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

Calculation of indices with QGIS on Sentinel 2A image. From the vegetation index (NDVI) to that of the normalized difference construction (NDBI)

NATURA GI

De l'héritage du passé aux paysages actuels : réflexions par les cartes sur leurs organisations, leurs structures et leurs fonctionnements actuels

International audienceFrom the legacy of the past to today's landscapes: reflections by maps on their organization, their structures and their current functioning ". Allex Grane, Drome River , 2010 terrain seminar, organized by the Historical Group of French Forests,"The time of the territories", Grâne, 23 and 24 October 2014 What we hear "The Blood Stone", how to take up the challenge of small management and medium-sized private forests?« De l'héritage du passé aux paysages actuels : réflexions par les cartes sur leur organisation, leurs structures et leurs fonctionnements actuels ». Entonnement d'Allex Grâne, rivière Drôme-2010 SÉMINAIRE DE TERRAIN ORGANISÉ PAR LE GHFF « Le temps des territoires », Grâne, 23 et 24 octobre 2014 Ce que nous dit « La Pierre sanglante », comment relever le défi de la gestion des petites et moyennes forêts privées

Conception, réalisation et diffusion d’une carte multimédia des ambiances sonores de la ville de Miami (Pour le Site Géoconfluences, ENS de Lyon et Direction Générale des Enseignements Scolaires)

International audience"Miami Sound City", interactive multimedia cartography at the service of the web site Geoconfluences, General Direction of School Teachings, Academy of Lyon. Authors / Speakers: Hervé Parmentier, Geomatics Cartographer, UMR 5600 EVS, University of Lyon, ENS of Lyon Violaine Jolivet, teaching professor of Geography, Dpt Udém, Montreal Marie Christine Doceul, PRAG, Editorial Manager Géoconfluences, UNIS Moderator: Moreau-Laurent Corinne Software (s): ArcGIS for Desktop, ArcGIS Online Intended audience: Any audience "Geoconfluences is a scientific digital geographic publication aimed at secondary school teachers and students for knowledge sharing and geography training, online since 2002. It is proposed by the Ministry of Education, through the DGESCO, and the Normal Hight School of Lyon, which hosts the publication on this website and which ensures the scientific and editorial management." (Wikipedia) The valorisation and popularization of scientific articles by researchers is the fundamental principle, a basis by which cartographic and infographic works enrich the contents of the authors edited by the editorial director. This interactive multimedia mapping project using the principle of a "story map" was mobilized to enhance the soundscape of Miami's Ms. Jolivet, Professor of Geography Udem, Montreal. "The interactive map wa created from a collection of samples sound coming from the city of Miami. There was produced to demonstrate the importance of sounds as a component of our relationship to the spaces experienced, visited, crossed and allows the user to browse at the city or to follow indicative commented thematic routes. ""Miami ville sonore", une cartographie interactive multimédia au service du site Géoconfluences, Direction Générale des Enseignements Scolaires, Académie de Lyon. Auteurs / intervenants : Hervé Parmentier, Cartographe géomaticien, UMR 5600 EVS, Université de Lyon, ENS de Lyon Violaine Jolivet, PR de Géographie, Dpt Udém, Montréal Marie Christine Doceul, PRAG, Responsable d'éditoriale Géoconfluences, UNIS Modérateur : Moreau-Laurent Corinne Logiciel(s) : ArcGIS for Desktop, ArcGIS Online Public visé : Tout public "Géoconfluences est une publication géographique numérique à caractère scientifique qui s'adresse aux enseignants et élèves du secondaire pour le partage du savoir et la formation en géographie, en ligne depuis 2002. Elle est proposée par le Ministère de l'Éducation nationale, à travers la DGESCO, et l'École normale supérieure de Lyon, qui héberge la publication sur son site et qui en assure le pilotage scientifique et éditorial." (Wikipédia) La valorisation et la vulgarisation d'articles scientifiques de chercheuses et chercheurs en est le principe fondamental, une base par laquelle des travaux cartographiques et infographiques viennent enrichir les contenus des auteur(e)s mis en forme par la responsable éditoriale. Ce travail de cartographie interactive multimédia utilisant le principe d'une "story map" a été mobilisé afin de valoriser des ambiances sonores de Miami de Mme Jolivet, Professeur de Géographie Udem , Montréal. "La carte interactive réalisée à partir d'une collecte d'échantillons sonores de la ville de Miami été produite pour démontrer l’importance des sons comme composante de notre rapport aux espaces vécus, visités, traversés et permet à l’utilisateur de parcourir à son gré la ville ou de suivre des parcours thématiques commentés indicatifs.

Magrit, exemples pratiques à la réalisation de cartes thématiques géostatistiques : mini-atelier de démonstrations partagéeshttps://25images.msh-lse.fr/datashs2020/video/magrit-exemples-pratiques-a-realisation-de-cartes-thematiques-geostatistiques/fr

National audienc

Calculation of indices with QGIS on Sentinel 2A image. From the vegetation index (NDVI) to that of the normalized difference construction (NDBI)

NATURA GI

De l'héritage du passé aux paysages actuels : réflexions par les cartes sur leurs organisations, leurs structures et leurs fonctionnements actuels

International audienceFrom the legacy of the past to today's landscapes: reflections by maps on their organization, their structures and their current functioning ". Allex Grane, Drome River , 2010 terrain seminar, organized by the Historical Group of French Forests,"The time of the territories", Grâne, 23 and 24 October 2014 What we hear "The Blood Stone", how to take up the challenge of small management and medium-sized private forests?« De l'héritage du passé aux paysages actuels : réflexions par les cartes sur leur organisation, leurs structures et leurs fonctionnements actuels ». Entonnement d'Allex Grâne, rivière Drôme-2010 SÉMINAIRE DE TERRAIN ORGANISÉ PAR LE GHFF « Le temps des territoires », Grâne, 23 et 24 octobre 2014 Ce que nous dit « La Pierre sanglante », comment relever le défi de la gestion des petites et moyennes forêts privées

Calculation of indices with QGIS on Sentinel 2A image. From the vegetation index (NDVI) to that of the normalized difference construction (NDBI)

NATURA GI

La prise en compte des extrêmes climatiques dans la gestion des tourbières

International audienceThe consideration of climate extremes in the management of peat bogs. Mires actual history, regarding water level as main indicator of extreme events, is sketched in four different locations, two northern France and two in Massif Central. Strength and weakness of these ecosystems are analysed. It appears that the four sites have, in recent times, 1976, 1989-1991 and recent years intense or relative droughts, well recovered and peat-making processes is still working. Positive factors are hydrogeomorphology and local peat dynamic. Mire managing has to understand these mechanisms and use them.L'histoire actuelle des tourbières dans leur rapport aux niveaux d'eau en tant qu'indicateur principal des événements extrêmes, est esquissée ici sur quatre sites différents : deux en France du nord et deux dans le Massif Central. Les forces et les faiblesses de ces écosystèmes sont analysées. Il s'avère que les quatre sites lors des sécheresses intenses ou relatives en 1976, 1989-1991 et dans les dernières années, ont bien récupéré et le processus de turbification fonctionne toujours. Les facteurs positifs sont l'hydrogéomorphologie et la dynamique de turbification locale. La gestion de la tourbière doit donc comprendre ces mécanismes et les utiliser