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

Influence of silicon nano-particles on Avena sativa L. to alleviate the biotic stress of Rhizoctonia solani

Abstract Avena sativa L. a cereal crop that is badly affected by several abiotic and biotic stresses. In the current study, silicon nanoparticles are used to mitigate the harmful effects of root rot disease caused by Rhizoctonia solani Kuhn on the growth of A. sativa. In vitro (Petri plates) and in vivo (pots experiment) were performed to measure the various physiological and biochemical parameters i.e. osmotic potential, chlorophyll, proline content, growth parameters, sugar, fresh and dry weight, and disease index. Results revealed that physiological and biochemical parameters were reduced under fungal stress with silicon nanoparticles treatment as compared to the control group. Si nanoparticles helped to alleviate the negative effects caused by fungus i.e. germination percentage upto 80%, germination rate 4 n/d, radical and plumule length was 4.02 and 5.46, dry weight 0.08 g, and relative water content was (50.3%) increased. Fungus + Si treatment showed the maximum protein content, i.e. 1.2 µg/g as compared to Fungus (0.3 µg/g) treated group. The DI was maximum (78.82%) when the fungus directly attacked the target plant and DI reduced (44.2%) when the fungus was treated with Si nanoparticles. Thus, silicon nanoparticles were potentially effective against the stress of R. solani and also used to analyze the plant resistance against fungal diseases. These particles can use as silicon fertilizers, but further studies on their efficacy under field conditions and improvement in their synthesis are still needed

Novel Mutations in Putative Nicotinic Acid Phosphoribosyltransferases of <i>Mycobacterium tuberculosis</i> and Their Effect on Protein Thermodynamic Properties

pncB1 and pncB2 are two putative nicotinic acid phosphoribosyltransferases, playing a role in cofactor salvage and drug resistance in Mycobacterium tuberculosis. Mutations have been reported in first- and second-line drug targets, causing resistance. However, pncB1 and pncB2 mutational data are not available, and neither of their mutation effects have been investigated in protein structures. The current study has been designed to investigate mutations and also their effects on pncB1 and pncB2 structures. A total of 287 whole-genome sequenced data of drug-resistant Mycobacterium tuberculosis isolates from Khyber Pakhtunkhwa of Pakistan were retrieved (BioSample PRJEB32684, ERR2510337-ERR2510445, ERR2510546-ERR2510645) from NCBI. The genomic data were analyzed for pncB1 and pncB2 mutations using PhyResSE. All the samples harbored numerous synonymous and non-synonymous mutations in pncB1 and pncB2 except one. Mutations Pro447Ser, Arg286Arg, Gly127Ser, and delTCAGGCCG1499213>1499220 in pncB1 are novel and have not been reported in literature and TB databases. The most common non-synonymous mutations exhibited stabilizing effects on the pncB1 structure. Moreover, 36 out of 287 samples harbored two non-synonymous and 34 synonymous mutations in pncB2 among which the most common was Phe204Phe (TTT/TTC), present in 8 samples, which may have an important effect on the usage of specific codons that may increase the gene expression level or protein folding effect. Mutations Ser120Leu and Pro447Ser, which are present in the loop region, exhibited a gain in flexibility in the surrounding residues while Gly429Ala and Gly127Ser also demonstrated stabilizing effects on the protein structure. Inhibitors designed based on the most common pncB1 and pncB2 mutants may be a more useful strategy in high-burden countries. More studies are needed to elucidate the effect of synonymous mutations on organism phenotype

Domiciliation of <i>Trichoderma asperellum</i> Suppresses <i>Globiosporangium ultimum</i> and Promotes Pea Growth, Ultrastructure, and Metabolic Features

The beneficial microorganisms represent a new and hopeful solution for a sustainable environment and development. In this investigation, Trichoderma asperellum ZNW, isolated from seeds, was domiciliated within the pea plant for improving growth, disease management, and enhancement of productivity. Globisporangium ultimum NZW was isolated from deformed pea seeds, representing the first record of the pathogen caused by pea damping-off. Both fungi were molecularly identified. T. asperellum ZNW produced several lytic enzymes and bioactive metabolites as detected by GC-MC. The SEM illustrated the mycoparasitic behavior of T. asperellum ZNW on G. ultimum NZW mycelia. In the pot experiment, T. asperellum domiciliated the root and grew as an endophytic fungus, leading to root vessel lignification. Under soil infection, T. asperellum reduced damping-off, by enhancing peroxidase, polyphenol, total phenols, and photosynthetic pigments content. The vegetative growth, yield, and soil dehydrogenase activity were improved, with an enhancement in the numerical diversity of the microbial rhizosphere. This work may enable more understanding of the plant-fungal interaction, yet, working on domiciliation is recommended as a new approach to plant protection and growth promotion under various ecological setups

Overexpression of Terpenoid Biosynthesis Genes Modifies Root Growth and Nodulation in Soybean (<i>Glycine max</i>)

Root nodule formation in many leguminous plants is known to be affected by endogen ous and exogenous factors that affect formation, development, and longevity of nodules in roots. Therefore, it is important to understand the role of the genes which are involved in the regulation of the nodulation signaling pathway. This study aimed to investigate the effect of terpenoids and terpene biosynthesis genes on root nodule formation in Glycine max. The study aimed to clarify not only the impact of over-expressing five terpene synthesis genes isolated from G. max and Salvia guaranitica on soybean nodulation signaling pathway, but also on the strigolactones pathway. The obtained results revealed that the over expression of GmFDPS, GmGGPPS, SgGPS, SgFPPS, and SgLINS genes enhanced the root nodule numbers, fresh weight of nodules, root, and root length. Moreover, the terpene content in the transgenic G. max hairy roots was estimated. The results explored that the monoterpenes, sesquiterpenes and diterpenes were significantly increased in transgenic soybean hairy roots in comparison with the control. Our results indicate the potential effects of terpenoids and terpene synthesis genes on soybean root growth and nodulation. The study provides novel insights for understanding the epistatic relationship between terpenoids, root development, and nodulation in soybean

