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

Geographical and temporal distribution of SARS-CoV-2 clades in the WHO European Region, January to June 2020

We show the distribution of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) genetic clades over time and between countries and outline potential genomic surveillance objectives. We applied three genomic nomenclature systems to all sequence data from the World Health Organization European Region available until 10 July 2020. We highlight the importance of real-time sequencing and data dissemination in a pandemic situation, compare the nomenclatures and lay a foundation for future European genomic surveillance of SARS-CoV-2

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

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Pencil Graphite Electrodes: A Versatile Tool in Electroanalysis

Due to their electrochemical and economical characteristics, pencil graphite electrodes (PGEs) gained in recent years a large applicability to the analysis of various types of inorganic and organic compounds from very different matrices. The electrode material of this type of working electrodes is constituted by the well-known and easy commercially available graphite pencil leads. Thus, PGEs are cheap and user-friendly and can be employed as disposable electrodes avoiding the time-consuming step of solid electrodes surface cleaning between measurements. When compared to other working electrodes PGEs present lower background currents, higher sensitivity, good reproducibility, and an adjustable electroactive surface area, permitting the analysis of low concentrations and small sample volumes without any deposition/preconcentration step. Therefore, this paper presents a detailed overview of the PGEs characteristics, designs and applications of bare, and electrochemically pretreated and chemically modified PGEs along with the corresponding performance characteristics like linear range and detection limit. Techniques used for bare or modified PGEs surface characterization are also reviewed

Past and Present of Electrochemical Sensors and Methods for Amphenicol Antibiotic Analysis

Amphenicols are broad-spectrum antibiotics. Despite their benefits, they also present toxic effects and therefore their presence in animal-derived food was regulated. Various analytical methods have been reported for their trace analysis in food and environmental samples, as well as in the quality control of pharmaceuticals. Among these methods, the electrochemical ones are simpler, more rapid and cost-effective. The working electrode is the core of any electroanalytical method because the selectivity and sensitivity of the determination depend on its surface activity. Therefore, this review offers a comprehensive overview of the electrochemical sensors and methods along with their performance characteristics for chloramphenicol, thiamphenicol and florfenicol detection, with a focus on those reported in the last five years. Electrode modification procedures and analytical applications of the recently described devices for amphenicol electroanalysis in various matrices (pharmaceuticals, environmental, foods), together with the sample preparation methods were discussed. Therefore, the information and the concepts contained in this review can be a starting point for future new findings in the field of amphenicol electrochemical detection

Curcumin Electrochemistry—Antioxidant Activity Assessment, Voltammetric Behavior and Quantitative Determination, Applications as Electrode Modifier

Curcumin (CU) is a polyphenolic compound extracted from turmeric, a well-known dietary spice. Since it has been shown that CU exerts beneficial effects on human health, interest has increased in its use but also in its analysis in different matrices. CU has an antioxidant character and is electroactive due to the presence of phenolic groups in its molecule. This paper reviews the data reported in the literature regarding the use of electrochemical techniques for the assessment of CU antioxidant activity and the investigation of the voltammetric behavior at different electrodes of free or loaded CU on various carriers. The performance characteristics and the analytical applications of the electrochemical methods developed for CU analysis are compared and critically discussed. Examples of voltammetric investigations of CU interaction with different metallic ions or of CU or CU complexes with DNA as well as the CU applications as electrode modifiers for the enhanced detection of various chemical species are also shown

Recent Trends in the Development of Carbon-Based Electrodes Modified with Molecularly Imprinted Polymers for Antibiotic Electroanalysis

Antibiotics are antibacterial agents applied in human and veterinary medicine. They are also employed to stimulate the growth of food-producing animals. Despite their benefits, the uncontrolled use of antibiotics results in serious problems, and therefore their concentration levels in different foods as well as in environmental samples were regulated. As a consequence, there is an increasing demand for the development of sensitive and selective analytical tools for antibiotic reliable and rapid detection. These requirements are accomplished by the combination of simple, cost-effective and affordable electroanalytical methods with molecularly imprinted polymers (MIPs) with high recognition specificity, based on their “lock and key” working principle, used to modify the electrode surface, which is the “heart” of any electrochemical device. This review presents a comprehensive overview of MIP-modified carbon-based electrodes developed in recent years for antibiotic detection. The MIP preparation and electrode modification procedures, along with the performance characteristics of sensors and analytical methods, as well as the applications for the antibiotics’ quantification from different matrices (pharmaceutical, biological, food and environmental samples), are discussed. The information provided by this review can inspire researchers to go deeper into the field of MIP-modified sensors and to develop efficient means for reliable antibiotic determination

A Derivative Spectrometric Method for Hydroquinone Determination in the Presence of Kojic Acid, Glycolic Acid, and Ascorbic Acid

A new, simple, and sensitive spectrometric method was developed for hydroquinone (HQ) determination in the presence of other depigmenting agents (kojic acid (KA), glycolic acid (GA), and ascorbic acid (AA)), commonly introduced in skin lightening products. The method is based on the oxidation of the depigmenting agents by potassium dichromate in sulfuric acid medium and subsequent measurement of the amplitude of the first-order derivative absorption spectrum at 268 nm. By applying the zero-crossing method, at this wavelength, the oxidation products of KA, AA, and GA do not interfere in the indirect determination of HQ. Beer’s law was obeyed in the range of 0.22–22 μg·mL−1 HQ, with a detection limit of 0.07 μg·mL−1. The developed method was applied with good results for the first time to the rapid determination of HQ in binary, ternary, and quaternary mixtures, thus proving that it could represent an effective tool for various skin lightening products analyses

Electrochemical Study of Ferulic Acid at a Pencil Graphite Electrode

Ferulic acid (FA), a hydroxycinnamic acid naturally found in fruits, vegetables and alcoholic beverages, has antioxidant, antiaging, antiviral and antibacterial activity being used in the medicine, food and pharmaceutical industries [1]. [...