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

Hypoxia and glycolytic metabolism in chordomas

Les chordomes sont des tumeurs rares. Elles représentent 1-4% de toutes les tumeurs osseuses. Ces tumeurs à histogénèse notochordienne sont d'origine mésodermique exprimant des marqueurs épithéliaux. Elles sont dans la majorité des cas de bas grade et d’évolutions insidieuses, mais toujours infiltrantes et destructrices pouvant donner des métastases. Au plan thérapeutique, ce sont des lésions réputées pour leur résistance aux cytotoxiques, aux rayonnements ionisants et aux thérapies ciblées actuelles. Leur prise en charge standard consiste en une chirurgie première suivie d'une radiothérapie complémentaire à haute dose. Le taux de contrôle local est de 70% et 50% à 5 ans et 10 ans respectivement et la survie médiane est de 6 ans. Les futurs challenges consistent à mieux définir le volume cible par l’imagerie multimodalité pour une radiothérapie personnalisée voire adaptative tenant compte des modifications tumorales morphologiques et métaboliques en cours de traitement. L’hypoxie est connue depuis longtemps comme un facteur de radiorésistance aux traitements. En effet, l'hypoxie induit un phénotype agressif avec un haut potentiel métastatique, favorisant la progression tumorale. Ces caractéristiques sont intimement liées à certaines modifications biologiques comme l’angiogenèse tumorale et le dérèglement du métabolisme cellulaire du glucose. Une meilleure connaissance de ces facteurs régulateurs des cibles biologiques constitue un vrai challenge pour le clinicien et les industriels dans le cadre du développement de nouvelles thérapeutiques. Dans ce cadre, mon projet de thèse a été construit en trois étapes : (i) nous avons récemment rapporté, pour la première fois, la présence de composantes cellulaires hypermétaboliques et de composantes cellulaires très hypoxiques quiescentes par l'imagerie TEP/CT, (ii) mettre en évidence sur des prélèvements de chordomes provenant de patients, les facteurs régulateurs de l'hypoxie (HIF-1, HIF-2) du métabolisme (GLUT1 ; MCT1 ; MCT4 ; Basigine, CAIX - CAXII) et de l’autophagie (BNIP3) par des techniques d'immunohistochimie ; (iii) quantification de ces marqueurs par des techniques de Western Blot. La corrélation de ces résultats biologiques aux résultats cliniques obtenus, montre que les patients présentant des lésions arborant un métabolisme glycolytique et un processus de survie autophagique présentent un phénotype agressif et radiorésistant. La présence de ces mécanismes de survie est fortement corrélée avec un contrôle local faible et une survie réduite. La mise en évidence de ces mécanismes et de leurs facteurs régulateurs nous permet d’envisager des traitements ciblés en association avec la chirurgie et la radiothérapie.Chordomas are rare tumors. They represent 1-4% of all bone tumors. These tumors are notochordal histogenesis and mesodermal origin expressing epithelial markers. They are in most cases low grade and have insidious development with destructive and invasive power. Therapeutically, they are known for their resistance to cytotoxic drugs, ionizing radiation and targeted therapies. "Gold standart" treatment for these lesions is a primary surgery followed by high doses of radiotherapy. The local control rate is 70% and 50% at 5 years and 10 years respectively and median survival is 6 years. Future challenges are to define better the target volume by multimodality imaging for radiation therapy or adaptive personalized taking into account changes in tumor metabolic and morphological processing. Hypoxia has long been known as a radioresistance factor. Indeed, hypoxia induces an aggressive phenotype with a high metastatic potential, promoting tumor progression. These characteristics are closely related to certain biological changes such as tumor angiogenesis and disruption of cellular metabolism of glucose. A better understanding of these regulators factors of biological targets is a real challenge for clinicians and industry in the development of new therapies. In this context, my thesis project was built in three steps: (i) we recently reported, for the first time, the presence of quiescent and hypoxic cellular components and hypermetabolic cellular components by PET / CT, (ii) highlight on samples from patients with chordoma, the hypoxia regulatory factors (HIF-1, HIF-2) metabolism (GLUT1, MCT1, MCT4; Basigine, CAIX - CAXII) and autophagy (BNIP3) by immunohistochemistry, (iii) quantification of these markers by immunoblotting techniques. The correlation of these laboratory findings to clinical results showed that patients with lesions displaying a glycolytic metabolism and survival autophagic process have an aggressive and radioresistant phenotype. The presence of these mechanisms is strongly correlated with poor local control and survival reduced. The highlight of these mechanisms and their regulatory factors allow us to consider targeted therapies in combination with surgery and radiotherapy

Étude de l'expression des biomarqueurs de l'hypoxie et du métabolisme des chordomes

Les chordomes sont des tumeurs rares. Elles représentent 1-4% de toutes les tumeurs osseuses. Ces tumeurs à histogénèse notochordienne sont d'origine mésodermique exprimant des marqueurs épithéliaux. Elles sont dans la majorité des cas de bas grade et d évolutions insidieuses, mais toujours infiltrantes et destructrices pouvant donner des métastases. Au plan thérapeutique, ce sont des lésions réputées pour leur résistance aux cytotoxiques, aux rayonnements ionisants et aux thérapies ciblées actuelles. Leur prise en charge standard consiste en une chirurgie première suivie d'une radiothérapie complémentaire à haute dose. Le taux de contrôle local est de 70% et 50% à 5 ans et 10 ans respectivement et la survie médiane est de 6 ans. Les futurs challenges consistent à mieux définir le volume cible par l imagerie multimodalité pour une radiothérapie personnalisée voire adaptative tenant compte des modifications tumorales morphologiques et métaboliques en cours de traitement. L hypoxie est connue depuis longtemps comme un facteur de radiorésistance aux traitements. En effet, l'hypoxie induit un phénotype agressif avec un haut potentiel métastatique, favorisant la progression tumorale. Ces caractéristiques sont intimement liées à certaines modifications biologiques comme l angiogenèse tumorale et le dérèglement du métabolisme cellulaire du glucose. Une meilleure connaissance de ces facteurs régulateurs des cibles biologiques constitue un vrai challenge pour le clinicien et les industriels dans le cadre du développement de nouvelles thérapeutiques. Dans ce cadre, mon projet de thèse a été construit en trois étapes : (i) nous avons récemment rapporté, pour la première fois, la présence de composantes cellulaires hypermétaboliques et de composantes cellulaires très hypoxiques quiescentes par l'imagerie TEP/CT, (ii) mettre en évidence sur des prélèvements de chordomes provenant de patients, les facteurs régulateurs de l'hypoxie (HIF-1, HIF-2) du métabolisme (GLUT1 ; MCT1 ; MCT4 ; Basigine, CAIX - CAXII) et de l autophagie (BNIP3) par des techniques d'immunohistochimie ; (iii) quantification de ces marqueurs par des techniques de Western Blot. La corrélation de ces résultats biologiques aux résultats cliniques obtenus, montre que les patients présentant des lésions arborant un métabolisme glycolytique et un processus de survie autophagique présentent un phénotype agressif et radiorésistant. La présence de ces mécanismes de survie est fortement corrélée avec un contrôle local faible et une survie réduite. La mise en évidence de ces mécanismes et de leurs facteurs régulateurs nous permet d envisager des traitements ciblés en association avec la chirurgie et la radiothérapie.Chordomas are rare tumors. They represent 1-4% of all bone tumors. These tumors are notochordal histogenesis and mesodermal origin expressing epithelial markers. They are in most cases low grade and have insidious development with destructive and invasive power. Therapeutically, they are known for their resistance to cytotoxic drugs, ionizing radiation and targeted therapies. "Gold standart" treatment for these lesions is a primary surgery followed by high doses of radiotherapy. The local control rate is 70% and 50% at 5 years and 10 years respectively and median survival is 6 years. Future challenges are to define better the target volume by multimodality imaging for radiation therapy or adaptive personalized taking into account changes in tumor metabolic and morphological processing. Hypoxia has long been known as a radioresistance factor. Indeed, hypoxia induces an aggressive phenotype with a high metastatic potential, promoting tumor progression. These characteristics are closely related to certain biological changes such as tumor angiogenesis and disruption of cellular metabolism of glucose. A better understanding of these regulators factors of biological targets is a real challenge for clinicians and industry in the development of new therapies. In this context, my thesis project was built in three steps: (i) we recently reported, for the first time, the presence of quiescent and hypoxic cellular components and hypermetabolic cellular components by PET / CT, (ii) highlight on samples from patients with chordoma, the hypoxia regulatory factors (HIF-1, HIF-2) metabolism (GLUT1, MCT1, MCT4; Basigine, CAIX - CAXII) and autophagy (BNIP3) by immunohistochemistry, (iii) quantification of these markers by immunoblotting techniques. The correlation of these laboratory findings to clinical results showed that patients with lesions displaying a glycolytic metabolism and survival autophagic process have an aggressive and radioresistant phenotype. The presence of these mechanisms is strongly correlated with poor local control and survival reduced. The highlight of these mechanisms and their regulatory factors allow us to consider targeted therapies in combination with surgery and radiotherapy.NICE-Bibliotheque electronique (060889901) / SudocSudocFranceF

