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

IRSN Irradiation facilities

International audienceThe irradiation processing obtained from ionizing radiation sources is a nuclear technique widely used both in academic research and in industrial area, as for instance : sterilization of objects; nuclear medicine including diagnostic imaging, radiation oncology and radiological protection; development of innovative electronic materials; harmful effects on solid materials and so on.As a French public industrial and commercial establishment, IRSN (Institut de Radioprotection et de Sûreté Nucléaire) contributes to public nuclear security and safety policies, as well as health, environmental and crisis management policies. So, in the frame of its missions, IRSN carries out research, analysis and expert work in the fields of nuclear safety and radioprotection. One key topic concerns more especially the ionizing radiations as used in industry and medicine or naturally present in the environment. Thus, IRSN owns several irradiation facilities to perform its basic and applied research and to enhance its expertise in this specific area.This communication presents an overview of the irradiation facilities available in IRSN as well as the linked skills and expertise, especially covering the fields of medicine, environment and industry. These experimental facilities are designed to address all kinds of ionizing radiations such as alpha, beta gamma, X-ray and nucleons (proton, neutron) and over very wide ranges of dose rate and energy. The samples that can be studied thanks to them can cover from micro to macro scales and for both inert and living matters. For instance, irradiations can be applied in one hand from the biological cell to the full organism (animal or plant) and on other hand from nanomaterial up to equipment as large as several cubic meters. Moreover, some of these facilities are also able to perform online measurements during the irradiation process. The main technical features of the irradiation facilities are detailed hereafter: type of radiation, dose rate, energy, irradiation conditions (temperature, pressure, type of atmosphere, etc.) and size of samples. The experimental sensors linked with the facilities allowing on-line measurements during the irradiation phase are also presented. Finally, the skills and expertise of IRSN are pointed out by showing some major outcomes coming from the R&D, Industry or nuclear fields. Through this communication, IRSN aims to promote its irradiation facilities and to share its skills and knowledge with both the national and international networks and with both the scientific and industrial communities having potential needs in irradiation processing

Study of the radiolytic decomposition of CsI and CdI2 aerosols deposited on stainless steel, quartz and Epoxy painted surfaces

International audienceCsI and CdI2 aerosol decomposition rate under irradiation has been quantified at 80 °C and 120 °C in presence of humidity and on different substrate (stainless steel, quartz and Epoxy paint). A model has been developed for the ASTEC-SOPHAEROS code to reproduce the data and help the identification of the gaps remaining in the understanding of iodine volatility in a severe accident of a Nuclear Power Plant (NPP). The current model applied to model the gaseous iodine behaviour in the containment of PHEBUS-FP tests does not fit with the experimental data probably because the nuclear aerosol reaching the containment are much more complex than pure CsI aerosols. It has been clearly shown than the radiolytic oxidation of metallic iodide aerosols into molecular iodine can significantly impact the source term evaluation even if additional experimental data area required to cover the variety and complexity of nuclear iodide aerosols

REVIEW OF THE POTENTIAL SOURCES OF ORGANIC IODIDES IN A NPP CONTAINMENT DURING A SEVERE ACCIDENT AND REMAINING UNCERTAINTIES

International audienceIn case of a severe accident, organic iodides (RI) are one of the volatile iodine species that can be released in the environment thus possibly contributing to people contamination by inhalation. The formation and decomposition reactions of organic iodides have been identified and studied through various experimental programs whose objectives were to understand their behavior and develop phenomenological models able to predict their volatility. Four potential sources of RI formation have been identified: (1) the reactor coolant system (RCS), (2) the containment sump, (3) the paints in the containment and (4) the containment gaseous phase. A review of the knowledge, chemical mechanisms leading to RI formation and decomposition and the remaining uncertainties is performed in order to recommend remaining needed experimental investigations. It has been identified that significant uncertainties remain on RI formation in the gaseous phase through reaction of iodine with volatile organic compounds (VOC, like methane) and that additional data should be obtained to improve its modeling as it can be a significant RI source during days after the beginning of the acciden

Etude de la radiolyse gamma du poly(chlorure de vinyle) (application à l'étude de la dégradation par irradiation et par lixiviation du PVC industriel)

Le travail présenté dans ce mémoire s inscrit dans le contexte de la gestion des déchets nucléaires plastiques. Cette étude a été menée sur du PVC pur et sur du PVC industriel (polymère formulé). La radiolyse à dose élevée (jusqu à 4 MGy) en condition anaérobie du PVC pur entraîne la formation majoritaire de radicaux polyényles, de séquences polyéniques, de chlorure d hydrogène et de réactions de réticulation. En condition aérobie, la radiolyse à dose élevée du PVC pur engendre la formation de radicaux peroxyles, chlorure d hydrogène, d eau acide, d acides carboxyliques, de cétones saturées ou conjuguée et de phénomènes de scission. L étude de la production de HCl par irradiation du PVC industriel a été menée jusqu à 40 MGy. Le HCl formé par radiolyse est totalement piégé par les charges calciques contenues dans le PVC industriel et par l eau produite par ces réactions de piégeage. Une étude qualitative sur la formation des produits de radiolyse a mis en évidence que les mécanismes de radiolyse du PVC industriel sont différents de ceux du PVC pur. Cette différence est liée à la présence d adjuvants entrant dans la formulation du PVC industriel. L irradiation des plastifiants tels que les esters d acide phtalique pourrait induire la formation de radicaux pouvant réagir, par réaction de greffage, avec les macroradicaux de PVC ou les séquences polyéniques formées par radiolyse des macromolécules de PVC. Les résultats des essais de lixiviation tendent à confirmer ce type de mécanisme.AIX-MARSEILLE3-BU Sc.St Jérô (130552102) / SudocSudocFranceF

