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

One day hospitalization for trans-rectal ultrasound guided prostate biopsy: Experiences of a single institution

Objective: To investigate one-day hospitalization for trans-rectal ultrasound guided prostate (TRUSP) biopsy. Materials and methods: From September 2009 to September 2012, 218 consecutive patients hospitalized for TRUSP biopsy in our hospital were enrolled. All were hospitalized for observation for one day after the procedure. Patients who were not discharged on the planned date or who were re-admitted were categorized as the “changed hospitalization plan” group. Perioperative laboratory data and variables were checked and recorded for statistical analysis to examine the differences between patients with and without changed hospitalization plan. The causes of changing hospitalization plans were recorded for descriptive analysis. Results: There were 202 (92.7%) patients discharged on the planned date and 16 (7.3%) for whom the hospitalization plan was changed. There were no statistical significances in laboratory tests between the groups; age was the only variable that was statistically significantly different (p = 0.032), especially in patients aged over 77 (p = 0.033).The most common causes of changing the hospitalization plan were urinary retention (n = 10, 4.6%) and fever (n = 6, 2.8%) which included sepsis (n = 3, 1.4%). Two of the three patients with sepsis were re-hospitalized. Conclusion: Age over 77 was the only significant risk factor for changed hospitalization plan. However, Postoperative fever was uncommon in patients hospitalized for one day for TRUSP biopsy. Prolonged admission to prevent rare cases of sepsis may be not reasonable

Pressure compression of the access tract for tubeless percutaneous nephrolithotomy

Objective: To obtain adequate hemostasis, we compressed the access tract at the end of operation for tubeless percutaneous nephrolithotomy (PCNL). The clinical results of 216 consecutive patients were evaluated by retrospective chart review. Materials and Methods: After stone extraction, an 8F Foley catheter was inserted into the renal pelvis and was then inflated and gently retracted. The working sheath was withdrawn to the renal capsule, the renal access tract was packed with oxidized regenerated cellulose (SurgicelTM) strips, and the tract was compressed with smaller dilators through the working sheath for 5 min. Results: Of the 216 patients, 139 were male and 77 were female. The mean age was 56.0 ± 11.7 years. The stone characteristics were renal stones in 146 patients, ureteral stones in 47 patients, and kidney with ureteral stones in 23 patients. The average stone size was 3.6 ± 2.1 cm, and the average operation time was 80.5 ± 30.1 min. The target stones were all removed in each patient and the overall postoperative stone-free rate was 73.6%. The postoperative blood transfusion rate was 1.4% (three patients). Postoperative fever was noted in 23 patients (10.6%) and sepsis was noted in three patients (1.4%). The average postoperative hospital stay was 3.2 ± 1.4 days. Conclusion: Our results suggest that pressure compression may be an alternative method to minimize hemorrhagic complications during tubeless PCNL

Additive manufacturing of composite materials and functionally graded structures using selective heat melting technique

The feasibility of using selective heat melting (SHM) to fabricate composite materials and functionally graded structures was investigated. We report, for the first time, the successful 3D printing of copper (Cu)-polyethylene (PE) composite, iron (Fe)-polyethylene (PE) composite and functionally graded CuO foams using the SHM technique. It was found that a low feed rate, high airflow rate and high airflow temperature were required for efficient delivery of heat from the emitted hot air to the powder bed, so that the PE binder particles can melt and form dense composites with smooth surfaces. The best mechanical properties were exhibited by composites with 80 vol.% PE, as lower PE concentrations led to deficient binding of the metal particles, while higher PE concentrations meant that very few metal particles were available to strengthen the composite. The strength exhibited by Cu-PE composites was comparable to engineering plastics such as polycarbonate, with the added advantage of being electrically conductive. The average conductivity of the samples, 0.152 ± 0.28 S/m, was on par with physically cross-linked graphene assemblies. By subjecting a Cu-PE composite, with Cu concentration graded from 10 vol.% to 30 vol.%, to a high temperature debinding and sintering treatment in air, CuO foam with graded porosity can be obtained. This CuO foam was observed to fail in a layer-by-layer manner under mechanical compression, which is a characteristic of functionally graded materials. Our study shows that, compared to existing 3D printing techniques, SHM can be cheaper, have wider material compatibility, occupy a smaller footprint and potentially induce less residual stresses in the fabricated parts. Therefore, it could be a valuable complement to current additive manufacturing techniques for fabricating mechanically strong composite materials and functionally graded structures.Accepted versio

Preoperative Quality of Life and Mental Health Can Predict Postoperative Outcomes and Quality of Life after Colorectal Cancer Surgery

Background and Objectives: It remains unclear which domains of preoperative health-related quality of life (HRQOL) and mental health are predictive of postoperative clinical and patient-reported outcomes in colorectal cancer (CRC) patients. Materials and Methods: A prospective cohort of 78 CRC patients undergoing elective curative surgery was recruited. The EORTC QLQ-C30 and HADS questionnaires were administered preoperatively and one month after surgery. Results: Preoperative cognitive functioning scores (95% CI 0.131–1.158, p = 0.015) and low anterior resection (95% CI 14.861–63.260, p = 0.002) independently predicted poorer 1-month postoperative global QOL. When postoperative complications were represented using the comprehensive complication index (CCI), poorer preoperative physical function scores were associated with higher CCI scores (B = −0.277, p = 0.014). Preoperative social function score (OR = 0.925, 95% CI 0.87 to 0.99; p = 0.019) was an independent predictor for 30-day readmission, while physical functioning score (OR = −0.620, 95% CI −1.073–−0.167, p = 0.008) was inversely related to the length of hospitalization. The overall regressions for 1-month postoperative global QOL (R2: 0.546, F: 1.961, p = 0.023) and 30-day readmission (R2: 0.322, χ2: 13.129, p Conclusions: Various QLQ-C30 domains were found to be predictive of postoperative outcomes, including complications, readmission, and length of hospitalization. Preoperative cognitive dysfunction and low AR were independent predictors of poorer postoperative global QOL. Future research should seek to examine the efficacy of targeting specific baseline QOL domains in improving clinical as well as patient-reported outcomes after CRC surgery

MiR-138 is a potent regulator of the heterogenous MYC transcript population in cancers

10.1038/s41388-021-02084-xONCOGENE4181178-118

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe