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

Oviatt Library Services Assessment, Spring 2007

Introduction: Overarching its instructional mission and collection development program is the Library???s strong service commitment, which connects CSUN faculty, staff, and students, as well as members of the greater community to information resources. Furthermore, the Library is committed to the continuous improvement of its services. Therefore, core to its planning process are regular surveys of its outcomes for services, particularly as to how they relate to student learning, as well as to overall patron satisfaction. See http://library.csun.edu/kdabbour/assessment.html#services for the list of Library service outcomes

Oviatt Library Annual Assessment Report to the College 2005-2006

The Oviatt Library's annual assessment report to the College for the Office of Academic Assessment for the academic year 2005-2006

Oviatt Library Assessment Planning Guide

Table of Contents: Our Vision; I. Student Learning, Library Collections, and Library Services Outcomes; I-A. Student Learning Outcomes for Information Competence; I-B. Outcomes for collections that support student learning, and faculty teaching and research; I-C. Outcomes for services that support student learning, and faculty teaching and research; II. Library Assessment Plan (a)Measurable Outcomes (b) Methodology (c) Responsible parties (d) Timeline; III. Disseminate assessment data to Library faculty and staff; IV. Disseminate assessment report to campus administratio

Oviatt Library Annual Assessment Report to the College 2009-2010

The Oviatt Library's annual assessment report to the College for the Office of Academic Assessment for the academic year 2009-2010

Library Assessment Plan, 2007-2012

Describes information competence student learning outcomes, Library collections outcomes, and Library services outcomes

CSUN Information Literacy Survey Preliminary Results

In July 2002, the U.S. Dept. of Education awarded the Oviatt Library at California State University, Northridge a five-year, $1.6 million grant under the Title V Hispanic-Serving Institutions (HSI) program. Entitled, ???Improving Student Success through Strengthening Library Collections, Archives, and Information Competence,??? one of the objectives of the grant project focuses on creating and administering valid and reliable information literacy assessment tools to CSUN students. Our main hypotheses are: ???[1] Students who have had previous library instruction will score better on the test questions than those who have not had previous library instruction. ???[2] Students who report greater frequency of use of library collections and/or its electronic resources will score better on the test questions than those who do not

CSUN Virtual Reference Pilot Program Part 2: Survey Results

Handout for poster on virtual reference for MLA Annual Conference, 2003. Includes results of survey conducted on virtual reference services at CSUN.Overview: Survey Dates: September 10, 2002 to April 18, 2003 Distribution: Automatic email form from the CSUN IP. Total completed transactions: 361\ud Total surveys returned: 110 Return Rate: 30% Service Issues: Overall, patrons were quite satisfied: Ninety-one percent found the information relevant or very relevant; and 86% found the librarian to be helpful or very helpful.\ud \ud Technical Problems:\ud Ninety-six percent reported having technical problems. Of the 17 users who commented on the problems they encountered, six (35%) seemed related to the co-browsing feature. The rest ranged from slowness complaints to error messages and disconnects. However, despite this, 89% found the service to be easy or very easy to use, and 84% reported that they would use the service again.\ud \ud CSUN Patron Characteristics:\ud Students made up 80% of the respondents. Of the 81 respondents who indicated their major, a variety of departments in each of the eight colleges at CSUN were represented. Most came from the colleges of social and behavioral sciences (14); arts media and communication (14); health and human development (13), and business (13). Humanities, including the liberal studies program, had nine respondents. Engineering and computer science had seven, and science and mathematics had six respondents. These data are in keeping with overall enrollment percentages by college