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

Highly Durable Compositionally Variant Bifunctional Tetrametallic Ni–Co–Mn–Fe Phosphide Electrocatalysts Synthesized by a Facile Electrodeposition Method for High-Performance Overall Water Splitting

In the recent few decades, the demand for green sources of energy that are clean and sustainable became very essential to reduce the greenhouse and global warming problems. Consequently, there is an increasing demand to identify nonprecious, cheap bifunctional electrocatalysts for water splitting. Herein, nanosheets of different earth-abundant Ni, Co, Mn, and Fe combinations are electrodeposited over commercial Ti mesh and tested for the overall water splitting. The bare Ti mesh requires overpotentials of −486.6 mV at −10 mA cm–2 and 534.5 mV at 10 mA cm–2 for the hydrogen evolution reaction (HER) and oxygen evolution reaction (OER), respectively. However, the electrodeposited catalysts show much higher catalytic activity for both HER and OER with overpotentials of −300 and 279 mV at −10 and 10 mA cm–2, respectively, lowering the overpotential needed to drive the OER by 50%. Nevertheless, to enhance the electrocatalytic performance of the fabricated catalysts, they are phosphidized using different phosphorous precursors. The resulted NiCoMnFe–P catalysts exhibit much lower HER overpotential (−200 mV at −10 mA cm–2), which is 40% lower than that needed by the bare Ti mesh. For the overall water splitting, a cell voltage of 1.71 V is recorded to achieve a current density of 10 mA cm–2. Lastly, the stability test of the overall device reveals very high stability with current retention of 90% over 22 h of continuous electrolysis. Furthermore, the synergy between the metallic components in the absence and presence of P is elucidated using density functional theory calculations, revealing optimized GH* and GH2O* for the HER reaction over the P-top site of the MnFeCoNiP catalyst. In addition, the calculations explain the superiority of the NiCoMnFe catalyst over the NiCoMnFeP counterpart for the OER

New photosensitizers that are based on carbazoles and have thiophene bridges with a low bandgap do 32% better than N719 metal complex dye

Synthesis of metal-free organic sensitizers is a promising route for obtaining low-cost, high-efficiency sensitizers for dye-sensitized solar cells (DSSCs). We present the results of a comprehensive photovoltaic analysis of four carbazole organic sensitizers with a D-A architecture in this study. MES 1-4 have been developed and used as sensitizers in DSSC applications. Using MES1-4 as sensitizers results in a broader light-harvesting ability (400–800 nm) and higher photovoltaic efficiency at a range of 6.06–9.55 %. Herein, the introduction of thiazolidine-4-one ring engineering into MES4 as a rich electron acceptor enhanced electron injection and inhibited electron recombination in thiazolidine-4-one sensitizers. The MES4 system has the highest light harvesting ability and reflectivity owing to the existence of distinct functional groups that enhanced the capacity to bind the dye with the semiconductor layer (TiO2 device’s efficiency). In conclusion, the DSSC using the novel electron acceptor thiazolidine-4-one ring sensitizer achieves an unexpected PCE of 9.55 % and a 32 % increase over using the N719 metal complex dye. All sensitizers based on carbazole compounds had good photovoltaic performance

Electrochemical Fabrication of Ternary Black Ti‐Mo‐Ni Oxide Nanotube Arrays for Enhanced Photoelectrochemical Water Oxidation

© 2020 Wiley-VCH GmbH Point defects play important and crucial roles in the design of high performance photocatalysts. We report on the electrochemical fabrication of black Ti−Mo-Ni−O nanotubes as a promising electrode material for solar-assisted water splitting. The ternary Ti−Mo-Ni−O catalyst was annealed in hydrogen atmosphere to induce point defects in the material to enhance its conductivity, charge carriers density, and performance. The effect of annealing duration on the performance of ternary Ti−Mo-Ni−O nanotube films was investigated. The hydrogen-annealed nanotubes showed enhanced optical characteristics in the visible spectrum, which can be related to the formation of defect states upon hydrogen annealing. The 10 h-annealed sample showed an exceptionally enhanced photocurrent density of ∼10 mA/cm2 with a remarkable open-circuit voltage of ∼−1.0 VAg/AgCl under AM 1.5G illumination. This improved photocurrent is in agreement with the obtained 75 % incident-photon-to-current-conversion-efficiency (IPCE), confirming the improved photoactivity of the hydrogen-treated mixed oxide nanotubes

