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

Bilateral greater Occipital Nerve Block for Headache after corrective Spinal Surgery: A Case Report

Post-Dural Puncture Headache is a common complication for patients with dural puncture and if untreated, it can result in complications such as subdural hematoma and seizures.The aim of this case report is to present a case of headache after corrective spinal surgery for idiopathic scoliosis resolved with a BGON block.</p

Macro-Policy Normalization and the G20

TRU

Dataset for "Divergent immunometabolic changes in adipose tissue and skeletal muscle with ageing in healthy humans"

This dataset provides all the raw data collected for a trial investigating the impact of ageing on adipose tissue, skeletal muscle, and systemic inflammatory and metabolic health in healthy, active, and non-obese Younger (20–35 years) and Older (60–85 years) males. This trial was a cross-sectional characterisation investigating the biological effects of ageing, in humans.Recruitment: One-hundred and nine individuals undertook preliminary screening, from which 24 males aged 20–35 (n = 12 [Young]) and 60–85 (n = 12 [Old]) years participated based on predetermined eligibility criteria (Table 1). Participants were recruited by local advertisement conducted in accordance with the Declaration of Helsinki. All participants provided written informed consent. Participant recruitment was conducted between August 2016 and March 2018. Design: participants attended the laboratory for a preliminary assessment, including body composition, resting metabolic rate, and anthropometric measures. Following this initial visit, potential participants had their physical activity levels monitored across seven consecutive days using a multi-sensor physical activity monitor, and completed weighed food and fluid records across three days. Participants meeting eligibility criteria following these initial assessments attended the laboratory on one more occasion (main experimental visit) to undergo fasted blood sampling, provide an adipose tissue and skeletal muscle biopsy, followed by a three-hour meal tolerance test. For preliminary assessment, participants undertook DEXA and pQCT scanning, and RMR assessments and blood pressure monitoring. After this, participant physical activity was monitored for seven consecutive days using a Sensewear multiaxial monitor and recorded weighed diet diaries during this period for three days (2 week days, one weekend day). Biochemical measures: Venous blood samples were collected from an antecubital vein. Samples for serum separation were rested at room temperature for 30 minutes prior to centrifugation at 3,000 x g for 10 minutes at 4oC. Plasma samples were immediately centrifuged upon collection and stored at −80oC until analysis. Peripheral Blood Mononuclear Cells (PBMCs) were isolated by density gradient separation (Ficoll®, Greiner Bio-One; Stonehouse, UK) in Leucosep® tubes for fresh analysis on the day of collection. Subcutaneous adipose tissue samples were obtained from ~5 cm lateral to the umbilicus with a 14G needle using the needle aspiration method under local anaesthesia (1 % Lidocaine hydrochloride; Hameln Pharmaceuticals; Gloucester, UK). Skeletal muscle was obtained from the Vastus Lateralis on the dominant leg under local anaesthesia using the Bergström technique A standardised mixed meal test was chosen to produce a physiological response similar to that of a conventional meal, formulated in-house equating to 2 g / kg body mass (BM) carbohydrate, 0.8 g / kg BM fat, and 0.4 g / kg BM protein. The beverage consisted of: Whey protein (MyProtein; Cheshire, UK); Elmlea double cream (Elmlea; Exeter, UK); Maltodextrin (MyProtein; Cheshire, UK); and 1 pint of whole milk as standard across participants, with 5 drops of vanilla flavouring (MyProtein; Cheshire, UK). Adipose tissue was cultured, ex vivo, in sterile culture plates (Nunc; Roskilde, Denmark), at a final concentration of 50 mg of tissue per millilitre, in endothelial cell basal medium (PromoCell; Heidelberg, Germany) supplemented with 0.1 % fatty acid-free bovine serum albumin (BSA) and 100 U/ mL penicillin and 0.1 mg/ mL streptomycin (Sigma-Aldrich; Gillingham, UK), for 3 hours at 37 oC, 5 % CO2, and 95 ± 5 % relative humidity (MCO-18A1C CO2 incubator; Sanyo, Japan) Adipose tissue (250 to 500 mg) was digested using 250 U/ mL type-I collagenase (Worthington Biochemical; New Jersey, USA) in PBS containing 2 % BSA (pH 7.4) for 45–60 minutes in a shaking water bath (225 r.p.m) at 37 oC Isolated adipocytes were incubated at 37 oC and 5 % CO2 in DMEM (supplemented with 10 % FBS), whereupon a fraction was serum-starved in 1 mL of unsupplemented DMEM for 30 minutes and then incubated with or without 100 nM of insulin for 30 minutes. A portion of isolated adipocytes was placed onto a glass slide and cover slip for imaging under a light microscope (Olympus; Tokyo, Japan). Adipocyte diameters were measured using ImageJ (National Institutes of Health; Wisconsin, USA) after image file randomisation to mask participant grouping. Between 35 and 100 mg of skeletal muscle was placed into 5 mL of DMEM (low glucose, with Glutamax™ GIBCO, Fisher Scientific) at 37 oC in a 60 mm Petri dish. Visible signs of blood were washed away by passing samples into successive Petri dishes containing fresh DMEM. Samples were teased apart using sterile tweezers, after-which, samples were reconstituted in 30 mL of PBS and centrifuged at 400 x g for 5 minutes at 4 oC. Cleaned tissue was digested enzymatically with collagenase B (0.5 U/ mL) in DMEM for one hour at 37 oC and 5 % CO2 rotating at ~40 rpm by a MACSmix™ tube rotator (Miltenyi Biotec; Surry, UK). Total RNA (including microRNAs) was extracted from frozen adipose tissue (approx. 100 mg) or skeletal muscle samples (30 to 50 mg) using miRNeasy Mini Kit (Qiagen; Crawley, UK) according to manufacturer instructions.Following RNA isolation, samples were DNase treated with TURBO DNase (Thermofisher™; Leicestershire, UK) according to manufacturer instructions, followed by phenol-chloroform extraction and ethanol precipitation. The purified RNA pellets were re-suspended in 35 µL of nucleotide-free water each (Thermofisher™; Leicestershire, UK) with 2 μL used for quality control. Thirty microlitres of RNA at a set concentration of 2.1 µg/ 30 µL was sent for RNA-sequencing. RNA-sequencing was performed on RiboZero-treated total RNA, on a HiSeq4000 (Illumina, Inc.; California, US) by the Oxford Genomics Centre (Wellcome Trust; Oxford, UK). In brief, total RNA was quantified using RiboGreen (Invitrogen; California, US) on the FLUOstar OPTIMA plate reader (BMG Labtech GmbH; Aylesbury, UK) and the size profile and integrity analysed on the 2200 or 4200 TapeStation (Agilent, RNA ScreenTape [Agilent Technologies; California, US]). RIN estimates for all samples were between 1.8 and 8.5. Input material was normalised to 200 ng prior to library preparation. Total RNA was depleted of ribosomal RNA using Ribo-Zero rRNA Removal Kit (Epicentre/Illumina, Human [Illumina®; California, US]) following manufacturer’s instructions. Library preparation was completed using NEBNext Ultra II mRNA kit (New England Biolabs Inc.; Massachusetts, US) following manufacturer’s instructions. Libraries were amplified (11 cycles) on a Tetrad (Bio-Rad Laboratories; California, US) using in-house unique dual indexing primers Individual libraries were normalised using Qubit, and the size profile was analysed on the 2200 or 4200 TapeStation. Individual libraries were normalised and pooled together accordingly. The pooled library was diluted to ~10 nM for storage. The 10 nM library was denatured and further diluted prior to loading on the sequencer. Paired end sequencing was performed using a HiSeq4000 75bp platform (Illumina, HiSeq 3000/4000 PE Cluster Kit and 150 cycle SBS Kit), generating a raw read count of >38.5 million reads per sample. FastQ sequencing files were uploaded to the Galaxy web platform (usegalaxy.org) for quality control analysis. Raw sequencing files were splice-aligned to the GRCh38/ hg38 reference genome using Hisat2 with a mapping distance <500 kb between reads. Ensembl (Cambridge, UK) was used to annotate sequencing files against the reference genome. Expression levels (fragments per kilobase of transcript per million mapped reads [FPKM]) were estimated using Stringtie. Differential expression analysis was undertaken using Cuffdiff v.7 and Deseq2 using Gencode v.29 as the reference database (GRCh38.p12). Functional annotation analysis was performed in the database for annotation, visualisation, and integrated discovery (DAVID) 6.8 (2019 release) and Genesis 1.8.1. Pathway analysis was performed using Kyoto encyclopaedia of genes and genomes (KEGG) and gene ontology (GO)-terms, using a modified Fisher exact test (EASE [expression analysis systematic explorer]. Total proteins from biopsies were recovered from the organic phase of QIAzol-treated tissue samples used for RNA extraction. Organic phases were extracted and processed for western blot analysis. Protein content was determined by BCA protein assay (Thermo Scientific™; Leicestershire, UK). Multi-parameter flow cytometry on PBMCs and tissue SVFs was undertaken on a FACSAria III. Baseline blood samples were analysed for plasma glucose, high-density lipoprotein (HDL) cholesterol, total cholesterol, triglycerides, and non-esterified fatty acids (NEFA) using clinical chemistry spectrophotometer (RX Daytona, Randox Laboratories; County Antrim, NI). Quantification of low-density lipoprotein (LDL) cholesterol was achieved using the Friedwald equation. nsulin was measured using Insulin ELISA kits (Mercodia, Mercodia AB; Sweden). All other biomarkers were measured by a commercial electrochemiluminescence technology (Mesoscale Diagnostics).Microsoft Exce

