR KIDNEY TRANSPLANTATION: REPORT OF TWO CASES

WOS: 000411688503410

Psychiatric Evaluation of Organ Donor Candidates in a University Hospital and Their Anxiety, Depression and Quality of Life Levels

Amaç: Çalışmamızda organ nakli verici adaylarının psikiyatrik değerlendirmeleri, anksiyete, depresyon ve yaşam kalitesi düzeyleri araştırılması amaçlanmıştır.Yöntem: Araştırma Mayıs 2015-Şubat 2016 tarihleri arasında yürütülmüştür. Toplam 102 gönüllü çalışmaya dahil edilmiştir. Hastalara Sosyodemografik veri formu, DSM-IV Eksen Tanıları İçin Yapılandırılmış Klinik Görüşme Ölçeği-Klinik Versiyonu(SCID-I/CV) ölçeği, Beck Anksiyete Ölçeği (BAÖ), Beck Depresyon Ölçeği (BDÖ), Belirti Tarama Listesi (SCL-90-R), SF-36 Yaşam Kalitesi Ölçeği (SF-36) uygulanmıştır. Bulgular: Başvuranların yaş ortalaması 41.64±12.02 olup, %42.2'si (n=43) erkek, %57.8'i (n=59) kadındı. Verici adaylarının alıcılara olan yakınlık dereceleri; %57.8'i (n=59) 1. derece akraba, %19.6'sı (n=20) eş, %22.5'i (n=23) diğer akraba ve tanıdık idi. Yakınlık derecelerine göre yapılan gruplandırmada; BDÖ, BAÖ ve SCL-90-R toplam puanı ile kişilerarası duyarlılık ortalaması gruplar arasında anlamlı düzeyde farklılık vardı. Sonuç: Dünya ortalamasına göre ülkemizde canlı verici sayısı kadavra vericiye göre daha fazla olup, genellikle verici adayları eş, birinci derece akraba gibi yakın aile içindeki bireylerden oluşmaktadır. Bu sebeple; nakil sürecinden doğrudan ve dolaylı olarak etkilenen aile içi ve yakın akrabalar verici adayı/verici olarak daha fazla ruhsal ve sosyal yönden etkilenebilmektedirler. Nakil süreci gibi uzun bir tedavi ve bakım gerektiren bir durumu iyi yönetebilmek için alıcı yanında vericilerin de psikososyal durumlarını değerlendirerek bu sürece dahil etmek gerekmektedirPsychiatric evaluation of organ donor candidates in a university hospital and their anxiety, depression and quality of life levelsObjective: The aim of this study was to conduct a psychiatric evaluation of organ donor candidates and to investigate their levels of anxiety, depression and quality of life.Material and Methods: This study was performed between May 2015 and February 2016. It included 102 volunteers. The socio-demographic Data Collection Form, DSM-IV Clinical Interview Form – Clinical Version Structured for Axis Diagnoses (SCID-I/CV), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Symptom Checklist (SCL-90-R), and SF-36 Quality of Life Survey (SF-36) were administered to the patients. Results: The average age of the applicants was found to be 41.64±12.02, 42.2% (n=43) being male and 57.8% (n=59) being female. When it comes to the degree of affinity between potential donors and recipients, 57.8% (n=59) were first-degree relatives, 19.6% (n=20) were spouses, and 22.5% (n=23) were other relatives and/or close relations. By dividing donor candidates into groups by the degree of their affinity to recipients, there were statistically significant differences revealed between BDI, BAI and SCL-90-R total scores and interpersonal sensitivity subscale scores. Conclusion: As compared to the global average, the number of living donors is higher than cadaver donors; and donor candidates mostly comprise spouses and first-degree relatives. Therefore, family members and first-degree relatives who are affected directly or indirectly by the transplant process are exposed to social and psychological effects more as the donor candidates/donors. It is of crucial importance to evaluate the psychosocial states of donors, in addition to recipients, in order to manage the long-lasting transplant process, a treatment- and care- demanding one in a more appropriate wa

Clinical Prognosis of Renal Retransplant Patients: A Single-Center Experience

1st International Transplant Network Congress -- OCT 17-21, 2018 -- Antalya, TURKEYWOS: 000487349900032PubMed: 31474292Background. Retransplantation is a treatment option in patients with end-stage renal failure due to graft loss. Outcomes of these patients due to high immunologic risk remain unclear. the aim of this study was to evaluate outcomes of renal retransplantation patients retrospectively. Methods. Renal retransplant patients in our unit were evaluated retrospectively between 2010 and 2018. Patients' demographic characteristics, primary diseases, the causes of prior graft loss, immunologic status, desensitization protocols, the induction and maintenance treatments, the complications during the follow-up period, numbers of acute rejections, and the clinical prognosis were all detected from the patients' files. Results. We retrospectively evaluated 17 patients who underwent a second or third renal allograft. of these, 16 received a second and the remaining 1 patient received a third renal allograft. Immunologically, all of the 17 patients had negative flow cytometry crossmatch, 1 patient had a positive complement-dependent cytotoxicity crossmatch (Auto 12%), 16 patients had positive panel reactive antibody, the median HLA-mismatch was 3.5, and the score of donor-specific antibody relative intensity score (RIS) was 6.4 +/- 6.3. Ten pretransplant patients had desensitization treatment. While scores for HLA-MM and HLA-RIS in the patients who had a desensitization therapy were determined higher, no statistical difference was observed (respectively, P = .28 and.55). No acute rejection episode developed. BK virus DNA viremia was detected in 4 patients during the posttransplant 6th month. We observed no patient death or no graft loss during the follow-up period. Conclusion. Although the retransplant patients who had a graft loss previously have high immunologic risks, retransplantation is reliable in these patients, but they should be followed up carefully in terms of BKV nephropathy