Système d'assistance à la conduite pour véhicules à deux-roues motorisés

À l'heure actuelle, le deux-roues motorisé (DRM) constitue un moyen de transport de plus en plus convoité, notamment pour les possibilités qu'il offre d'esquiver les engorgements de trafic. Ce constat est justifié par le nombre de DRM circulant quotidiennement et impliquant un trafic de plus en plus croissant. Néanmoins, ce phénomène conduit à l'explosion du nombre d accidents et par conséquent un grand nombre de victimes classant ainsi, les DRM dans la catégorie des modes de transport particulièrement dangereux et ses utilisateurs dans celle des usagers très vulnérables. A première vue, le développement des aides à la conduite actives pourrait résoudre le problème de contrôlabilité du véhicule mais cette solution n'est plus envisageable dès lors qu'il s'agit de pertes de contrôle irréversibles qui constituent, par ailleurs un pourcentage très important des accidents de DRM en tant que véhicule seul. En effet, ce type de système intervient, alors que le véhicule se trouve déjà dans une situation dégradée. De plus, l adaptabilité des aides actives sur les véhicules à deux roues motorisés reste problématique. Actuellement, l'accent est mis sur le développement des systèmes de sécurité prévenant le conducteur de DRM suffisamment en amont d'un danger pour éviter la situation conflictuelle, c'est le cas des aides préventives. Ce travail de thèse s'inscrit dans ce cadre et y contribue au niveau de la modélisation, l'identification, l'estimation d'état, l'analyse de la dynamique limite et la mise en place d'une plate-forme expérimentale. Ainsi, plusieurs points ont été traités: Modélisation du système Véhicule-Infrastructure-Conducteur (V-I-C). Développement d observateurs pour l estimation des variables d états et des entrées inconnues. Mise en place d un modèle vitesse limite, servant de référence pour l unité d avertissement, qui tient compte de plusieurs critères (dynamique du véhicule, comportement du conducteur, géométrie de la route). Identification d'un modèle mathématique propre au véhicule prototype (Scooter). Mise en place d une plate-forme expérimentale qui s'articule autour de l'instrumentation d'un scooter par un ensemble de capteurs et centrale d'enregistrement.Nowadays, the use of Powered Two Wheeled (PTW) vehicles is constantly growing, upsetting driving practices and road traffic. Unfortunately, this expansion is also inflected by an important increase of motorcycle's fatalities (20 times higher when driving a car). Recent statistics confirm this observation and consider riders as the most vulnerable road users. In 2010, the French Agency of Road Safety made a finding of around 1000 deaths (25% of traffic fatalities), while the traffic proportion of motorcycles does not exceed 1%. Several research programs are launched to answer this issue and to find solutions in term of preventive and / or active security systems. At first sight, the development of active driving assistance could solve the problem of motorcycle's controllability. The safety systems are not enough or efficient when situations are irreversible. Example of poor cornering which is responsible for most bike accidents involving single-vehicle motorcycle crashes. Indeed, this type of system occurs while the vehicle is still in a degraded situation. In addition, the adaptability of active assistance of PTW vehicles remains dangerous. Currently, the focus is on the development of safety systems warning riders sufficiently before hazardous situations.The present PhD thesis aims into this framework and gives several contributions in terms of: modeling, identification, state estimation and study of dynamic limit applied to an experimental benchmark. Thus, several points were studied: Modeling of System Driver-Vehicle-Infrastructure (D-V-I). Development of observers to estimate the state variables and unknown inputs. Establishment of a model of limit speed, as a reference for the unity of warning, which takes into account several criteria (vehicle dynamics, driver behavior, road geometry). Identification of a mathematical model specific to the prototype vehicle (Scooter). Establishment of an experimental platform which is based on the instrumentation of a Scooter with a set of sensors and central registration.EVRY-Bib. électronique (912289901) / SudocSudocFranceF