Ternary Ti-Mo-Fe Nanotubes as Efficient Photoanodes for Solar-Assisted Water Splitting

Designing efficient and stable water splitting photocatalysts is an intriguing challenge for energy conversion systems. We report on the optimal fabrication of perfectly aligned nanotubes on trimetallic Ti-Mo-Fe alloy with different compositions prepared via the combination of metallurgical control and facile electrochemical anodization in organic media. The X-ray diffraction (XRD) patterns revealed the presence of composite oxides of anatase TiO2and magnetite Fe3O4with better stability and crystallinity. With the optimal alloy composition Ti-(5.0 atom %) Mo-(5.0 atom %) Fe anodized for 16 h, enhanced conductivity, improved photocatalytic performance, and remarkable stability were achieved in comparison with Ti-(3.0 atom %) Mo-(1.0 atom %) Fe samples. Such optimized nanotube films attained an enhanced photocatalytic activity of ∼0.272 mA/cm2at 0.9 VSCE, which is approximately 4 times compared to the bare TiO2nanotubes fabricated under the same conditions (∼0.041 mA/cm2at 0.9 VSCE). That was mainly correlated with the emergence of Mo and Fe impurities within the lattice, providing excess charge carriers. Meanwhile, the nanotubes showed outstanding stability with a longer electron lifetime. Moreover, carrier density variations, lower charge transfer resistance, and charge carriers dynamics features were demonstrated via the Mott-Schottky and electrochemical impedance analyses

Impact of palladium/palladium hydride conversion on electrochemical CO₂ reduction via in-situ transmission electron microscopy and diffraction

Electrochemical conversion of CO2 offers a sustainable route for producing fuels and chemicals. Pd-based catalysts are effective for converting CO2 into formate at low overpotentials and CO/H2 at high overpotentials, while undergoing poorly understood morphology and phase structure transformations under reaction conditions that impact performance. Herein, in-situ liquid-phase transmission electron microscopy and select area diffraction measurements are applied to track the morphology and Pd/PdHx phase interconversion under reaction conditions as a function of electrode potential. These studies identify the degradation mechanisms, including poisoning and physical structure changes, occurring in PdHx/Pd electrodes. Constant potential density functional theory calculations are used to probe the reaction mechanisms occurring on the PdHx structures observed under reaction conditions. Microkinetic modeling reveals that the intercalation of *H into Pd is essential for formate production. However, the change in electrochemical CO2 conversion selectivity away from formate and towards CO/H2 at increasing overpotentials is due to electrode potential dependent changes in the reaction energetics and not a consequence of morphology or phase structure changes.</p

Impact of palladium/palladium hydride conversion on electrochemical CO2 reduction via in-situ transmission electron microscopy and diffraction

Abstract Electrochemical conversion of CO2 offers a sustainable route for producing fuels and chemicals. Pd-based catalysts are effective for converting CO2 into formate at low overpotentials and CO/H2 at high overpotentials, while undergoing poorly understood morphology and phase structure transformations under reaction conditions that impact performance. Herein, in-situ liquid-phase transmission electron microscopy and select area diffraction measurements are applied to track the morphology and Pd/PdHx phase interconversion under reaction conditions as a function of electrode potential. These studies identify the degradation mechanisms, including poisoning and physical structure changes, occurring in PdHx/Pd electrodes. Constant potential density functional theory calculations are used to probe the reaction mechanisms occurring on the PdHx structures observed under reaction conditions. Microkinetic modeling reveals that the intercalation of *H into Pd is essential for formate production. However, the change in electrochemical CO2 conversion selectivity away from formate and towards CO/H2 at increasing overpotentials is due to electrode potential dependent changes in the reaction energetics and not a consequence of morphology or phase structure changes