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

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

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

Keeping your cool in relationship conflicts : emotion regulation and the demand-withdraw pattern

The demand-withdraw communication pattern is a destructive pattern that couples may\ud engage in during conflict. In this pattern, one partner engages in demanding behaviors\ud such as pressuring for change, criticizing, and/or complaining, while the other withdraws\ud through either nonverbal disengagement or conversation avoidance (Christensen, 1988).\ud The present study examined the degree to which deficits in emotion regulation are\ud associated with the demand-withdraw behaviors. It may be that those least capable of\ud regulating aversive emotions during conflict are most likely to engage in demanding or\ud withdrawing behaviors. Ninety-three college students who were currently in a romantic\ud relationship completed a questionnaire packet. Results showed that greater deficits in\ud emotion regulation were associated with higher levels of demand-withdraw behaviors.\ud This general association appeared to be driven primarily by the self-demand/partner-withdraw\ud pattern. Findings indicate that emotion regulation skills play an important role\ud in relationship conflicts. Thus, one way to help couples reduce demand-withdraw\ud communication could be to focus on improving partners??? emotion regulation capabilities

Chronic Effects of Coated Silver Nanoparticles on Marine Invertebrate Larvae: A Proof of Concept Study.

Silver nanoparticles (AgNPs), owing to their unique physical and chemical properties, have become increasingly popular in consumer products. However, data on their potential biological effects on marine organisms, especially invertebrates, remain very limited. This proof of principle study reports the chronic sub-lethal toxicity of two coated AgNPs (oleic acid coated AgNPs and polyvinylpyrrolidone coated AgNPs) on marine benthic invertebrate larvae across three phyla (i.e., the barnacle Balanus Amphitrite, the slipper-limpet Crepidula onyx, and the polychaete Hydroides elegans) in terms of growth, development, and metamorphosis. Bioaccumulation and biodistribution of silver were also investigated. Larvae were also exposed to silver nitrate (AgNO3) in parallel to distinguish the toxic effects derived from nano-silver and the aqueous form of silver. The sub-lethal effect of chronic exposure to coated AgNPs resulted in a significant retardation in growth and development, and reduction of larval settlement rate. The larval settlement rate of H. elegans was significantly lower in the coated AgNP treatment than the AgNO3 treatment, suggesting that the toxicity of coated AgNPs might not be solely evoked by the release of silver ions (Ag+) in the test medium. The three species accumulated silver effectively from coated AgNPs as well as AgNO3, and coated AgNPs were observed in the vacuoles of epithelial cell in the digestive tract of C. onyx. Types of surface coatings did not affect the sub-lethal toxicity of AgNPs. This study demonstrated that coated AgNPs exerted toxic effects in a species-specific manner, and their exposure might allow bioaccumulation of silver, and affect growth, development, and settlement of marine invertebrate larvae. This study also highlighted the possibility that coated AgNPs could be taken up through diet and the toxicity of coated AgNPs might be mediated through toxic Ag+ as well as the novel modalities of coated AgNPs

Particle size distribution by frequency percent of total particle volume and cumulative percentage of size classes.

<p>The individual graphs demonstrate the particles size of OAgNPs (A) and PAgNPs (B) counted using transmission electronic microscope (No. of particle counted = 106).</p

Total silver uptake (μg g^-1 dw) by <i>C</i>. <i>gracilis</i> (A) and <i>I</i>. <i>galbana</i> (B) after 24 h of exposure.

<p>Each bar represents the mean (+ SD) of triplicates. One-way ANOVA was used for the statistics analysis. Significant different between FSW control and treatments was identified by Tukey’s test; *: <i>p</i> < 0.05; ***: <i>p</i> < 0.001. Ctrl: FSW control, SN: AgNO₃, O: OAgNP and P: PAgNP.</p

Effect of OAgNPs, PAgNPs and AgNO₃ on the cumulative molts per larva of <i>B</i>. <i>amphitrite</i> on Day 5.

<p>Each bar represents the mean (+ SD) of four replicates. One-way ANOVA was used for the statistics analysis. Different letters above the bar indicate the means that are significantly different as identified by Tukey’s test. Ctrl: FSW control, SN: AgNO₃, O: OAgNP and P: PAgNP.</p

Concentration of silver released from coated AgNPs mixed in filter seawater at 10 and 100 μg L^-1.

<p>OAgNPs at 10 μg L^<b>-1</b> (O10; open triangle) and 100 μg L^<b>-1</b> (O100; filled triangle). PAgNPs at 10 μg L^<b>-1</b> (P10; open circle) and 100 μg L^<b>-1</b> (P100; filled circle). Samples were collected every 24 h followed by ultracentrifugation for silver measurement using inductively coupled plasma-optical emission spectrometer. Each data point represents the mean (± SD) of duplicate.</p