Motorcycle Roll motion Stabilization and Observer Design

International audienceThis paper is devoted for the development of a stabilized roll motion model of a motorcycle coupled to a PI observer for state and unknown input estimation. The feedback controller is designed for robust stabilization by yaw angle feedback to the steering torque, it is based on the loop shaping Hinfin method for static feedback controller design. The controller and the observer are designed on a linear rider-motorcycle model and then tested on a model with nonlinear tire-road interaction forces. Simulation and preliminary experimental results show the effectiveness of the approach

A predetermined finite time impulsive unknown input observer for nonlinear systems via Takagi-Sugeno models

International audienceIn this paper, the design of an impulsive observer that estimates the state and the unknown inputs in a predetermined finite time is proposed for nonlinear systems represented by Takagi Sugeno models. The stability conditions are formulated under LMI formalism. An pplication on a chaotic system is performed to show the effectiveness of the proposed observer

Motorcycle Lateral Dynamic Estimation and Lateral Tire-Road Forces Reconstruction Using Sliding Mode Observer

International audienceExtensive researches have shown that most of road accidents occur as a result of driver errors. A close examination of accident data reveals that losing the vehicle control is responsible for a huge proportion of car accidents. This observation is even more valid on motorcycle, recall that, last decade about 1600 french people are killed each year. Preventing such kind of accidents using vehicle control systems, requires certain input data concerning vehicle dynamic parameters and vehicle road interaction. Unfortunately, some parameters like tire-road forces and lateral speed, which have a major impact on vehicle dynamics, are difficult to measure. Therefore, this data must be estimated. Due to the system nonlinearities and unmodeled dynamics, an observer based on sliding technique is proposed in this paper. The estimation process method use the motorcycle dynamic response's and standard sensors cheap and easily-available. Observer performances are tested and compared to the motorcycle model responses in different simulation conditions, various initial conditions and measurement noise. The effectiveness of the present approach is make out through the simulation results and show its practical potential as a low-cost solution for calculating lateral-tire forces and motorcycle lateral speed in a accuarate way

Dynamique limite pour systèmes d'alertes aux conducteurs des deux-roues motorisés

National audienceDans cet article, on décrit une méthodologie de développement d'une aide à la conduite dédiée aux véhicules à deux roues motorisés. Les systèmes actifs d'assistance étant difficles à mettre en oeuvre, dès lors qu'il s'agit de perte de contrôle irréversible, nous nous intéressons dans ce papier aux seuls cas des systèmes de sécurité dit ''préventifs''. Ce type de système intervient suffisamment en amont d'un danger pour éviter la situation conflictuelle. Le travail présenté dans ce papier s'inscrit dans ce cadre et il vise à concevoir une assistance au conducteur l'informant suffisamment à l'avance sur une vitesse excessive en virage prenant en compte les trois acteurs de conduite (Véhicule-Infrastructure-Conducteur). Ce modèle de vitesse, utilise les limites dynamiques de stabilité du véhicule pour limiter la vitesse longitudinale avant l'entrée en virage

Preventive Safety: Warning System for Control Loss of Two-Wheeled Vehicle

International audienceThe present study aims at identifying existing and emerging Intelligent Transport System (ITS) that have the possibility to enhance the safety of motorcycle rider. A review of the literature revealed that very few commercially available ITS currently exist specifically for motorcycles, although several emerging technologies were identified. Consultations with international experts in ITS, motorcycle safety, motorcycle manufacturers and various road safety research organizations confirmed this report. However, there are emerging and existing technologies for other vehicles that have the potential to address key motorcycle safety issues. In spite of the emergence of active and passive safety, these systems in most cases do not avoid the accident. The purpose of this paper is to provide assistance to the rider by incorporating a warning system for accident situations, which can alert the driver sufficiently in advance so that he can anticipate the accident