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

Hoja oficial del lunes: Año XXXVI Número 1823 - 1972 Junio 26

Artigo analítico sobre a retórica das imagens de biociências em periódicos em bancas de jornal, que pretende contribuir para pesquisas empíricas sobre representações sociais dominantes no imaginário contemporâneo, analisando as imagens das capas da mídia impressa sobre vida, saúde e doença. As mensagens veiculadas buscam ser impressionantes, atrativas e, sobretudo, convincentes, o que mobiliza a análise da retórica, com sua capacidade de convencimento da palavra fortalecida pela imagem. O texto articula um ensaio teórico sobre metodologia de análise da retórica, com a apresentação de resultados preliminares de campo, coletados em Porto Alegre e Rio de Janeiro. A abordagem contribui para a análise do papel social da divulgação das biociências na cultura atual.This is an analytical article on the rhetoric of bioscience images in periodicals available from newspaper kiosks. The aim was to contribute towards empirical investigations on the dominant social representations in the contemporary imaginary, through analyzing the frontpage images of magazines on life, health and disease. The messages carried sought to cause an impression, to be attractive and, especially, to be convincing. This led to an analysis on the rhetoric, with its capacity to convince through words strengthened through the image. This paper comprises a theoretical essay on the methodology of rhetoric analysis, and it presents preliminary field results gathered in Porto Alegre and Rio de Janeiro. This approach contributes towards analyzing the social role of dissemination of the biosciences within present-day culture

Vivências e Estágios na Realidade do SUS : educação permanente em saúde e aprendizagem de uma saúde que requer integralidade e trabalho em redes colaborativas

As Vivências e Estágios na Realidade do SUS (VER-SUS) constituem importante dispositivo que permite aos estudantes experimentarem um novo espaço de aprendizagem, que é o cotidiano de trabalho das organizações de saúde, e desenvolver protagonismo na sua própria formação. Pretende estimular discussões relativas à integração entre educação e trabalho na saúde, articulando os gestores, trabalhadores e instituições formadoras na perspectiva da reorientação das práticas de ensino e de atenção e, dessa forma, estimular a formação de trabalhadores para o SUS, comprometidos eticamente com os princípios e diretrizes do sistema e que se entendam como atores sociais, agentes políticos, capazes de promover transformações. O projeto é composto por uma experiência de imersão na realidade do SUS em que os estudantes têm a oportunidade de vivenciar a realidade do SUS e assim se qualificarem para atuação no sistema de saúde. O foco das vivências são as redes de atenção à saúde, o entendimento do funcionamento dessas redes na perspectiva que esse futuro trabalhador do SUS poderá identificar o cenário de aprendizagem como o seu futuro cenário de prática profissional. Neste trabalho apresentaremos um breve histórico e algumas construções que compões a atual organicidade do projeto