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

Potential of Core-Collapse Supernova Neutrino Detection at JUNO

JUNO is an underground neutrino observatory under construction in Jiangmen, China. It uses 20kton liquid scintillator as target, which enables it to detect supernova burst neutrinos of a large statistics for the next galactic core-collapse supernova (CCSN) and also pre-supernova neutrinos from the nearby CCSN progenitors. All flavors of supernova burst neutrinos can be detected by JUNO via several interaction channels, including inverse beta decay, elastic scattering on electron and proton, interactions on C12 nuclei, etc. This retains the possibility for JUNO to reconstruct the energy spectra of supernova burst neutrinos of all flavors. The real time monitoring systems based on FPGA and DAQ are under development in JUNO, which allow prompt alert and trigger-less data acquisition of CCSN events. The alert performances of both monitoring systems have been thoroughly studied using simulations. Moreover, once a CCSN is tagged, the system can give fast characterizations, such as directionality and light curve

Detection of the Diffuse Supernova Neutrino Background with JUNO

As an underground multi-purpose neutrino detector with 20 kton liquid scintillator, Jiangmen Underground Neutrino Observatory (JUNO) is competitive with and complementary to the water-Cherenkov detectors on the search for the diffuse supernova neutrino background (DSNB). Typical supernova models predict 2-4 events per year within the optimal observation window in the JUNO detector. The dominant background is from the neutral-current (NC) interaction of atmospheric neutrinos with 12C nuclei, which surpasses the DSNB by more than one order of magnitude. We evaluated the systematic uncertainty of NC background from the spread of a variety of data-driven models and further developed a method to determine NC background within 15\% with {\it{in}} {\it{situ}} measurements after ten years of running. Besides, the NC-like backgrounds can be effectively suppressed by the intrinsic pulse-shape discrimination (PSD) capabilities of liquid scintillators. In this talk, I will present in detail the improvements on NC background uncertainty evaluation, PSD discriminator development, and finally, the potential of DSNB sensitivity in JUNO

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

Directionality measurement of CNO neutrinos with Borexino detector

International audienc

Ten years of cosmic muons observation with Borexino

The Borexino detector at Gran Sasso has now accumulated over ten years of continuous data which represent a magnificent opportunity to study the cosmic muon flux at a deep underground location. We present here a precision measurement of the flux and of the expected seasonal modulation. We present the correlation with the atmospheric temperature variations from global atmospheric models. We measure the correlation parameters and infer the kaon-to-pion ratio in the production of cosmic muons from high energy primaries. We also find evidence of a long term modulation that is not present in the atmospheric data and we investigate a possible positive correlation with the solar activity. Finally we observe a seasonal modulation of the production rate of cosmogenic neutrons that is in phase with the muon modulation but shows a surprisingly larger amplitude

Sensitivity to neutrinos from the solar CNO cycle in Borexino

Neutrinos emitted in the carbon, nitrogen, oxygen (CNO) fusion cycle in the Sun are a sub-dominant, yet crucial component of solar neutrinos whose flux has not been measured yet. The Borexino experiment at the Laboratori Nazionali del Gran Sasso (Italy) has a unique opportunity to detect them directly thanks to the detector’s radiopurity and the precise understanding of the detector backgrounds. We discuss the sensitivity of Borexino to CNO neutrinos, which is based on the strategies we adopted to constrain the rates of the two most relevant background sources, $pep$ neutrinos from the solar pp-chain and $^{210}$Bi beta decays originating in the intrinsic contamination of the liquid scintillator with $^{210}$Pb. Assuming the CNO flux predicted by the high-metallicity Standard Solar Model and an exposure of 1000 days $\times$ 71.3 t, Borexino has a median sensitivity to CNO neutrino higher than 3 $\sigma$. With the same hypothesis the expected experimental uncertainty on the CNO neutrino flux is 23%, provided the uncertainty on the independent estimate of the $^{210}\text {Bi}$ interaction rate is 1.5 $\hbox {cpd}/100~\hbox {ton}$. Finally, we evaluated the expected uncertainty of the C and N abundances and the expected discrimination significance between the high and low metallicity Standard Solar Models (HZ and LZ) with future more precise measurement of the CNO solar neutrino flux

Experimental evidence of neutrinos produced in the CNO fusion cycle in the Sun

International audienceFor most of their existence, stars are fuelled by the fusion of hydrogen into helium. Fusion proceeds via two processes that are well understood theoretically: the proton–proton (pp) chain and the carbon–nitrogen–oxygen (CNO) cycle. Neutrinos that are emitted along such fusion processes in the solar core are the only direct probe of the deep interior of the Sun. A complete spectroscopic study of neutrinos from the pp chain, which produces about 99 per cent of the solar energy, has been performed previously; however, there has been no reported experimental evidence of the CNO cycle. Here we report the direct observation, with a high statistical significance, of neutrinos produced in the CNO cycle in the Sun. This experimental evidence was obtained using the highly radiopure, large-volume, liquid-scintillator detector of Borexino, an experiment located at the underground Laboratori Nazionali del Gran Sasso in Italy. The main experimental challenge was to identify the excess signal—only a few counts per day above the background per 100 tonnes of target—that is attributed to interactions of the CNO neutrinos. Advances in the thermal stabilization of the detector over the last five years enabled us to develop a method to constrain the rate of bismuth-210 contaminating the scintillator. In the CNO cycle, the fusion of hydrogen is catalysed by carbon, nitrogen and oxygen, and so its rate—as well as the flux of emitted CNO neutrinos—depends directly on the abundance of these elements in the solar core. This result therefore paves the way towards a direct measurement of the solar metallicity using CNO neutrinos. Our findings quantify the relative contribution of CNO fusion in the Sun to be of the order of 1 per cent; however, in massive stars, this is the dominant process of energy production. This work provides experimental evidence of the primary mechanism for the stellar conversion of hydrogen into helium in the Universe