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

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Besi Süresinin İvesi Erkek Kuzuların Besi Performansı ve Karkas Özelliklerine Etkisi

Bu çalışma Diyarbakır’da bulunan Güneydoğu Anadolu Tarımsal Araştırma Enstitüsü koyunculuk işletmesinde 2005 yılında gerçekleştirilmiştir. Araştırmada 2005 yılında doğan ve farklı sürelerde besiye tabi tutulan İvesi erkek kuzuların besi performansı ile kesim ve karkas özelliklerinin belirlenmesi amaçlanmıştır. Deneme kuzularına sütten kesime kadar analarından ayrılmadan yem verilmiş ve 2 aylık yaşta sütten kesilmişlerdir. Her birinde 15, 16 ve 14 baş erkek kuzu bulunan gruplara sırasıyla 60 BS60 , 75 BS75 ve 91 BS91 günlük entansif besi uygulanmıştır. Besi gruplarının besi sonu canlı ağırlık ortalamaları sırasıyla; 36.07±1.64, 39.07±1.13 ve 42.11± 1.50 kg olarak tespit edilmiş ve BS60 grubu ile BS91 grubunun besi sonu canlı ağırlık ortalamaları arasındaki fark önemli P &lt; 0.05 bulunmuştur. Gruplarda karkas randımanı yukarıdaki sırayla; % 47.41±0.677, 51.63±0.869 ve 50.13±0.294 olarak tespit edilmiştir. Grupların günlük ortalama canlı ağırlık artışı sırasıyla; 0.26±0.018 0.24±0.007 ve 0.22± 0.016 kg ve 1 kg canlı ağırlık artışı için tüketilen konsantre yem miktarı yem değerlendirme sayısı ise 5.410, 5.635 ve 6.160 kg olmuştu

Impact and post impact behavior of layer fabric composites

In this study, the effect of impact and post impact behavior of E-glass/epoxy composite plates having different layer fabrics were investigated by considering energy profile diagram and the related load-deflection curves. Different impact energies (5. J-60. J)were subjected to the plates consisting of eight layers of plain weave (1D), double (2D) and triple (3D) layer fabrics. The impact tests were continued until complete perforation of layer fabrics. The damage modes and damage processes of layer fabrics under varied impact energies were also discussed. At the end of the impact tests, the damaged samples were mounted into a compression apparatus to determine the Compression After Impact (CAI) strength of layer fabric samples. The results of these impact and post impact tests showed that contact force occurring between the impactor and the composite specimen increased and the CAI strength reduced by increasing the impact energy. The objective of this study was to determine the perforation threshold of E-glass/epoxy composite plates having different layer fabrics as plain weave (1D), double (2D), and triple (3D) layer fabrics. © 2012 Elsevier Ltd.108M128 National Council for Scientific ResearchThis study was sponsored by The Scientific and Technological Research Council of Turkey (TUBITAK), (Project No: 108M128). Partial financial support by Pul-tech FRP, in Usak-Turkey, was also gratefully acknowledged

Poly(hydroxyethyl methacrylate-co-methacryloylamidotryptophane) nanospheres and their utilization as affinity adsorbents for porcine pancreas lipase adsorption

