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

Clinical and histochemical response to automated microneedling therapy in treatment of traumatic scars

Background: Post traumatic skin injuries are challenging to manage. Patients may have erythematous, hypertrophic, or atrophic scars. Microneedling therapy is minimally invasive non-surgical and non-ablative procedure used for skin rejuvenation that relies on the principle of neocollagenesis. Aim: We aimed to assess the clinical and histochemical response to automated microneedling therapy in treatment of traumatic scars. Methods: This prospective study included twenty patients with traumatic scars. All patients received 4 monthly sessions of automated microneedling therapy. Outcome assessment included modified Vancouver Scar Scale, digital photographic documentation and patient's satisfaction. Histochemical evaluation by quantitative morphometric assessment for collagen and elastic fibers using image analyzer performed before and 3 months after treatment for Masson’s trichrome and Orcein stained sections respectively.&nbsp; Results: There was statistically significant improvement in scar vascularity (p= 0.018), scar pigmentation (p= 0.008), and scar pliability (p= 0.002) and sum of mVSS (P=0.000002). Histochemically, there was significant increase in collagen content, (p= 0.023), and elastin content (p= 0.003) as quantified by image analyzer. There was no significant correlations (r: 0.158 and -0.259; p-values: 0.55 and 0.34) between micro-needling therapy and scar type (atrophic versus hypertrophic)

Physiological and Biochemical Changes in Vegetable and Field Crops under Drought, Salinity and Weeds Stresses: Control Strategies and Management

Weeds are one of the most damaging biotic stresses in crop production, and drought and salinity are considered the most serious abiotic stresses. These factors harmfully affect growth and development in several vegetable and field crops by causing harmful effects on physiological and biochemical characteristics such as water uptake, photosynthesis, relative water content, electrolyte leakage, and antioxidant compounds linked with oxidative stress and the accumulation of reactive oxygen species (ROS). These oxidative stress-related components affect most physiological and biochemical characteristics in plants under natural conditions and environmental stresses, especially weed infestation, salinity, and drought stress. ROS such as superoxide (O2&bull;&minus;), hydrogen peroxide (H2O2), peroxyl radical (ROO&bull;), and singlet oxygen (1O2) are very important molecules produced naturally as by-products of metabolic processes in chloroplasts, mitochondria, peroxisomes, and the apoplast. Under stress conditions such as weed infestation, drought and salinity, the morphological and yield characteristics of stressed plants are negatively affected; however, superoxide (O2&bull;&minus;) and hydrogen peroxide (H2O2) are significantly increased. The negative impact of weeds can be mitigated with integrated controls which include herbicides, allelopathy, and crop rotation as well as the different methods for weed control. The defense system in various crops mainly depends on both enzymatic and nonenzymatic antioxidants. The enzymatic antioxidants include superoxide dismutase, glutathione reductase, and catalase; nonenzymatic antioxidants include ascorbic acid, carotenoids, &alpha;-Tocopherols, proline, glutathione, phenolics, and flavonoids. These antioxidant components can scavenge various ROS under several stresses, particularly weeds, drought and salinity. In this review, our objective is to shed light on integrated weeds management and plant tolerance to salinity and drought stresses associated with the ROS and the induction of antioxidant components to increase plant growth and yield in the vegetable and field crops

Physiological and Biochemical Changes in Vegetable and Field Crops under Drought, Salinity and Weeds Stresses: Control Strategies and Management

Weeds are one of the most damaging biotic stresses in crop production, and drought and salinity are considered the most serious abiotic stresses. These factors harmfully affect growth and development in several vegetable and field crops by causing harmful effects on physiological and biochemical characteristics such as water uptake, photosynthesis, relative water content, electrolyte leakage, and antioxidant compounds linked with oxidative stress and the accumulation of reactive oxygen species (ROS). These oxidative stress-related components affect most physiological and biochemical characteristics in plants under natural conditions and environmental stresses, especially weed infestation, salinity, and drought stress. ROS such as superoxide (O2•−), hydrogen peroxide (H2O2), peroxyl radical (ROO•), and singlet oxygen (1O2) are very important molecules produced naturally as by-products of metabolic processes in chloroplasts, mitochondria, peroxisomes, and the apoplast. Under stress conditions such as weed infestation, drought and salinity, the morphological and yield characteristics of stressed plants are negatively affected; however, superoxide (O2•−) and hydrogen peroxide (H2O2) are significantly increased. The negative impact of weeds can be mitigated with integrated controls which include herbicides, allelopathy, and crop rotation as well as the different methods for weed control. The defense system in various crops mainly depends on both enzymatic and nonenzymatic antioxidants. The enzymatic antioxidants include superoxide dismutase, glutathione reductase, and catalase; nonenzymatic antioxidants include ascorbic acid, carotenoids, α-Tocopherols, proline, glutathione, phenolics, and flavonoids. These antioxidant components can scavenge various ROS under several stresses, particularly weeds, drought and salinity. In this review, our objective is to shed light on integrated weeds management and plant tolerance to salinity and drought stresses associated with the ROS and the induction of antioxidant components to increase plant growth and yield in the vegetable and field crops