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

Consenso colombiano de atención, diagnóstico y manejo de la infección por SARS-COV-2/COVID-19 en establecimientos de atención de la salud Recomendaciones basadas en consenso de expertos e informadas en la evidencia

The “Asociación Colombiana de Infectología” (ACIN) and the “Instituto de Evaluación de Nuevas Tecnologías de la Salud” (IETS) created a task force to develop recommendations for Covid 19 health care diagnosis, management and treatment informed, and based, on evidence. Theses reccomendations are addressed to the health personnel on the Colombian context of health services. © 2020 Asociacion Colombiana de Infectologia. All rights reserved

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

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

Colombian consensus recommendations for diagnosis, management and treatment of the infection by SARS-COV-2/ COVID-19 in health care facilities - Recommendations from expert´s group based and informed on evidence

La Asociación Colombiana de Infectología (ACIN) y el Instituto de Evaluación de Nuevas Tecnologías de la Salud (IETS) conformó un grupo de trabajo para desarrollar recomendaciones informadas y basadas en evidencia, por consenso de expertos para la atención, diagnóstico y manejo de casos de Covid 19. Estas guías son dirigidas al personal de salud y buscar dar recomendaciones en los ámbitos de la atención en salud de los casos de Covid-19, en el contexto nacional de Colombia

Centrality evolution of the charged-particle pseudorapidity density over a broad pseudorapidity range in Pb-Pb collisions at root s(NN)=2.76TeV

Peer reviewe

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Macromicetos en Zona Rural de Villavicencio

Titulo en ingles:  Macrofungi  in the  Rural Zone  of VillavicencioRESUMEN:  Los macromicetos degradadores de materia orgánica, como la madera, son un grupo de microorganismos particulares con una alta diversidad de hábitos y formas. Mediante colecciones puntuales se recolectaron 30 especímenes en la zona rural de la ciudad de Villavicencio, que posee un paisaje de Piedemonte. En el muestreo predominaron los basidiomicetos. El orden Polyporales y la familia Polyporaceae fueron los mejor representados y los géneros más frecuentes Trametes y Auricularia. Se espera que este estudio contribuya al conocimiento de la diversidad micológica en los Llanos Orientales de Colombia.Palabras claves: Hongos, saprófitos, Llanos, Basidiomicetos.ABSTRACT:  Organic material degrading macrofungi, are a group of particular microorganisms with a high diversity of forms and habits. Thirty specimens were collected through punctual sampling in rural zone of Villavicencio, this city has a foothills landscape. During the sampling predominated the Basidiomycetes. The Polyporal order and the  Polyporaceae family were the best represented and the most frequent gender were Trametes and Auricularia. It is hoped that this study will contribute to the knowledge of mycological diversity in Los Llanos Orientales of Colombia.Key words: Fungi, saprophytes, Llanos, Basidiomycetes.Titulo en ingles:  Macrofungi  in the  Rural Zone  of VillavicencioRESUMEN:  Los macromicetos degradadores de materia orgánica, como la madera, son un grupo de microorganismos particulares con una alta diversidad de hábitos y formas. Mediante colecciones puntuales se recolectaron 30 especímenes en la zona rural de la ciudad de Villavicencio, que posee un paisaje de Piedemonte. En el muestreo predominaron los basidiomicetos. El orden Polyporales y la familia Polyporaceae fueron los mejor representados y los géneros más frecuentes Trametes y Auricularia. Se espera que este estudio contribuya al conocimiento de la diversidad micológica en los Llanos Orientales de Colombia.Palabras claves: Hongos, saprófitos, Llanos, Basidiomicetos.ABSTRACT:  Organic material degrading macrofungi, are a group of particular microorganisms with a high diversity of forms and habits. Thirty specimens were collected through punctual sampling in rural zone of Villavicencio, this city has a foothills landscape. During the sampling predominated the Basidiomycetes. The Polyporal order and the  Polyporaceae family were the best represented and the most frequent gender were Trametes and Auricularia. It is hoped that this study will contribute to the knowledge of mycological diversity in Los Llanos Orientales of Colombia.Key words: Fungi, saprophytes, Llanos, Basidiomycetes

Nuevo método para la cuantificación de la actividad endoglucanasa basado en el complejo celulosa-rojo congo