WOS: 000282905600030Novel nanospheres with an average size of 350 nm utilizing N-methacryloyl-(L)-tryptophane methyl ester (MATrp) as a hydrophobic monomer were prepared by surfactant free emulsion polymerization of 2-hydroxyethyl methacrylate (HEMA), (MATrp) conducted in an aqueous dispersion medium. MATrp was synthesized using methacryloyl chloride and (t)-tryptophane methyl ester. Specific surface area of the nonporous nanospheres was found to be 1902.3 m(2)/g. poly(HEMA-MATrp) nanospheres were characterized by Fourier Transform Infrared Spectroscopy (FTIR) and scanning electron microscopy (SEM). Average particle size and size distribution measurements were also performed. Elemental analysis of MATrp for nitrogen was estimated at 1.36 mmol/g nanospheres. Then, poly( HEMA-MATrp) nanospheres were used in the adsorption of porcine pancreas lipase in a batch system. Using an optimized adsorption protocol, a very high loading of 558 mg enzyme/g nanospheres was obtained. The adsorption phenomena appeared to follow a typical Langmuir isotherm. The K-m, value for immobilized lipase (16.26 mM) was higher than that of free enzyme (10.34 mM). It was observed that enzyme could be repeatedly adsorbed and desorbed without significant loss in adsorption amount or enzyme activity. These findings show considerable promise for this material as an adsorption matrix in industrial processes. (C) 2010 Elsevier B.V. All rights reserved

Impact and post impact behavior of layer fabric composites

In this study, the effect of impact and post impact behavior of E-glass/epoxy composite plates having different layer fabrics were investigated by considering energy profile diagram and the related load-deflection curves. Different impact energies (5 J-60 J)were subjected to the plates consisting of eight layers of plain weave (1D), double (2D) and triple (3D) layer fabrics. The impact tests were continued until complete perforation of layer fabrics. The damage modes and damage processes of layer fabrics under varied impact energies were also discussed. At the end of the impact tests, the damaged samples were mounted into a compression apparatus to determine the Compression After Impact (CAI) strength of layer fabric samples. The results of these impact and post impact tests showed that contact force occurring between the impactor and the composite specimen increased and the CAI strength reduced by increasing the impact energy. The objective of this study was to determine the perforation threshold of E-glass/epoxy composite plates having different layer fabrics as plain weave (1D), double (2D), and triple (3D) layer fabrics. (c) 2012 Elsevier Ltd. All rights reserved

Utilization of Eggshell Membrane and Olive Leaf Extract for the Preparation of Functional Materials

Eggshell membrane (ESM) is a natural proteinaceous by-product of the food industry, especially in the pasteurized egg industry, resulting in the availability of much discarded egg waste. In the literature, eggshell (ES) and ESM usage for their adsorbent properties to remove various organic and inorganic hazardous chemicals, especially from wastewater, has gained interest. In addition, agricultural (olive leaf) and food industry (eggshell and eggshell membrane) waste can together be valorized to produce value-added functional products. This study's objective was to evaluate the eggshell membrane's loading capacity for bioactive compounds obtained from olive leaf extract (OLE) in order to prepare functional biomaterial. In this study, waste eggshell membranes were used to adsorb the phenolic compounds from olive leaf extract to design functional biomaterials. Using the foam separation method, both separation of the eggshell membrane and adsorption of bioactive compounds to the eggshell membrane were achieved simultaneously. The characterization studies showed that OLE was successfully adsorbed to the eggshell membrane. Cytotoxicity and antimicrobial studies showed that prepared OLE-loaded membranes were functional materials with bioactive properties. In conclusion, ESM was determined as a promising protein in the production of functional antioxidative and antimicrobial food or dietary supplement after the adsorption of bioactive olive leaf polyphenols.King Saud University, Riyadh, Saudi Arabia [RSP-2021/197]; Agricultural Research Station at North Carolina Agricultural and Technical State University (Greensboro, North); National Institute of Food and Agriculture (NIFA) [C.X3375-21-170-1, NC.X341-5-21-170-1]The participation of the authors Turki M. S. Aldawoud and Charis M. Galanakis in this work was supported by the Researchers Supporting Project number (RSP-2021/197) of King Saud University, Riyadh, Saudi Arabia. Author (S.A.I.) would also like to acknowledge the support of the Agricultural Research Station at North Carolina Agricultural and Technical State University (Greensboro, NC 27411, USA). This research was funded, in part, by grants (project Number NC.X3375-21-170-1 and NC.X341-5-21-170-1) from the National Institute of Food and Agriculture (NIFA). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NIFA