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

Hydrogel Nanocomposite-Derived Nickel Nanoparticles/Porous Carbon Frameworks as Non-Precious and Effective Electrocatalysts for Methanol Oxidation

Innovative and facile methods for the preparation of metal nanoparticles (MNPs) with A highly uniform distribution and anchored on a unique substrate are receiving increasing interest for the development of efficient and low-cost catalysts in the field of alternative and sustainable energy technologies. In this study, we report a novel and facile metal-ions adsorption-pyrolysis method based on a hydrogel nanocomposite for the preparation of well-distributed nickel nanoparticles on 3D porous carbon frameworks (Ni@PCFs). The pyrolysis temperature effect on electrocatalytic activity toward methanol oxidation and catalyst stability was investigated. Physicochemical characterizations (SEM, TEM, and XRD) were used to determine the morphology and composition of the prepared electrocatalyst, which were then linked to their electrocatalytic activity. The experimental results indicate that the catalyst synthesized by pyrolysis at 800 °C (Ni@PCFs-8) exhibits the highest electrocatalytic activity for oxidation of methanol in alkaline media. Additionally, prepared Ni@PCFs-8 displays a remarkable increase in electrocatalytic activity after activation in 1 M KOH and excellent stability. The adsorption-pyrolysis pathway ensures that the Ni NPs are trapped in the PCFs, which can provide highly reactive surface sites. This work may provide a facile and effective strategy for preparing uniformly distributed metallic NPs on a 3D PCF substrate with high catalytic activity for energy applications

Tragacanth Gum Hydrogel-Derived Trimetallic Nanoparticles Supported on Porous Carbon Catalyst for Urea Electrooxidation

The fabrication of electrocatalysts with high catalytic activity, high durability and low cost towards urea oxidation by a facile method is a great challenge. In this study, non-precious NiCoFe trimetallic supported on porous carbon (NiCoFe@PC) was prepared via gelation and pyrolysis method, presenting a remarkable electrocatalytic activity with low onset potential for urea oxidation in an alkaline medium. Field-emission scanning electron microscopy (FESEM) and transmission electron microscopy (TEM) were used to clarify the morphology of the NiCoFe@PC nanostructure and its nanoparticle size of 17.77 nm. The prepared catalyst with the composition ratio of 24.67, 5.92 and 5.11% for Ni, Fe and Co, respectively, with highly crystalline nanoparticles, fixed on porous carbon, according to energy-dispersive X-ray (EDX) and X-ray diffraction (XRD) analysis. The FeCoNi@PC catalyst showed a catalytic activity of 44.65 mA/cm2 at 0.57 V vs. Ag/AgCl and a low onset potential of 218 mV, which is superior to many other transition bi/trimetallic-based catalysts previously reported

Enhanced Adsorption of Textile Dyes by a Novel Sulfonated Activated Carbon Derived from Pomegranate Peel Waste: Isotherm, Kinetic and Thermodynamic Study

The rapid growth of the dye and textile industry has raised significant public concerns regarding the pollution caused by dye wastewater, which poses potential risks to human health. In this study, we successfully improved the adsorption efficiency of activated carbon derived from pomegranate peel waste (PPAC) through a single-step and surface modification approach using 5-sulfonate-salicylaldehyde sodium salt. This innovative and effective sulfonation approach to produce sulfonated activated carbon (S-PPAC) proved to be highly effective in removing crystal violet dye (CV) from polluted water. The prepared PPAC and S-PPAC were characterized via FESEM, EDS, FTIR and BET surface area. Characterization studies confirmed the highly porous structure of the PPAC and its successful surface modification, with surface areas reaching 1180.63 m2/g and 740.75 m2/g for the PPAC and S-PPAC, respectively. The maximum adsorption capacity was achieved at 785.53 mg/g with the S-PPAC, an increase of 22.76% compared to the PPAC at 45 °C. The isothermic adsorption and kinetic studies demonstrated that the adsorption process aligned well with the Freundlich isotherm model and followed the Elovich kinetic model, respectively. The thermodynamic study confirmed that the adsorption of CV dye was endothermic, spontaneous and thermodynamically favorable onto PPAC and S-PPAC

Synthesis of New S-Triazine Bishydrazino and Bishydrazido-Based Polymers and Their Application in Flame-Retardant Polypropylene Composites

In this study six new s-triazine bishydrazino and bishydrazido-based polymers were synthesized via condensation of bishydrazino s-triazine derivatives with terephthaldehyde or via nucleophilic substitution of dichloro-s-triazine derivatives with terephthalic acid hydrazide. The synthesized polymers were characterized by different techniques. The new polymers displayed good thermal behavior with great values in terms of limited oxygen indexed (LOI) 27.50%, 30.12% for polymers 5b,c (bishydrazino-s-triazine based polymers) and 27.23%, 29.86%, 30.85% for polymers 7a–c (bishydrazido-s-triazine based polymers) at 800 °C. Based on the LOI values, these polymers could be classified as flame retardant and self-extinguishing materials. The thermal results also revealed that the type of substituent groups on the triazine core has a considerable impact on their thermal behavior. Accordingly, the prepared polymers were mixed with ammonium polyphosphate (APP) in different proportions to form an intumescent flame-retardant (IFRs) system and were introduced into polypropylene (PP) to improve the flame-retardancy of the composites. The best results were obtained with a mass ratio of APP: 5a–c or 7a–c of 2:1, according to the vertical burning study (UL-94). In addition, the presence of 25% “weight ratio” of IFR in the composite showed great impact and passed UL-94 V-0 and V-1 tests