Titulo en ingles: A new method for quantifying endoglucanase activity based on Congo red-carboxymethyl cellulosecomplex depolymerisation.RESUMEN: El objetivo de este trabajo fue establecer un método de cuantificación para la actividad endoglucanasa basado en la despolimerización del complejo polisacárido-rojo Congo, con este fin se describió el comportamiento matemático de la viscosidad y la absorbancia del medio de cultivo carboximetilcelulosa- rojo Congo. Para medir el impacto de un hongo celulolítico como Trichoderma viride sobre el medio, se realizó el seguimiento de la viscosidad y la absorbancia del medio de cultivo inoculado por 8 días. El cálculo de la concentración de enzima se realizó correlacionando los resultados de pruebas de azúcares reductores por DNS con la pérdida de absorbancia del medio de cultivo CMC. Para evaluar la aplicabilidad de la técnica se probaron cuatro cepas de deuteromicetos celulolíticos y se encontró que el uso de la variable pérdida de absorbancia del medio CMC, fue efectiva para diferenciar la actividad endoglucanasa de las cepas. El método basado en rojo Congo-CMC es más rápido y sensible que el DNS. Se recomienda aplicar este nuevo método en los screening para la bioprospección de hongos celulolíticos.Palabras clave: Endoglucanasa, carboximetilcelulosa, rojo Congo, hongos celuloliticos.ABSTRACT:  The aim of this work was to establish a method for quantifying endoglucanase activity based on the depolymerisation of the Congo red-polysaccharide complex. The mathematical viscosity and absorbance patternsforCongo red-carboxymethylcellulose(CMC) culture media were thus described. The inoculated media'sviscosity and absorbance were monitored for 8 daysto measure the impact of a cellulolytic fungus such as Trichodermaviride on the media. Enzymeconcentration was calculated by correlating reducing sugars'absorbance test results using3,5-dinitrosalicylic acid (DNS) with loss of CMC culture mediaabsorbance. Four cellulolytic deuteromycetesstrains were testedto assess the technique'sapplicability;it was found that usingCMC media absorbancelosswas effective for differentiatingstrains'endoglucanase activity. The Congored- CMC method was faster and more sensitive than the DNS method. This new method should thusbe appliedin screening assays when bioprospecting cellulolytic fungi in soil.Key words: Endoglucanase, carboxymethylcellulose, Congo red, cellulolytic fungusTitulo en ingles: A new method for quantifying endoglucanase activity based on Congo red-carboxymethyl cellulosecomplex depolymerisation.RESUMEN: El objetivo de este trabajo fue establecer un método de cuantificación para la actividad endoglucanasa basado en la despolimerización del complejo polisacárido-rojo Congo, con este fin se describió el comportamiento matemático de la viscosidad y la absorbancia del medio de cultivo carboximetilcelulosa- rojo Congo. Para medir el impacto de un hongo celulolítico como Trichoderma viride sobre el medio, se realizó el seguimiento de la viscosidad y la absorbancia del medio de cultivo inoculado por 8 días. El cálculo de la concentración de enzima se realizó correlacionando los resultados de pruebas de azúcares reductores por DNS con la pérdida de absorbancia del medio de cultivo CMC. Para evaluar la aplicabilidad de la técnica se probaron cuatro cepas de deuteromicetos celulolíticos y se encontró que el uso de la variable pérdida de absorbancia del medio CMC, fue efectiva para diferenciar la actividad endoglucanasa de las cepas. El método basado en rojo Congo-CMC es más rápido y sensible que el DNS. Se recomienda aplicar este nuevo método en los screening para la bioprospección de hongos celulolíticos.Palabras clave: Endoglucanasa, carboximetilcelulosa, rojo Congo, hongos celuloliticos.ABSTRACT:  The aim of this work was to establish a method for quantifying endoglucanase activity based on the depolymerisation of the Congo red-polysaccharide complex. The mathematical viscosity and absorbance patternsforCongo red-carboxymethylcellulose(CMC) culture media were thus described. The inoculated media'sviscosity and absorbance were monitored for 8 daysto measure the impact of a cellulolytic fungus such as Trichodermaviride on the media. Enzymeconcentration was calculated by correlating reducing sugars'absorbance test results using3,5-dinitrosalicylic acid (DNS) with loss of CMC culture mediaabsorbance. Four cellulolytic deuteromycetesstrains were testedto assess the technique'sapplicability;it was found that usingCMC media absorbancelosswas effective for differentiatingstrains'endoglucanase activity. The Congored- CMC method was faster and more sensitive than the DNS method. This new method should thusbe appliedin screening assays when bioprospecting cellulolytic fungi in soil.Key words: Endoglucanase, carboxymethylcellulose, Congo red, cellulolytic fungu