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

Preparation And Properties Of Cinnamon Essential Oil Loaded Antibacterial Nanocellulose/chitosan Aerogels For Biomedical Applications

Aerogel is a novel functional material consists of fibers scaffold and air, without water or any other solvent. Pure nanocellulose aerogel has numerous unique characteristics but it normally combined with inorganic materials to overcome its undesired drawbacks such as the high water absorption and poor mechanical properties, which favour the microbial colonization in its surfaces. The aim of this study was to isolate and characterize cellulose nano fibers (CNFs) from kenaf bast fibers using supercritical carbon dioxide (Sc.CO2) and investigate its role of Sc.CO2 in enhancing the properties of CNFs. The study also aim to fabricate and characterize antibacterial CNFs/chitosan aerogels, cross-linking the isolated CNFs with chitosan and loading the aerogel with cinnamon essential oil as the main antibacterial agent. The aerogel was fabricated using a green approach; consist of high-pressure homogenization and freeze-drying techniques. The results of CNFs isolation confirm the ability of Sc.CO2 to enhance the properties of isolated CNFs compared with non-Sc.CO2 obtained CNFs, in term of particle size, thermal properties and zeta potential value. The Sc.CO2 obtained CNFs had an average fibre length, and diameter of 53.72 and 7.14 nm, respectively, while non-Sc.CO2 obtained CNFs had longer fibre length and diameter (302.87 and 97.93 nm). Higher thermal stability and lower negativity value was also recorded for Sc.CO2 obtained CNFs. Extraction of cinnamon essential oil was conducted using Sc.CO2, which was found to be of low yield but high purity

Recent Advances in Carbon and Activated Carbon Nanostructured Aerogels Prepared from Agricultural Wastes for Wastewater Treatment Applications

The global demand for clean water has become increasingly important in the past decade as a result of the growing world population, civilization, and the increase in sources of contaminations. Aerogels are an exceptional form of porous materials with extraordinary unique properties. The aerogel has been fabricated from different inorganic and organic materials and incorporated with a variety of novel compounds for specific applications and to enhance its performance in the desired application. Activated carbon is well known for its water-pollutant adsorption, it has been prepared from several organic materials including agricultural wastes and used to treat water from organic dyes, heavy metals, oils, and toxic chemicals. However, as a powder form, activated carbon must be incorporated either into a filter or undergo a post-treatment step to remove the adsorbent from treated water. This review highlighted the development of agricultural waste-based carbon and activated carbon loaded nano-structured aerogels. A review of the types of aerogels and the properties based on the precursor materials was conducted to extensively discuss the potential use of agricultural waste-based carbon and activated carbon loaded nano-structured aerogels in wastewater treatment applications. We also discussed the challenges and future prospects of carbon and activated carbon nano-structured aerogels for wastewater treatment applications

Insights into the Role of Biopolymer-Based Xerogels in Biomedical Applications

Xerogels are advanced, functional, porous materials consisting of ambient, dried, cross-linked polymeric networks. They possess characteristics such as high porosity, great surface area, and an affordable preparation route; they can be prepared from several organic and inorganic precursors for numerous applications. Owing to their desired properties, these materials were found to be suitable for several medical and biomedical applications; the high drug-loading capacity of xerogels and their ability to maintain sustained drug release make them highly desirable for drug delivery applications. As biopolymers and chemical-free materials, they have been also utilized in tissue engineering and regenerative medicine due to their high biocompatibility, non-immunogenicity, and non-cytotoxicity. Biopolymers have the ability to interact, cross-link, and/or trap several active agents, such as antibiotic or natural antimicrobial substances, which is useful in wound dressing and healing applications, and they can also be used to trap antibodies, enzymes, and cells for biosensing and monitoring applications. This review presents, for the first time, an introduction to biopolymeric xerogels, their fabrication approach, and their properties. We present the biological properties that make these materials suitable for many biomedical applications and discuss the most recent works regarding their applications, including drug delivery, wound healing and dressing, tissue scaffolding, and biosensing

Recent Progress in Modification Strategies of Nanocellulose-Based Aerogels for Oil Absorption Application

Oil spills and oily wastewater have become a major environmental problem in recent years, directly impacting the environment and biodiversity. Several techniques have been developed to solve this problem, including biological degradation, chemicals, controlled burning, physical absorption and membrane separation. Recently, biopolymeric aerogels have been proposed as a green solution for this problem, and they possess superior selective oil absorption capacity compared with other approaches. Several modification strategies have been applied to nanocellulose-based aerogel to enhance its poor hydrophobicity, increase its oil absorption capacity, improve its selectivity of oils and make it a compressible and elastic magnetically responsive aerogel, which will ease its recovery after use. This review presents an introduction to nanocellulose-based aerogel and its fabrication approaches. Different applications of nanocellulose aerogel in environmental, medical and industrial fields are presented. Different strategies for the modification of nanocellulose-based aerogel are critically discussed in this review, presenting the most recent works in terms of enhancing the aerogel performance in oil absorption in addition to the potential of these materials in near future

