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

Thermal conductivity of an aluminum composite material (a feasibility study)

This project involved the mixing of aluminum and diamond powders to produce a composite material. Samples of varying percentages of aluminum to diamond ratio were to be produced. This material was then to be formed into pellets utilizing the powder pressing method in a push through die produced by this student. The pellet was to be sintered, then tested for thermal conductivity by means of the Guarded-Comparative-Longitudinal Heat Flow Technique. The data obtained from this test was to be compared to the existing thermal conductivity models

Medieval technology -- arms race.

The effort to produce a 6th grade society-technology curriculum unit to precede a trip to Higgins Armory for Worcester students, took one step forward in this project. The precursor projects were deemed too long last year, and a team cut the unit back from 2 months to a week of social studies and science classes, but did not produce [a] final draft. In this project the unit was refined and cleaned up, further shortened and sent out for review by people in science and social studies, in Worcester and other districts, and examined in light of the Mass. state curriculum guideline for science education -- particularly strand 4, Science, Technology and Human Affairs. It was still found wanting as it must be in a different format and integrate all 4 science strands -- not just focus on the one easiest to connect with social studies. However, these critiques have suggested a strategy that might work to meet all the competing criteria and be of very high quality. Another team will have to take up that challenge, and go to the stage of field testing. This project builds upon the prior projects of Tom Russell, author of "The Tangled Web of the Bronze Age," Beverly Koch, author of "Medieval Technology" and the team of Paul Proulx and Brian Leary, who worked with the Higgins Armory to draw in this local resource and provide a brief preparation experience for 6th graders who would be visiting the Armory. At one point it was thought that all 6th graders in the city would be doing so each year as a special rate had been negotiated, but that effort was never fully funded with money reserved exclusively for that purpose. A teacher had to take the initiative and ask to be scheduled for such a trip. By mid year few teachers had so the money was released to other purposes. These changes did not seriously impede the current project, since the approvals necessary to proceed to field testing were not received. Another round of revisions will be needed before they will be received and meeting the requirements of both the science and social studies coordinators may not be possible. A closer working relationship with one of the curriculum coordinators will probably be necessary to reach this milestone next year, and go to field testing

Optimization of Coated Friction Drilling Tool for a FML Composite

10.1080/10426914.2020.1832684Materials and Manufacturing Processes363351-36

Sliding wear behaviour of salt bath nitrided 316LN austenitic stainless steel

The wear behaviour of AISI 316LN austenitic stainless steel has been studied by varying the duration of nitriding. AISI 316LN steel was nitrided using salt bath nitriding which consist of a mixture of 70:30 ratio of alkaline cynates and carbonates. Nitriding was carried out for two time durations namely 60 min and 100 min. Pin-on-Disc wear test were carried out for both the untreated and treated sample at room temperature. The wear parameters were changed to understand the wear mechanism of AISI 316LN steel along with the nitrided sample by varying the sliding distance for 250 m, 500 m and 1000 m. Due to the presence of different wear mechanism the rate of wear varies as a function of sliding distance. For untreated sample the wear mechanism was dominant with adhesion, abrasion and plastic deformation. An optical micrograph, X-ray diffraction analysis, wear morphology, hardness measurement and surface roughness were carried out. Due to the presence of compound layer as a result of nitriding AISI 316LN austenitic stainless steel, the mechanism of wear was restricted to abrasive wear. Untreated specimens have more significant wear loss when compared to treated specimen as work hardening and an increase in hardness of wear track resulted in material pull out. Stability of the compound layer is achieved as a result of longer duration of nitriding. Abrasive wear is resisted to a greater extend due the availability of compound layer. AISI 316LN steel which was nitrided for 100 min exhibited a more stable compound layer when compared to the same nitrided for 60 min

A family of conserved bacterial virulence factors dampens interferon responses by blocking calcium signaling

Interferons (IFNs) induce an antimicrobial state, protecting tissues from infection. Many viruses inhibit IFN signaling, but whether bacterial pathogens evade IFN responses remains unclear. Here, we demonstrate that the Shigella OspC family of type-III-secreted effectors blocks IFN signaling independently of its cell death inhibitory activity. Rather, IFN inhibition was mediated by the binding of OspC1 and OspC3 to the Ca(2+) sensor calmodulin (CaM), blocking CaM kinase II and downstream JAK/STAT signaling. The growth of Shigella lacking OspC1 and OspC3 was attenuated in epithelial cells and in a murine model of infection. This phenotype was rescued in both models by the depletion of IFN receptors. OspC homologs conserved in additional pathogens not only bound CaM but also inhibited IFN, suggesting a widespread virulence strategy. These findings reveal a conserved but previously undescribed molecular mechanism of IFN inhibition and demonstrate the critical role of Ca(2+) and IFN targeting in bacterial pathogenesis

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