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

First Sagittarius A* Event Horizon Telescope results. II. EHT and multiwavelength observations, data processing, and calibration

We present Event Horizon Telescope (EHT) 1.3 mm measurements of the radio source located at the position of the supermassive black hole Sagittarius A* (Sgr A*), collected during the 2017 April 5–11 campaign. The observations were carried out with eight facilities at six locations across the globe. Novel calibration methods are employed to account for Sgr A*'s flux variability. The majority of the 1.3 mm emission arises from horizon scales, where intrinsic structural source variability is detected on timescales of minutes to hours. The effects of interstellar scattering on the image and its variability are found to be subdominant to intrinsic source structure. The calibrated visibility amplitudes, particularly the locations of the visibility minima, are broadly consistent with a blurred ring with a diameter of ∼50 μas, as determined in later works in this series. Contemporaneous multiwavelength monitoring of Sgr A* was performed at 22, 43, and 86 GHz and at near-infrared and X-ray wavelengths. Several X-ray flares from Sgr A* are detected by Chandra, one at low significance jointly with Swift on 2017 April 7 and the other at higher significance jointly with NuSTAR on 2017 April 11. The brighter April 11 flare is not observed simultaneously by the EHT but is followed by a significant increase in millimeter flux variability immediately after the X-ray outburst, indicating a likely connection in the emission physics near the event horizon. We compare Sgr A*'s broadband flux during the EHT campaign to its historical spectral energy distribution and find that both the quiescent emission and flare emission are consistent with its long-term behavior.http://iopscience.iop.org/2041-8205Physic

First Sagittarius A* Event Horizon Telescope Results. II. EHT and Multiwavelength Observations, Data Processing, and Calibration

We present Event Horizon Telescope (EHT) 1.3 mm measurements of the radio source located at the position of the supermassive black hole Sagittarius A* (Sgr A*), collected during the 2017 April 5–11 campaign. The observations were carried out with eight facilities at six locations across the globe. Novel calibration methods are employed to account for Sgr A*'s flux variability. The majority of the 1.3 mm emission arises from horizon scales, where intrinsic structural source variability is detected on timescales of minutes to hours. The effects of interstellar scattering on the image and its variability are found to be subdominant to intrinsic source structure. The calibrated visibility amplitudes, particularly the locations of the visibility minima, are broadly consistent with a blurred ring with a diameter of ∼50 μas, as determined in later works in this series. Contemporaneous multiwavelength monitoring of Sgr A* was performed at 22, 43, and 86 GHz and at near-infrared and X-ray wavelengths. Several X-ray flares from Sgr A* are detected by Chandra, one at low significance jointly with Swift on 2017 April 7 and the other at higher significance jointly with NuSTAR on 2017 April 11. The brighter April 11 flare is not observed simultaneously by the EHT but is followed by a significant increase in millimeter flux variability immediately after the X-ray outburst, indicating a likely connection in the emission physics near the event horizon. We compare Sgr A*’s broadband flux during the EHT campaign to its historical spectral energy distribution and find that both the quiescent emission and flare emission are consistent with its long-term behavior

Caracterización clínica y hallazgos microbiológicos durante episodios de neutropenia febril en pacientes con cáncer

Revista Ciencias Biomédicas Vol.10, Núm.2 (2021) Pag. 91-97Introducción: con el aumento en la detección temprana de las neoplasias y el inicio de protocolos de quimioterapia, radioterapia o ambas, ha aumentado la prevalencia de la neutropenia febril en estos pacientes. Objetivo: establecer características clínicas y hallazgos microbiológicos de los episodios de neutropenia febril en pacientes con cáncer que ingresaron al Hospital Universitario del Caribe. Métodos: se realizó un estudio descriptivo de corte transversal. Se incluyeron pacientes mayores de 18 años con diagnóstico de neutropenia febril y neoplasia hematológica o tumor solido ingresados entre 2015 y 2016. Resultados: se encontró un total de 31 episodios de neutropenia febril en 23 pacientes con una edad media de 44.7 años, el 13% correspondía a pacientes mayores de 60 años y aproximadamente el 10% tenía más de una comorbilidad. Predominó el sexo masculino (53%). El tiempo de hospitalización promedio fue de 30.6 días. El 77.4% de los episodios de neutropenia correspondían a casos de neoplasias hematológicas y el 64% estuvieron precedidos por administración de quimioterapia. El recuento de neutrófilos absolutos promedio fue de 366 y más de la mitad de los episodios cursaron con neutropenia moderada y severa (77.4%). La mortalidad global durante el periodo de estudio fue del 22%. El principal foco infeccioso al ingreso fue urinario (17.6%). Con relación a los agentes microbianos en el 79% se aislaron bacterias y en el 20% hongos; las bacterias aisladas con mayor frecuencia correspondieron a la familia Enterobacteriaceae (47.3%). Conclusión: la tasa de neutropenia postquimioterapia fue alta, sobre todo en pacientes con neoplasias hematológicas

Effect of biomass smoke on chronic obstructive pulmonary disease in rural localities of colombia: a cross-sectional study

Objectives The aim of this study was to assess the differences associated to the change of biofuel used to cook as a way to estimate the proportion of respiratory abnormalities of respiratory function associated to biomass exposure.Methods A cross-sectional study was designed to evaluate the respiratory function through spirometry in subjects cooking with biomass or natural gas. All patientswere evaluated by a general physician and a pulmonologist. We compared the prevalence of spirometry abnormalities across those cooking with natural gas versus those cooking with biofuel. A multivariable logistic regression and multiple linear regression were used to adjust differences by potential confounding factors.Results 203 subjects were studied. There was a significant increase in the prevalence of severe obstructive pattern (OR 5.50; 95 % CI 1.17-25.79) in subjects who cook with biomass compared with natural gas users. Values of forced expired volume in one second (FEV1) and forced vital capacity (FVC) were statistically lower among those cooking with biomass. The prevalence of respiratory morbidity and symptoms were not statistically significant between both groups.Conclusions These findings suggest that replacing biomass fuel by natural gas may be an important public health intervention in Colombia, because it can reduce the prevalence of abnormal patterns of pulmonary function

Hematemesis masiva secundaria a uncinariasis: Presentación de un caso

Revista Ciencias Biomédicas Vol.7, Núm.1 (2016) Pag. 139 - 143Introducción: la uncinariasis sigue siendo en la actualidad un problema de salud pública. La pobre higiene y las condiciones de vida insalubres contribuyen a la permanencia del parásito. Dichos agentes se localizan principalmente en el intestino delgado, donde se fijan a la mucosa, expolian sangre y producen anemia crónica. El objetivo es presentar el caso clínico de un paciente con uncinariasis que además de la anemia presentaba hematemesis severa. Caso clínico: paciente masculino de 27 años, recluido en centro penitenciario, que ingresó por cuadro de tres días de hematemesis asociada a dolor en epigastrio, astenia y adinamia. Entre sus antecedentes refería hospitalizaciones previas por hemorragias del tracto digestivo con endoscopias sin hallazgos patológicos. Al realizar nueva endoscopia se observaron uncinarias vivas a nivel duodenal y áreas de lesiones de la mucosa. Se realizó tratamiento con bencimidazoles, alcanzando resolución del cuadro clínico. Conclusión: aunque la hemorragia de vías digestivas es una presentación atípica de la uncinariasis, estos parásitos deben tenerse en cuenta como agentes causales cuando se trata un paciente con hemorragia del tracto digestivo