Genetic diversity of Libyan date palms cultivars using amplified fragment length polymorphism and biochemical analysis

Phoenix dactylifera L. is a flowering plant species commonly known as the date palm and is widely cultivated in most Middle East countries, including Libya. The present study analysed the biochemical and genetic diversity of fully mature eight Libyan date palm cultivars grown in different regions using the amplified fragments length polymorphism (AFLP) technique. Six pairs of AFLP molecular marker combinations were utilised to discriminate the eight date palm genotypes. Fruit dimensions (length x diameter) varied based on the type; Majhool Alheelo fruit had the highest value (15.29 cm2), while the lowest value was for Alkhadraya fruits (7.9 cm2). Reducing sugar content ranged from 10.4 per cent of flesh dry weight in Umfetity cultivars to 61.2 per cent in Sufeer-genab, which also showed the highest polymorphism percentage (P%=4.9), while Alkhadarya was the lowest (P%=0.519). The phylogenetic tree indicated that the most distantly related cultivars were Sufeer-genab, Alhamraya and Majhool Alhelo. The two most closely related cultivars were the Alsaeedy Show and Alkhadarya, grown in different regions. Our results indicate that the nutritional and genetic diversity of Libyan cultivars is not closely matched with the growing region

Preparation and Characterization of Nanocellulose/Chitosan Aerogel Scaffolds Using Chemical-Free Approach

Biopolymer-based aerogels are open three-dimensional porous materials that are characterized by outstanding properties, such as a low density, high porosity and high surface area, in addition to their biocompatibility and non-cytotoxicity. Here we fabricated pure and binary blended aerogels from cellulose nanofibers (CNFs) and chitosan (CS), using a chemical-free approach that consists of high-pressure homogenization and freeze-drying. The prepared aerogels showed a different porosity and density, depending on the material and mixing ratio. The porosity and density of the aerogels ranged from 99.1 to 90.8% and from 0.0081 to 0.141 g/cm3, respectively. Pure CNFs aerogel had the highest porosity and lightest density, but it showed poor mechanical properties and a high water absorption capacity. Mixing CS with CNFs significantly enhance the mechanical properties and reduce its water uptake. The two investigated ratios of aerogel blends had superior mechanical and thermal properties over the single-material aerogels, in addition to reduced water uptake and 2-log antibacterial activity. This green fabrication and chemical-free approach could have great potential in the preparation of biopolymeric scaffolds for different biomedical applications, such as tissue-engineering scaffolds

Hydrophobicity and Biodegradability of Silane-Treated Nanocellulose in Biopolymer for High-Grade Packaging Applications

The growing concern about pollution produced by plastic waste and the consequent environmental dangers has led to increased interest in replacing plastics with sustainable and biodegradable alternatives. Biopolymers such as seaweed have been examined for their film-forming characteristics to make edible films for packaging applications. This study aimed to prepare biopolymeric packaging films through a solvent-casting process using natural red seaweed (Kappaphycus alvarezii) and kenaf cellulose nanofiber (CNF), followed by film surface treatment using silane. The hydrophobic properties of the seaweed/CNF biopolymer were examined through water solubility (WS), moisture absorption capacity (MAC), water vapor permeability (WVP), and contact angle (CA) measurements. Fourier transform infra-red (FT-IR) film spectra clearly showed successful modification of the seaweed film (SF) by silane and the incorporation of kenaf CNF over the surface of the seaweed film. The wettability-related analysis showed positive results in determining the modified film’s hydrophobicity properties. Film degradation analysis using the soil burial method showed a lower degradation rate for films with a higher CNF loading. Overall, the characterization results of the seaweed/CNF biopolymer film predicted hydrophobicity properties. The slow degradation rate was improved with surface modification using silane treatment and the incorporation of kenaf CNF filler with the seaweed matrix. As a result, we found that the seaweed/CNF biopolymer film could be used as high-grade packaging material in many potential applications

Insights into Solar Disinfection Enhancements for Drinking Water Treatment Applications

Poor access to drinking water, sanitation, and hygiene has always been a major concern and a main challenge facing humanity even in the current century. A third of the global population lacks access to microbiologically safe drinking water, especially in rural and poor areas that lack proper treatment facilities. Solar water disinfection (SODIS) is widely proven by the World Health Organization as an accepted method for inactivating waterborne pathogens. A significant number of studies have recently been conducted regarding its effectiveness and how to overcome its limitations, by using water pretreatment steps either by physical, chemical, and biological factors or the integration of photocatalysis in SODIS processes. This review covers the role of solar disinfection in water treatment applications, going through different water treatment approaches including physical, chemical, and biological, and discusses the inactivation mechanisms of water pathogens including bacteria, viruses, and even protozoa and fungi. The review also addresses the latest advances in different pre-treatment modifications to enhance the treatment performance of the SODIS process in addition to the main limitations and challenges