Investigation of radio-oxidative ageing conditions on EVA/EPDM blends: Understanding the limitations posed as to representing long term in-use exposures

International audienceThe effect of gamma-irradiation and temperature to accelerate, in a representative way, the ageing of EVA (Ethylene Vinyl Acetate)/EPDM (Ethylene Propylene Diene Monomer) blends was investigated. These blends constitute model materials of cable insulation used in Nuclear Power Plants (NPPs). Physicochemical evolutions of the blends were monitored by InfraRed (IR) spectroscopy, gel fraction measurements and Differential Scanning Calorimetry (DSC). After having pointed out the main similarities between the thermooxidative degradation (100 °C) and the radiooxidative degradation at room temperature, both stresses were combined to accelerate the ageing. It is shown that combining gamma-irradiation and high temperature, or subsequent thermooxidation after radiooxidation, accelerates the ageing but may cause distortion within the degradation mechanisms. These limitations of representativeness encountered are particularly due to an increase in chain scission reactions and formation of new crystallites in the blend

Multiscale analysis of the radiooxidative degradation of EVA/EPDM composites. ATH filler and dose rate effect

International audienceThis study is focused on the radiooxidative degradation of polymeric insulation of electric cables used in Nuclear Power Plants (NPPs). In order to investigate the degradation mechanisms of the insulation, model composites with ATH (Aluminium TriHydrate) filler and blends (without filler) based on a cross-linked mixture of EVA (Ethylene Vinyl Acetate) and EPDM (Ethylene Propylene Diene Monomer) were submitted to gamma-rays. In normal operating conditions of a NPP, the dose rate which electric cables are exposed to is around 0.1 Gy h−1. In this work, artificial accelerated ageing test process has been applied at a relatively low dose rate of 7 Gy h−1. Gamma-irradiations at higher dose rates typically used to accelerate the ageing, in the range 0.2–1 kGy h−1, were also carried out.The first part of the study is focused on irradiations performed at relatively low dose rate and is devoted to the highlighting of the radiooxidative degradation mechanisms of EVA/EPDM blend with and without ATH filler. Correlations between the evolutions of the chemical, morphological and mechanical/electrical properties of the materials occurring after the ageing process are presented. It is shown that the degradation process is governed by radical oxidation mechanism involving chain scissions leading to the formation of carboxylic acids as end-groups. One of the main effects of the ATH filler is the progressive loss of the mechanical properties of the composite upon radiooxidation whereas they are maintained in the case of the unfilled sample. Despite the oxidation of the polymer, no change in the electrical properties of the blend and of the composite could be observed.The second part of the study focuses on the dose rate effect. It is shown that one of the main consequences of an increase of the dose rate from 7 Gy h−1 to 0.2–1 kGy h−1 is a reduction of the chain scission process yield by a factor of about 20. Therefore, an important and consistent finding is that there are some limits that must not be exceeded in terms of dose rate to ensure a global satisfactorily representativeness of the accelerated ageing process

A FTIR/chemometrics approach to characterize the gamma radiation effects on iodine/epoxy-paint interactions in Nuclear Power Plants

International audienceThe effects of radiation on polymeric materials are a topic of concern in a wide range of industries including the sterilization, and the nuclear power industry. While much work has concentrated on systems like polyolefins that are radiation sterilized, some work has been done on epoxy systems. The epoxy system studied is an epoxy/amine paint which is representative of the paint that covers the inner surfaces of the French nuclear reactor containment buildings. In case of a severe accident on a Nuclear Power Plant, fission products can be released from the nuclear fuel to the reactor containment building. Among them, volatile iodine (I 2) can be produced and can interact with the epoxy-paint. This paint is also subjected to gamma radiation damages (due to the high dose in the containment coming from radio-nuclides released from the fuel). So the epoxy-paint studied was exposed to gamma radiation under air atmosphere after being loaded with I 2 or not. The aim of this study is to characterize by FTIR spectroscopy the iodine-paint interactions, then to identify the radiation damages on the epoxy-paint, and to check their effects on these iodine-paint interactions. This work shows the potential of multi-block analysis method (ANOVA-PCA and COMDIM = AComDim) for such a study as it allows to identify the nature of iodine/epoxy-paint interactions and to characterize the gamma radiation damages on the epoxy-paint. AComDim method conduces to the extraction of Common Components to different tables and highlights factors of influence and their interactions

Influence of Gamma Irradiation on Electric Cables Models: Study of Additive Effects by Mid-Infrared Spectroscopy

International audienceCables, especially their insulation and jacket materials made of polymers, are vulnerable toageing degradation during normal operation. However, they must remain functional for the entirelife of a nuclear power plant, or even in the event of an accident for cables with a safety requirement.This study focuses on models of crosslinked polyethylene (XLPE)-based insulation of cables anddeals with the structure modification and the behavior of XLPE for nuclear applications due to theeffect of additives. Various additives are added to the polymer formulation to evaluate their impacton ageing. The samples are irradiated at room temperature by several gamma doses, up to 374 kGy,with two dose rates (40 Gy/h and 300 Gy/h) and compared with a non-irradiated sample used asreference. To understand the impact of gamma irradiation on the materials, the principal componentanalysis (PCA) method is applied on spectra recorded through attenuated total reflectance–Fouriertransform infrared (ATR-FTIR) spectroscopy. The results highlight the effects of ageing depending onthe dose rate and on the formulation of the materials, with the identification of different degradationproducts. A curve resolution study compares the effects of different additives on polymer oxidationand shows that the low dose rate leads to a higher degradation than the high dose rate