Incisional Complications and Cosmetic Evaluation After Hand-assisted Retroperitoneoscopic Donor Nephrectomy

1st International Transplant Network Congress -- OCT 17-21, 2018 -- Antalya, TURKEYAydogdu, Ibrahim/0000-0001-7900-8598; SARDOGAN, CEYDA/0000-0002-4263-3653WOS: 000487349900018PubMed: 31474288Purpose. Hand-assisted retroperitoneoscopic (HARP) donor nephrectomy prevents major complications, but incision site complications may be more frequent in hand-assisted approach. We evaluated long-term incisional complication rates and cosmetic outcomes after HARP donor nephrectomy in our series. Materials and Methods. A total of 609 donors who underwent nephrectomy between February 2009 and June 2016 were invited for physical examination and face-to-face interview. A total of 209 donors (35.3%) participated to the study. Sex, age, body mass index (BMI), mean follow-up period, incision-related outcomes of cosmesis, and postoperative complications were evaluated. Body image scale (BIS) and cosmetic scale (CS) (scar test) questionnaires were applied. Higher cosmesis and body image scores indicated greater satisfaction. Results. A total of 191 donors had paramedian (91.4%), and 18 donors had Pfannenstiel incision (8.6%); 121 donors were female (57.9%). the donor mean age and BMI were 49.1 (SD, 1.8) years and 29.7 (SD, 5.1), respectively. Body mass index was significantly lower in the Pfannenstiel group (P < .001). the mean BIS score was 18.9 (SD, 1.8), and the CS questionnaire score was 19.3 (SD, 4,7). the BIS score was significantly better in donors with Pfannenstiel incisions (P < .001), but there was no statistical significance in CS score. the total rate of wound infection was 4.8%, and rate of incisional hernia was 4.8%. the rate of incisional hernia was more frequent in donors with paramedian incision (5.2%), but there was no statistical significance. Six donors (2.9%) required rehospitalization because of incision site complications. Conclusion. Hand-assisted retroperitoneoscopic donor nephrectomy avoids intra-abdominal complications, but rate of incision site complications can be higher in hand-assisted procedure. the donors were convinced from the cosmetic outcome after HARP donor nephrectomy. the ones who had Pfannenstiel incision had better satisfaction according to BIS score

The incidence of new onset diabetes after transplantation and related factors: Single center experience

WOS: 000400322000009PubMed ID: 28262264Aim: New-onset diabetes after transplantation (NODAT) is a frequent metabolic complication and is considered a risk factor for patients undergoing renal transplant. The aim of this study was to evaluate the incidence and developing duration of new-onset diabetes after transplant (NODAT) and influencing factors. Methods: All patients' data was investigated retrospectively. Diabetics, follow-up period < 6 months, age < 18years were excluded. Demographic, clinical and laboratory data was recorded. Patients were divided into two groups: with/without NODAT. NODAT group was divided into four subgroups according to the time of developing NODAT, which were 0-3, 3-6, 6-12 and 12 months later. Two groups were compared, to investigate the incidence of NODAT and risk factors associated with the occurrence of NODAT. Results: We retrospectively analyzed the records of 570 patients, of which 420 patients were included. Seventy (16.6%) patients had NODAT (36 female, mean age 51.7 +/- 8.2 years, mean follow-up 41.6 +/- 21.5 months), 52.8% of patients developed NODAT within the first three months of being diagnosed. 350 patients (116 female, mean age 43.2 +/- 12.5 years, mean follow-up 41.6 21.5 months) were without NODAT. The incidence of impaired fasting glucose (IFG) during the first week after transplant was found to be higher in the patients with NODAT (p <0.001). There was positive correlation between NODAT and older age, obesity, family history of diabetes, presence of IFG, fasting plasma glucose, total and LDL-cholesterol, triglycerides, parathormone. Old age, obesity, presence of IFG, pretransplant hypertriglyceridemia and hyperparathyroidism were predictors of development of NODAT. Conclusion: Incidence of NODAT, especially the first six months, was high. All patients should be screened for IFG within the first week. Patients with dyslipidemia, elderly and obese patients should be closely monitored for the risk of development of NODAT. (C) 2017 Sociedad Espanola de Nefrologia. Published by Elsevier Espana, S.L.U

COVID-19 in kidney transplant recipients: A multicenter experience in Istanbul.

© 2020 Wiley Periodicals LLCIntroduction: Management of COVID-19 in kidney transplant recipients should include treatment of the infection, regulation of immunosuppression, and supportive therapy. However, there is no consensus on this issue yet. This study aimed to our experiences with kidney transplant recipients diagnosed with COVID-19. Material and Methods: Kidney transplant recipients diagnosed with COVID-19 from five major transplant centers in Istanbul, Turkey, were included in this retrospective cohort study. Patients were classified as having moderate or severe pneumonia for the analysis. The primary endpoint was all-cause mortality. The secondary endpoints were acute kidney injury, the average length of hospital stay, admission to intensive care, and mechanical ventilation. Results: Forty patients were reviewed retrospectively over a follow-up period of 32 days after being diagnosed with COVID-19. Cough, fever, and dyspnea were the most frequent symptoms in all patients. The frequency of previous induction and rejection therapy was significantly higher in the group with severe pneumonia compared to the moderate pneumonia group. None of the patients using cyclosporine A developed severe pneumonia. Five patients died during follow-up in the intensive care unit. None of the patients developed graft loss during follow-up. Discussion: COVID-19 has been seen to more commonly cause moderate or severe pneumonia in kidney transplant recipients. Immunosuppression should be carefully reduced in these patients. Induction therapy with lymphocyte-depleting agents should be carefully avoided in kidney transplant recipients during the pandemic period