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

Field assessment of surge and continuous furrow irrigation methods in relation to tillage systems

Surge flow irrigation is one of the irrigation techniques for controlling furrow irrigation. The aim of this study was to investigate the effect of surge furrow irrigation on water management compared with continuous irrigation for different tillage systems. An experimental field was treated with various tillage systems (mouldboard plough, chisel plough and rotary plough) and water irrigation application methods (continuous flow, control) in which irrigation water was applied continuously, and surge flow (3-surges, 4-surges and 5-surges) in which irrigation water was applied intermittently until it reached the tail end of the furrow. The results showed that water savings obtained using the surge technique were 18.58, 11.84 and 18.93% lower water use than with continuous flow, for the mouldboard, chisel and rotary ploughs, respectively. The 3-surges treatment with the rotary plough reduced the advance time by 25.36% from that for continuous irrigation. The 4-surges treatment with the mouldboard plough had the highest water application efficiency (88.13%). The 3-surges treatment with the rotary plough had the highest distribution uniformity (85.01%). The rotary plough did not cause as much soil aeration around the root system as the other tillage systems. The field research provided information about surge flow, aimed at reducing advance times and increasing irrigation efficiency

Field assessment of surge and continuous furrow irrigation methods in relation to tillage systems

Surge flow irrigation is one of the irrigation techniques for controlling furrow irrigation. The aim of this study was to investigate the effect of surge furrow irrigation on water management compared with continuous irrigation for different tillage systems. An experimental field was treated with various tillage systems (mouldboard plough, chisel plough and rotary plough) and water irrigation application methods (continuous flow, control) in which irrigation water was applied continuously, and surge flow (3-surges, 4-surges and 5-surges) in which irrigation water was applied intermittently until it reached the tail end of the furrow. The results showed that water savings obtained using the surge technique were 18.58, 11.84 and 18.93% lower water use than with continuous flow, for the mouldboard, chisel and rotary ploughs, respectively. The 3-surges treatment with the rotary plough reduced the advance time by 25.36% from that for continuous irrigation. The 4-surges treatment with the mouldboard plough had the highest water application efficiency (88.13%). The 3-surges treatment with the rotary plough had the highest distribution uniformity (85.01%). The rotary plough did not cause as much soil aeration around the root system as the other tillage systems. The field research provided information about surge flow, aimed at reducing advance times and increasing irrigation efficiency

Hydrocracking of waste chicken fat as a cost effective feedstock for renewable fuel production: A kinetic study

In this study, low cost waste chicken fat (WCF) feedstock was used for fuel-like hydrocarbon production. The effects of varying reaction parameters on the hydrocracking of waste chicken fat using NiW/SiO2–Al2O3 catalyst were investigated. The reactions were carried out in a fixed bed down flow reactor at reaction temperatures of 400–450 °C, liquid hourly space velocity (LHSV) of 1, 2, 4 h−1, H2/oil molar ratio of 450 v/v and hydrogen pressures of 6.0 MPa. The effects on hydrocracking conversion and distribution of products were investigated. The liquid product was analyzed using gas chromatography (GC) to quantify n-alkanes. Hydrocracking conversion and organic liquid products (OLPs) were evaluated by ASTM D-2887 distillation. The results showed that the catalytic hydrocracking of WCF generates fuels that have chemical and physical properties comparable to those specified for petroleum-based fuels. The amount of kerosene/diesel fractional product decreased with an increase in the temperature and a decrease in the LHSV; while gasoline like petroleum fuel increased. A considerable elimination of O2 from chicken waste fat molecules has been indicated by FTIR analysis. The oxygen removal pathway of WCF over NiW/SiO2–Al2O3 catalyst is primarily carried out by hydro-deoxygenation. The reaction was found to follow the second order mechanism, and the estimated activation energy Ea was 96 kJ mol−1. The exploited catalyst was employed in another run where the results showed the catalyst stability and can be used for several times

Management of early complications of hepatic artery post living donor liver transplantations in adults

Background: Liver transplantation has rightly gained recognition as an established therapy for end stage liver disease and acute liver failure. Liver transplantation in humans has come a very long way in a short period of time. The aim were to identify the causes and the risk factors of early complications of hepatic artery post LDLT in adults. Methods: This is a retrospective &amp; prospective analysis study, which was carried out in Orthopedic Surgery This study was conducted on a retrospective review of 20 recipient patients who underwent LDLT and suffering from an early hepatic artery complications at Cairo University Hospitals and Dar Al Foad Hospital from starting the program till 2016. Results. Risk factors were examined as predictors of success including age, sex, history of HCV +/- HCC and any co-morbidity (DM, HTN), the Child-Pugh score, MELD score, identification of potential risk factors (trans-arterial chemo embolization (TACE) &amp; Hyper-coaglable states), careful preoperative evaluations (Donor &amp; Recipient). Conclusion: Early HA complications remain a major cause of morbidity and mortality after LDLT. Urgent revascularization is necessary to avoid graft loss.&nbsp

Fructose improves titanium dioxide nanoparticles induced alterations in developmental competence of mouse oocytes

Abstract Aims We investigated the effects of intraperitoneal injections of titanium dioxide nanoparticles (TiO2 NPs, 100 mg/kg) for 5 consecutive days on the developmental competence of murine oocytes. Furthermore, study the effects of TiO2 NPs on antioxidant and oxidative stress biomarkers, as well as their effects on expression of apoptotic and hypoxia inducing factor-1α (HIF1A) protein translation. Moreover, the possible ameliorating effects of intraperitoneal injections of fructose (2.75 mM/ml) was examined. Materials and methods Thirty sexually mature (8–12 weeks old; ~ 25 g body weight) female mice were used for the current study. The female mice were assigned randomly to three treatment groups: Group1 (G1) mice were injected intraperitoneal (ip) with deionized water for 5 consecutive days; Group 2 (G2) mice were injected ip with TiO2 NPs (100 mg/kg BW) for 5 consecutive days; Group 3 (G3) mice were injected ip with TiO2 NPs (100 mg/kg BW + fructose (2.75 mM) for 5 consecutive days. Results Nano-titanium significantly decreased expression of GSH, GPx, and NO, expression of MDA and TAC increased. The rates of MI, MII, GVBD and degenerated oocytes were significantly less for nano-titanium treated mice, but the rate of activated oocytes was significantly greater than those in control oocytes. TiO2 NPs significantly increased expression of apoptotic genes (BAX, Caspase 3 and P53) and HIF1A. Intraperitoneal injection of fructose (2.75 mM/kg) significantly alleviated the detrimental effects of TiO2 NPs. Transmission electron microscopy indicated that fructose mitigated adverse effects of TiO2 NPs to alter the cell surface of murine oocytes. Conclusion Results of this study suggest that the i/p infusion of fructose for consecutive 5 days enhances development of murine oocytes and decreases toxic effects of TiO2 NPs through positive effects on oxidative and antioxidant biomarkers in cumulus-oocyte complexes and effects to inhibit TiO2-induced increases in expression of apoptotic and hypoxia inducing factors

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