High Temperature X-Ray Diffraction Study of Barium Pyrophosphate

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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

Parallelized approaches to solve the capacitated lot-sizing problem with lost sales and setup times

International audienceMulti-item lot-sizing problems faced in industrial contexts are often too large to be directly solved by standard optimization solvers. To this purpose, parallelization approaches are very useful to transform the single resolution of a complex problem into the resolution of smaller independent sub-problems, leading to much smaller computational times. We first motivate and propose new practically relevant instances for the Capacitated Lot-Sizing Problem (CLSP) with lost sales, setup times and target ending inventory. Two ways of paralleli-zing the problem are then introduced. A first approach is based on a Lagrangian relaxation of the item binding capacity constraints. We show that the problem linked to each item can be solved in polynomial time. A second approach uses a parallelized version of Relax-And-Fix and Fix-and-Optimize heuristics where, instead of optimizing the time intervals in chronological order at each iteration, different time intervals are optimized in parallel. The best interval is picked according to various strategies and is fixed for the following iterations

Parallélisation des heuristiques relax-and-fix pour résoudre un problème de lot-sizing avec contraintes de capacité

International audienceParallélisation des heuristiques relax-and-fix pour résoudre un problème de lot-sizing avec contraintes de capacit

Motivations and analysis of the capacitated lot-sizing problem with setup times and minimum and maximum ending inventories

International audienc

Capacitated lot-sizing problem with inventory constraints within periods

International audienc

Motivations and analysis of the capacitated lot-sizing problem with setup times and minimum and maximum ending inventories

International audienc

Epidemiological study of sausage in Algeria: Prevalence, quality assessment, and antibiotic resistance of Staphylococcus aureus isolates and the risk factors associated with consumer habits affecting foodborne poisoning

Aim: The first aim was to assess the quality and determine the prevalence and antibiotic susceptibility of Staphylococcus aureus contamination of raw sausage sold in ten municipalities in the Northeast of Algeria. Second, a consumer sausage purchasing survey was designed to investigate potential risk factors that have a significant association with the occurrence of foodborne poisoning among sausage consumers' behavior and its relationship with independent variables. Materials and Methods: A total of 230 butcheries from ten departments (Daira) of Algiers with more than 40 municipalities were included randomly in these studies to collect raw sausage samples and to distribute 700 structured questionnaires to meat consumers. Our two studies were conducted at the same time, between June 2016 and April 2018. Sausage samples were taken once per butchery to estimate the prevalence of S. aureus contamination and therefore deduct the quality assessment of raw sausage (Merguez) sold in Algiers, Algeria. All isolated strains were tested for their antimicrobial resistance. Furthermore, questionnaires were distributed and used to collect information on various aspects of sausage consumption and foodborne disease. The data collected were analyzed with different statistical approaches, such as the Chi-square test and the odds ratio (OR) univariable logistic model. All the risk factors were analyzed by studying their association with the occurrence of consumers who claimed to have food poisoning after consuming sausage. Results: The overall prevalence of S. aureus contamination from sausages was 25.22% (n=58/230). Over 83.33% of strains showed resistance to at least one of the antibiotics tested. The most important was for tetracycline (58%) followed by fosfomycin (33%), penicillin G (25%), and oxacillin (36%). Moreover, the multiple antibiotic resistance (MAR) index include 20 profiles with MAR >0.2. Out of the 440 meat consumers, 22.16% revealed having food poisoning after sausage consumption. The risk factors recorded were: Consumption outside of home (24.30%, OR=1.769, p=0.040), during the summer season (24.30%, OR=1.159) and during lunch (26.50%, OR=1.421). Conclusion: Our study highlights a high prevalence of S. aureus contamination in Merguez, especially in some departments of Algiers, and the high multidrug resistance of S. aureus isolates against tetracycline and oxacillin; thus, S. aureus contamination in sausage is considered a potential risk to public health. Therefore, to reduce and prevent the spread of resistant strains, robust management and monitoring of antibiotic use should be established. Therefore, it is necessary to improve the sanitation conditions and education regarding personal hygiene and change certain consumption habits of Algerian consumers to ensure food safety. Finally, it can be concluded that the application of the HACCP system is essential either in butcheries producing sausage and/or slaughterhouses. From this perspective, studies might be performed to characterize Staphylococcus spp. and S. aureus to investigate their virulence factors