Improving Yield Components and Desirable Eating Quality of Two Wheat Genotypes Using Si and NanoSi Particles under Heat Stress

Global climate change is a significant challenge that will significantly lower crop yield and staple grain quality. The present investigation was conducted to assess the effects of the foliar application of either Si (1.5 mM) or Si nanoparticles (1.66 mM) on the yield and grain quality attributes of two wheat genotypes (Triticum aestivum L.), cv. Shandweel 1 and cv. Gemmeiza 9, planted at normal sowing date and late sowing date (heat stress). Si and Si nanoparticles markedly mitigated the observed decline in yield and reduced the heat stress intensity index value at late sowing dates, and improved yield quality via the decreased level of protein, particularly glutenin, as well as the lowered activity of &alpha;-amylase in wheat grains, which is considered a step in improving grain quality. Moreover, Si and nanoSi significantly increased the oil absorption capacity (OAC) of the flour of stressed wheat grains. In addition, both silicon and nanosilicon provoked an increase in cellulose, pectin, total phenols, flavonoid, oxalic acid, total antioxidant power, starch and soluble protein contents, as well as Ca and K levels, in heat-stressed wheat straw, concomitant with a decrease in lignin and phytic acid contents. In conclusion, the pronounced positive effects associated with improving yield quantity and quality were observed in stressed Si-treated wheat compared with Si nanoparticle-treated ones, particularly in cv. Gemmeiza 9

Molecular Identification of Zantedeschia Culture with Determination of Its Morphometric and Metabolic Activities for Mediterranean Acclimatization

Calla lily (Zantedeschia albomaculata (Hook.) Baill.) is an herbaceous or semi-evergreen perennial grown from rhizomes. It is commonly named &ldquo;Spotted Arum&rdquo;. Ribosomal RNAs (rRNAs) are found in all known organisms and are known for being functionally equivalent in all of them. A completely new in vitro culture protocol was applied to Z. albomaculata with two hormones, 6-Benzylaminopurine (BAP) and kinetin, to obtain full growth and multiplication. Due to their highly conserved sequences, the analysis of small-subunit rRNAs (16S&ndash;18S rRNAs) can provide precise statistical evaluation of a wide variety of phylogenetic connections. As a result, the plant&rsquo;s 18S rRNA gene allowed for identification and partial sequencing. Also, the traditional floral method and the novel application technique for identification were applied to Z. albomaculata. In this paper we systemically describe the structural strategies of the plant&rsquo;s adaptation to the surroundings at the morphological, physiological, and anatomical scale. Most the essential oils and fatty acids found in Z. albomaculata are omega fatty acids, octadecenoic acid, linoleic acid, and palmitic acid. All these fatty acids have industrial, medicinal, and pharmaceutical applications. The significant findings are the spadix sheathing leaves, and the precipitation of raphides calcium oxalate. The mitotic index showing the division activity was recorded, and it was 17.4%. The antimicrobial activity of Z. albomaculata ethanol extract was performed via the well diffusion method. This extract has shown high activity against Escherichia coli and Pseudomonas aeruginosa, compared to its lower activity against Bacillus cereus. By defining these characteristics and in vitro culture conditions, we will be able to acclimatize the plant in greenhouses, and then transfer it to the open field. The findings of this work identified the general characteristics of Zantedeschia albomaculata as an ornamental and medicinal plant in order to acclimatize this plant for cultivation in the Mediterranean climate

Isolation and Identification of Flavonoids from Black Cumin (<i>Nigella sativa</i>) by HPLC-MS and In Silico Molecular Interactions of Their Major Compounds with <i>Fusarium oxysporum</i> Trypsin-like Serine Protease

Fusarium oxysporum is one of the most harmful soil-borne pathogens that cause root rot, damping-off, and wilt disease in many plant species. Management of Fusarium oxysporum diseases is often by using many harmful and expensive chemical fungicides which have many harmful effects on the environment and human health. The current study was conducted to identify the chemical constituents of black cumin seeds’ methanolic extract and investigate the ability of the major constituents to inhibit the Fusarium oxysporum trypsin-like serine protease, which play an important role in F. oxysporun pathogenicity. The HPLC-MS analysis of black cumin seeds’ methanolic extract revealed the presence of seven major compounds: amentoflavone, Procyanidin C2, Quercetin3-O-sophoroside-7-O-rhamnoside, 5,7-Dihydroxy-3,4-dimethoxyflavone, Borapetoside A, tetrahydroxy-urs-12-en-28-O-[b-D-glucopyranosyl (1-2)-b-D-glucopyranosyl] ester, and kudzusapongenol A-hexA-pen. The results of molecular docking between these compounds and the active site of Fusarium oxysporium trypsin showed that only four compounds were able to bind to the active site of F. oxysporum trypsin. Amentoflavone, 5,7-Dihydroxy-3,4-dimethoxyflavone, and Quercetin3-O-sophoroside-7-O-rhamnoside have the highest binding energy, −6.4, −6.5, and −6.5 Kcal/mol, respectively. In addition, the results clarify that 5,7-Dihydroxy-3,4-dimethoxyflavone was the only compound to form a hydrogen bond with Asp189 (the residue responsible for substrate specificity). The results of the study strongly indicate that flavonoids of black cumin seeds’ methanolic extract could be used as effective inhibitors for the F. oxysporum trypsin-like serine protease