Ecological and aromatic impact of two Gram-negative bacteria ( Psychrobacter celer and Hafnia alvei) inoculated as part of the whole microbial community of an experimental smear soft cheese

The impact of the growth of two Gram-negative bacteria, Psychrobacter celer and Hafnia alvei, inoculated at 10(2) and 10(6) cfu/g, on the dynamics of a multispecies community as well as on volatile aroma compound production during cheese ripening was investigated. Results showed that P. celer was able to successfully implant itself in cheese, regardless of its inoculation level. However, when it was inoculated at a high level, the bacterial biodiversity was drastically lowered from day 25 to the end of ripening. Overall, the presence of P. celer led to the higher production of volatile aroma compounds such as aldehydes, ketones and sulfur compounds. Regardless of its inoculation level, H. alvei barely affected the growth of the bacterial community and was subdominant at the end of ripening. It influenced total volatile aroma compound production with volatile sulfur compounds being the most abundant. Overall, these two bacteria were able to implant themselves in a cheese community and significantly contributed to the aromatic properties of the cheese. Their role in flavoring and their interactions with the technological microorganisms must be considered during cheese ripening and should be further investigated

FEEDING INFLUENCES ADIPOSE TISSUE RESPONSES TO EXERCISE IN OVERWEIGHT MEN

Dataset for the following study: Abstract Feeding profoundly affects metabolic responses to exercise in various tissues but the effect of feeding status on human adipose tissue responses to exercise has never been studied. Ten healthy overweight men aged 26 ± 5 years (mean ± SD) with a waist circumference of 105 ± 10 cm walked at 60% of maximum oxygen uptake under either FASTED or FED conditions in a randomised, counterbalanced design. Feeding comprised 648 ± 115 kcal 2 h before exercise. Blood samples were collected at regular intervals to examine changes in metabolic parameters and adipokine concentrations. Adipose tissue samples were obtained at baseline and one hour post-exercise to examine changes in adipose tissue mRNA expression and secretion of selected adipokines ex-vivo. Adipose tissue mRNA expression of PDK4, ATGL, HSL, FAT/CD36, GLUT4 and IRS2 in response to exercise were lower in FED compared to FASTED conditions (all p ≤ 0.05). Post-exercise adipose IRS2 protein was affected by feeding (p ≤ 0.05), but Akt2, AMPK, IRS1, GLUT4, PDK4 and HSL protein levels were not different. Feeding status did not impact serum and ex-vivo adipose secretion of IL-6, leptin or adiponectin in response to exercise. This is the first study to show that feeding prior to acute exercise affects post-exercise adipose tissue gene expression and we propose that feeding is likely to blunt long-term adipose tissue adaptation to regular exercise