In Situ Preparation of Novel Porous Nanocomposite Hydrogel as Effective Adsorbent for the Removal of Cationic Dyes from Polluted Water

The use of some hydrogels as adsorbents for pollutants removal from wastewater is limited due to their high swelling properties and the difficulty in recovering them after the adsorption process. To overcome these problems, a new hydrogel nanocomposite based on chitosan-grafted-polyacrylic acid/oxidized electrospun carbon nanofibers (CT-g-PAA/O-ECNFs) was prepared by an in situ grafting polymerization process. The prepared hydrogel nanocomposite was used as a novel effective and highly reusable adsorbent for the removal of methylene blue (MB) from polluted water with low cost. The morphology and the structure of CT-g-PAA/O-ECNFs were investigated by numerous techniques. The effect of incorporating O-ECNFs on the swelling capability of the prepared hydrogel was explored in distillated water and MB solution at normal pH. The effect of parameters including ratio of O-ECNFs, contact time, pH, initial concentration, and temperature on adsorption process were explored. The adsorption isotherm and kinetic were studied by numerous non-linear models. The obtained results confirmed that the incorporation of O-ECNFs into the hydrogel network decreased the swelling capacity and improved its ability towards MB dye removal. The adsorption process depended on the pH value of the dye solution. Additionally, the adsorption and kinetic results were fitted using the Freundlich isotherm model and pseudo second order model (PSO), respectively. Moreover, the new adsorbents can be recycled for at least five cycles keeping its adsorption capacity and can be easily recovered without loss in its initial weight

Modified Electrospun Polymeric Nanofibers and Their Nanocomposites as Nanoadsorbents for Toxic Dye Removal from Contaminated Waters: A Review

Electrospun polymer nanofibers (EPNFs) as one-dimensional nanostructures are characterized by a high surface area-to-volume ratio, high porosity, large number of adsorption sites and high adsorption capacity. These properties nominate them to be used as an effective adsorbent for the removal of water pollutants such as heavy metals, dyes and other pollutants. Organic dyes are considered one of the most hazardous water pollutants due to their toxic effects even at very low concentrations. To overcome this problem, the adsorption technique has proven its high effectiveness towards the removal of such pollutants from aqueous systems. The use of the adsorption technique depends mainly on the properties, efficacy, cost and reusability of the adsorbent. So, the use of EPNFs as adsorbents for dye removal has received increasing attention due to their unique properties, adsorption efficiency and reusability. Moreover, the adsorption efficiency and stability of EPNFs in aqueous media can be improved via their surface modification. This review provides a relevant literature survey over the last two decades on the fabrication and surface modification of EPNFs by an electrospinning technique and their use of adsorbents for the removal of various toxic dyes from contaminated water. Factors affecting the adsorption capacity of EPNFs, the best adsorption conditions and adsorption mechanism of dyes onto the surface of various types of modified EPNFs are also discussed. Finally, the adsorption capacity, isotherm and kinetic models for describing the adsorption of dyes using modified and composite EPNFs are discussed

Biocidal Polymers: Synthesis, Characterization and Antimicrobial Activity of Bis-Quaternary Onium Salts of Poly(aspartate-co-succinimide)

Microbial multidrug resistance presents a real problem to human health. Therefore, water-soluble polymers based on poly(aspartate-co-succinimide) were synthesized via reaction of poly(aspartate-co-succinimide) with bis-quaternary ammonium or quaternary salts. The resultant copolymers were characterized by various techniques such as FTIR, TGA, 1HNMR, 13CNMR and elemental microanalysis. Antimicrobial activities of the new onium salts were investigated against Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, and Salmonella typhi, and the fungi; Candida albicans,Aspergillus niger, Cryptococcus neoformans and Aspergillus flavus by agar diffusion method. Antimicrobial activity was studied in terms of inhibition zone diameters, in addition to the estimation of minimal inhibitory concentration (MIC) of the prepared compounds. A. niger and E. coli were the most affected microorganisms among the tested microorganisms with an inhibition zone of 19&ndash;21 (mm) in case of biocides, (V) and (VII). The obtained results showed that the quaternary onium salts have higher activity compared to the aspartate copolymer with MIC concentrations of 25 mg/mL for (VII) and (V) and 50 mg/mL for (VI) and (IV)

Mesoporous Carbon of Carbonized Human Urine Waste: A Valuable Heterogeneous Catalyst for Chromene and Xanthene Derivative Synthesis

Human urine is universal unused waste material that is regularly disposed of by the human body. We, for the first time, presented an economically beneficial, sustainable, and novel route to synthesize mesoporous human urine carbon (HUC)-containing heteroatoms, i.e., C, Na, Cl, N, S, and P, using a human urine waste. The as-synthesized HUC were envisaged for their structural elucidation, morphology evolution, crystal structure, functional bonding, and elemental composition analyses through various sophisticated technologies. The HUC catalyst had a moderately crystalline nature due to the graphitic phase of carbon with a particle size of 20&ndash;50 nm, which was successfully used to synthesizing chromenes, 1,8-di-oxo-octahydroxanthenes, and benzypyrazolylcoumarin and biscoumarin derivatives through a one-pot multicomponent reaction with 20 mg of catalyst in EtOH/H2O solvent. This eco-friendly and simple method offers numerous advantages such as easy purification, clean reaction, and excellent yield for organic synthesis. The HUC catalyst can be recycled ten times and reused multiple times after activation without affecting catalytic performance