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

Determination of the sea waters quality of Arzew-Algeria Gulf

This work consists of assessing the degree of pollution caused by wastewater near the gulf of Arzew- Algeria. This study is based on the analysis of the physicochemical parameters, the parameters indicating pollution and the determination of heavy metals (Pb, Zn, Cd, Fr, Cr, Ni) on seawater samples taken from the site. Four companions of seasonal sampling were carried out during the year 2015. The results obtained show significant values in physicochemical parameters, pollution indicator parameters and heavy metal content in seawater samples. The results of the pollution indicator parameters show the presence of important pollution at the site studied. The results obtained are far superior to the Algerian standards defined. It is clear from the determination of heavy metals that the site under investigation shows a slight contamination by metals. The absence of treatment and the long-term exposure to these discharges will lead to severe metal pollution in seawater

Impact of nitrate ammonium and calcium (CAN27%) on the environment.

In this research, a detailed study for energy consumption levels evaluation and environmental impacts assessment in the fertilizers production sector in Algeria was achieved. An analysis of the various inputs and outputs to the process to identify different sources of pollution throughout the life cycle of fertilizer was used. One product is making the subject in this study; CAN 27% N. The flows of material and energy for each phase of the life cycle were counted and the associated environmental problems were identified. The analysis was conducted according to the LCA standards ISO (International Standard Organization) 14040 series and the impacts categories studied are Global Warming Potential, Acidification Potential, Troposphere Ozone Precursor Potential, and Resources use. The results show that Cumulative Energies Requirement and GHG emission in Algerian fertilizers production process are significant. Ammonia plant use 82% of total natural gas that is consumed by fertilizer manufactory. Production of ammonia per year requires 4,506.107MJ of electricity and 2,059.108of natural gas and generates 1.82 T CO2 eq. (equivalent)

Impact of nitrate ammonium and calcium (CAN27%) on the environment.

In this research, a detailed study for energy consumption levels evaluation and environmental impacts assessment in the fertilizers production sector in Algeria was achieved. An analysis of the various inputs and outputs to the process to identify different sources of pollution throughout the life cycle of fertilizer was used. One product is making the subject in this study; CAN 27% N. The flows of material and energy for each phase of the life cycle were counted and the associated environmental problems were identified. The analysis was conducted according to the LCA standards ISO (International Standard Organization) 14040 series and the impacts categories studied are Global Warming Potential, Acidification Potential, Troposphere Ozone Precursor Potential, and Resources use. The results show that Cumulative Energies Requirement and GHG emission in Algerian fertilizers production process are significant. Ammonia plant use 82% of total natural gas that is consumed by fertilizer manufactory. Production of ammonia per year requires 4,506.107MJ of electricity and 2,059.108of natural gas and generates 1.82 T CO2 eq. (equivalent)

Numerical investigation of hydrodynamic nanofluid convective flow in a porous enclosure

In this study, the steady state behavior of natural convection transport on a nanofluid in square enclosure was studied. The model equations were solved using Comsol Multiphysics; a solver for partial differential Navier–Stokes equations based on a two-dimensional Finite Element Method (FEM) over a range of Rayleigh numbers (103-106). Impact of the Rayleigh Number, the Darcy Number, the porosity, the solid fraction volume of porous medium and the nanoparticle concentration on natural convection are depicted. Obtained Results reveal that convection mode increases with rise of Rayleigh number. The simulated results were compared with other numerical data from the literature, which indicate that good agreement is founded

Thermal behavior of ceramic particles in a gaseous medium at high temperature

Numerical simulation of the interaction between the spherical particle and plasma gas is carried out. The aim of this study is to investigatethermal transfer between the plasma gas and solid particle during the plasma spray process and to validate the well-known empirical correlation of the Ranz and Marshall. In the conditions of molten or semi-molten states of prepared substrate, the medium (plasma jet) can affect the high velocities of particles. On the basis of direct numerical simulation, the computational analysis has been carried out by using computational fluid dynamics (CFD) of heat transfer in atmospheric pressure and mid-temperature range (3000k–12000k) of a plasma flow over a spherical particle. Our proposed model improves correlation with experiments compared to the existing approaches in the literature

Thermal behavior of ceramic particles in a gaseous medium at high temperature

Numerical simulation of the interaction between the spherical particle and plasma gas is carried out. The aim of this study is to investigatethermal transfer between the plasma gas and solid particle during the plasma spray process and to validate the well-known empirical correlation of the Ranz and Marshall. In the conditions of molten or semi-molten states of prepared substrate, the medium (plasma jet) can affect the high velocities of particles. On the basis of direct numerical simulation, the computational analysis has been carried out by using computational fluid dynamics (CFD) of heat transfer in atmospheric pressure and mid-temperature range (3000k–12000k) of a plasma flow over a spherical particle. Our proposed model improves correlation with experiments compared to the existing approaches in the literature

Hydrothermal and Entropy Investigation of Ag/MgO/H2O Hybrid Nanofluid Natural Convection in a Novel Shape of Porous Cavity

In this study, a new cavity form filled under a constant magnetic field by Ag/MgO/H2O nanofluids and porous media consistent with natural convection and total entropy is examined. The nanofluid flow is considered to be laminar and incompressible, while the advection inertia effect in the porous layer is taken into account by adopting the Darcy–Forchheimer model. The problem is explained in the dimensionless form of the governing equations and solved by the finite element method. The results of the values of Darcy (Da), Hartmann (Ha) and Rayleigh (Ra) numbers, porosity (εp), and the properties of solid volume fraction (ϕ) and flow fields were studied. The findings show that with each improvement in the Ha number, the heat transfer rate becomes more limited, and thus the magnetic field can be used as an outstanding heat transfer controller

Hydrothermal and Entropy Investigation of Ag/MgO/H₂O Hybrid Nanofluid Natural Convection in a Novel Shape of Porous Cavity

In this study, a new cavity form filled under a constant magnetic field by Ag/MgO/H2O nanofluids and porous media consistent with natural convection and total entropy is examined. The nanofluid flow is considered to be laminar and incompressible, while the advection inertia effect in the porous layer is taken into account by adopting the Darcy–Forchheimer model. The problem is explained in the dimensionless form of the governing equations and solved by the finite element method. The results of the values of Darcy (Da), Hartmann (Ha) and Rayleigh (Ra) numbers, porosity (εp), and the properties of solid volume fraction (ϕ) and flow fields were studied. The findings show that with each improvement in the Ha number, the heat transfer rate becomes more limited, and thus the magnetic field can be used as an outstanding heat transfer controller