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

Molecular and serological assessment of parvovirus B-19 infection in Egyptian children with sickle cell disease

Background/Purpose: Human parvovirus B-19 (PB-19) is a cause of hemolysis, red blood cell aplasia, and severe conditions in patients with sickle cell anemia, but the molecular mechanisms of the infection are still insufficiently understood. This study aimed to detect PB-19 DNA together with its antibodies in the sera of Egyptian children with sickle cell disease and to assess the contribution of this infection, which causes transient cessation of erythropoiesis, in precipitating severe anemia in some cases. Methods: One hundred children with sickle cell disease seeking medical advice in the pediatric-hematology clinic were recruited. Sera of the patients were compared with those of 60 healthy children regarding the presence of PB-19 immunoglobulin (Ig)G and IgM as well as detection of its DNA by nested-polymerase chain reaction technique. Results: There were statistically significant differences in the prevalence of PB-19 IgM, IgG, and DNA among patients when compared with controls (p < 0.001, p = 0.001, and p < 0.001 respectively). Acute PB-19 infection detected by positive IgM and DNA was found in 30% of the patients, while chronic PB-19 infection detected by positive IgG and DNA was detected in 24% of the patients. Anemia was worse in children with acute PB-19 infection than in those with chronic infection, while anemia was mild in children with old infection. Conclusion: PB-19 infection is detected at high rates among Egyptian children with sickle cell disease and it may result in severe anemia. So, PB-19 must be suspected and screened for in such group of patients

Association of NOS3 gene polymorphisms with essential hypertension in Sudanese patients: a case control study

Abstract Background Essential hypertension (EH) is influenced by various environmental and genetic factors. Nitric oxide is important for the functional integrity of the vascular endothelium and is produced in endothelial cells by the enzyme endothelial nitric oxide synthase (eNOS). EH has a strong genetic component, and the NOS3 gene, which encodes eNOS, represents an interesting candidate for contribution to the phenotype. The most clinically relevant polymorphisms in the NOS3 gene are rs1799983 in exon 7 (encoding Glu298Asp), a variable number tandem repeat (VNTR) in intron 4, and rs2070744 (T-786C) in the promoter region. This study aims to investigate the association between these three polymorphisms in the NOS3 gene and EH in Sudanese patients. Methods Hypertensive patients (n = 157) > 18 years of age with established hypertension from various hospitals in Khartoum, and controls (n = 85) > 18 years of age and with blood pressure measurements 1% of the Sudanese population under study. Conclusion The results of this study indicated that the rs2070744 polymorphism in NOS3 may be a genetic susceptibility factor for EH in the Sudanese population. The c allele of intron 4 VNTR is not rare in the Sudanese population

Surface and Catalytic Properties of the CuO/AlO System Treated with Different Proportions of ZnO

The effects of ZnO treatment on the surface and catalytic properties of CuO/Al 2 O 3 were investigated. All the samples studied contained a fixed amount of CuO (13.5 wt%) while the amount of ZnO dopant was varied in the range 0.68–6.46 wt%. The pure and variously doped solids were subjected to heat treatment (precalcination) in the temperature range 400–600°C. The samples obtained were investigated by XRD methods, nitrogen adsorption at −196°C and studies of their catalytic influence on the decomposition of H 2 O 2 at 20–40°C. The results obtained indicated that ZnO treatment of CuO/Al 2 O 3 followed by precalcination at 500°C led to a progressive decrease in the degree of crystallinity of the CuO phase to an extent proportional to the amount of ZnO present in the system. This suggests that such treatment led to a significant decrease in the particle size of the CuO crystallites produced. The BET surface areas of the treated solids increased on increasing the amount of ZnO present in the system. Similarly, the catalytic activity, as expressed in terms of the reaction rate constant for the decomposition of H 2 O 2 , increased on increasing the amount of dopant added to reach a maximum value (ca. 67%) when 1.7 wt% ZnO had been added to the system, and then subsequently decreased on further addition of dopant. It was found that ZnO treatment of CuO/Al 2 O 3 did not modify the activation energy of the catalyzed reaction but rather changed the concentration of catalytically active constituents without changing their energetic nature

Additional file 1: of Association of NOS3 gene polymorphisms with essential hypertension in Sudanese patients: a case control study

Questionnaire data. This excel file contains data collected by interviewed questionnaire from both patients and controls. Also the file contain BMI measurement, blood pressure measurements and lab investigation results. (XLSX 120 kb

Fat Distribution in Obese Adolescents: Anthropometry, BIA and CT Maced

Abstract Objectives: Assess the association between the anthropometric measurements of obesity, body composition with total and regional fat areas determined by CT in obese adolescents. Patients and method: 33 obese adolescents and 20 control group were assessed using anthropometry and body composition. CT measured total abdominal, subcutaneous and visceral fat areas. Results: Anthropometric, body composition and CT findings of fat content were significantly higher in obese adolescents. Visceral obesity estimated by CT in obese adolescents was significantly higher than control group (66.7 % vs. 15 %,). In obese subjects, total abdominal and subcutaneous fat had a significant positive correlation with BMI, waist, hip circumferences and Fat mass, while visceral fat had a significant positive correlation with total abdominal fat and waist circumference. In control subjects, total abdominal and subcutaneous fat had a significant positive correlation with BMI, waist, hip measurements, waist / hip ratio and fat free mass, while visceral fat had a significant positive correlation with BMI, waist, hip measurements, waist/ hip ratio, FM, PBF and total abdominal fat. Conclusion: CT is useful for diagnosis of visceral abdominal obesity in both obese and non obese subjects. Waist circumference is a good predictor of total abdominal, subcutaneous and visceral fat in obese adolescents

Cetuximab-conjugated andrographolide loaded chitosan-pectin composite nanoparticles for colorectal cancer

The target specificity of drug-loaded nanoparticles can be increased by coating them with ligands that can bind to the target receptors overexpressed on the surface of cancer cells. The purpose of the current study was to examine the potential therapeutic importance of cetuximab-conjugated chitosan-pectin composite nanoparticles as novel nanocarriers for targeted delivery of andrographolide for colon cancer therapy against 1,2-dimethylhydrazine (DMH) in mice. The animals were divided into six groups: control, DMH, andro-treated group, unconjugated nanoparticle-treated group (Ch-Pec-Andro-NPs), conjugated nanoparticle-treated group (Cet-Ch-Pec-Andro-NPs), and 5-Flurouracil-treated group (5-FU). The results from the study showed that the abnormal levels of most of the haematological, liver, and kidney tissue function markers, lipid profile, aberrant crypt foci (ACF), and colorectal markers induced by DMH were observed to be ameliorated in the treatment groups in increasing order of activity, i.e., Andro, Ch-Pec-Andro-NPs, and Cet-Ch-Pec-Andro-NPs. Despite the fact that the same amount of andrographolide was used in each treatment group, the improved therapeutic activity of Cet-Ch-Pec-Andro-NPs was attributed to the targeted delivery of andrographolide to the cancer site, which was facilitated by an anti-EGFR antibody decorated on its surface