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

In-Place Multicore SIMD Fast Fourier Transforms

International audienceWe revisit 1D Fast Fourier Transforms (FFT) implementation approaches in the context of compute units composed of multiple cores with SIMD ISA extensions and sharing a multi-banked local memory. A main constraint is to spare use of local memory, which motivates us to use in-place FFT implementations and to generate the twiddle factors with trigonometric recurrences. A key objective is to maximize bandwidth of the multi-banked local memory system by ensuring that cores issue maximum-width aligned non-temporal SIMD accesses. We propose combining the SIMD lane-slicing and sample partitioning techniques to derive multicore FFT implementations that do not require matrix transpositions and only involve one stage of bit-reverse unscrambling. This approach is demonstrated on the Kalray MPPA3 processor compute unit, where it outperformsthe classic six-step algorithm for multicore FFT implementation

Optimization des algorithmes de calibration sur plate-forme embarquée manycore

International audienceThis paper presents the porting and the optimization of full polarization, direction independent calibration algorithm for radio-interferometry, on an embedded many-core platform. In astronomy, calibration algorithms consist of solving for the unknown complex antenna gains using a known model of the sky. Calibration is a key computation to provide images of the sky at good quality and high resolutions. In the context of the Square Kilometer Array (SKA) project, real-time and low power execution of the calibration is challenging. In this paper, we show that the CohJohnes algorithm provides good properties for being executed efficiently on the new generation of many-core embedded platforms. Experimental results are provided using the Kalray MPPA Bostan platform running 288 64-bit VLIW cores and delivering up to 845 GFLOPS at 12W.Le papier présente le portage et l'optimisation d'un algorithme calibration polarisé et indépendant de la direction pour des outils de radio interférométrie sur une plate-forme embarquée manycore. En radioastronomie, les algorithmes de calibration ont pour objectif de trouver les gains complexes inconnus des antennes à partir d'un modèle connu du ciel. La calibration est une étape primordiale permettant de fournir des images du ciel de bonne qualité et à haute-résolution. Dans le contexte du projet SKA (Square Kilometer Array), le challenge est de calculer ces algorithmes de calibration en temps-réel et à faible consommation électrique. Dans ce papier, nous montrons que les algorithmes de CohJohnes ont de bonnes propriétés pour être exécutées efficacement sur la nouvelle generation de processeurs embarqués manycores. Les résultats expérimentaux présentés montrent que les 288 coeurs VLIW 64-bits de la plateforme MPPA Bostan peuvent être utilisés générant 845 GFLOPS pour une consommation de 12W

Implementation of a Fast Fourier Transform Algorithm onto a Manycore Processor

International audienceThe Fourier transform is the main processing step applied to data collected from the Square Kilometre Array (SKA) receivers. The requirement is to compute a Fourier transform of 2 19 real byte samples in real-time, while minimizing the power consumption. We address this challenge by optimizing a FFT implementation for execution on the Kalray MPPA manycore processor. Although this processor delivers high floating-point performances, we use fixed-point number representations in order to reduce the memory consumption and the I/O bandwidth. The result is an execution time of 1,07ms per FFT, including data transfers. This enables to use only two first-generation MPPA chips per flow of data coming from the receivers, for a total power consumption of 17.4W

A Distributed Framework for Low-Latency OpenVX over the RDMA NoC of a Clustered Manycore

International audienceOpenVX is a standard proposed by the Khronos group for cross-platform acceleration of computer vision and deep learning applications. OpenVX abstracts the target processor architecture complexity and automates the implementation of processing pipelines through high-level optimizations. While highly efficient OpenVX implementations exist for shared memory multi-core processors, targeting OpenVX to clustered manycore processors appears challenging. Indeed, such processors comprise multiple compute units or clusters, each fitted with an on-chip local memory shared by several cores. This paper describes an efficient implementation of OpenVX that targets clustered manycore processors. We propose a framework that includes computation graph analysis, kernel fusion techniques, RDMA-based tiling into local memories, optimization passes, and a distributed execution runtime. This framework is implemented and evaluated on the 2nd-generation Kalray MPPA (R) clustered manycore processor. Experimental results show that super-linear speed-ups are obtained for multi-cluster execution by leveraging the bandwidth of on-chip memories and the capabilities of asynchronous RDMA engines

Impact d’une aganglionnose colique induite sur la barrière épithéliale chez un modèle gros animal

Impact d’une aganglionnose colique induite sur la barrière épithéliale chez un modèle gros animal. 73. Congrès de la Société Française de Chirurgie Pédiatrique (SFCP

Impact on the epithelial barrier of an induced rectal aganglionnosis in a large animal model

Impact on the epithelial barrier of an induced rectal aganglionnosis in a large animal model. 17. Annual Congress of the European Paediatric Surgeons’ Association (EUPSA

Improving 3D Lattice Boltzmann Method stencil with asynchronous transfers on many-core processors

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Pumpless Lung Assist as a Bridge to Medical Therapy in a Teenager With Pulmonary Arterial Hypertension and Partial Anomalous Pulmonary Venous Return

International audienceHeart failure is the main cause of death in patients with pulmonary arterial hypertension and congenital heart disease. We used an original approach in a 15-year-old girl with rapidly progressive right heart failure secondary to severe pulmonary arterial hypertension and partial anomalous pulmonary venous return. After surgical congenital heart defect repair on cardiopulmonary bypass, she was weaned off bypass using a central Novalung for 11 days, then started on triple specific pulmonary vasodilator therapy