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

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Contribution à l'étude de l'hétérogénéité des cellules stromales / souches mésenchymateuses, focus sur les marqueurs de surface et la sénescence

Mesenchymal Stromal / Stem Cells (MSC) hold great potential and are currently the most used in clinical trials with cell-based treatments. MSC quality and therapeutic effectiveness are influenced by in vitro expansion but also by other factors such as donor parameters. To ameliorate the success rate of MSC therapies, this study focused on MSC heterogeneity. To put together cell characterization and ways to act when facing cell heterogeneity, this work was oriented toward the study of surface markers that can be monitored on living cells, and can serve to sort them.Les Cellules Stromales / Souches Mésenchymateuses (CSM) ont un grand potentiel pour de nombreuses applications et sont actuellement les cellules les plus utilisées pour les essais cliniques développant de nouvelles thérapies cellulaires. La qualité et l’efficacité thérapeutique des CSM sont influencées par leur amplification in vitro et d’autres facteurs tels que les paramètres liés au donneur de cellules. Pour améliorer les chances de succès des thérapies à base de CSM, cette étude a ciblé l’étude de l’hétérogénéité des CSM grâce à leurs marqueurs de surface

Mesenchymal stem cell interacted with PLCL braided scaffold coated with poly- l -lysine/hyaluronic acid for ligament tissue engineering

International audienc

The First SeaWiFS HPLC Analysis Round-Robin Experiment (SeaHARRE-1)

Four laboratories, which had contributed to various aspects of SeaWiFS calibration and validation activities, participated in the first SeaWiFS HPLC Analysis Round-Robin Experiment (SeaHARRE-1): Horn Point Laboratory (USA), the Joint Research Centre (Italy), the Laboratoire de Physique et Chimie Marines (France), and the Marine and Coastal Management group (South Africa). The analyses of the data are presented in Chapter 1 and the individual methods of the four groups are presented in Chapters 2-5. The average (or overall) conclusions of the round-robin are derived from 12 in situ stations occupied during a cruise in the Mediterranean Sea, although, only 11 stations are used in the analyses. The data set is composed of 12 replicates taken during each sampling opportunity with 3 replicates going to each of the 4 laboratories. The average (or overall) results from the intercomparison of 15 pigments or pigment associations are as follows (in some cases, data subsets that exclude pigments which were not analyzed by all the laboratories, or that had unusually large variances, are used to exclude a variety of problematic pigments): a) the accuracy of the four methods in determining the concentration of total chlorophyll a is 7.9%, (one method did not separate mono- and divinyl chlorophyll a, and if the samples containing significant divinyl chlorophyll a concentrations are ignored, the four methods have an accuracy of 6.7%); b) the accuracy in determining the full set of pigments is 19.1%; c) there is a reduction in accuracy of approximately - 12.2% for every decade (factor of 10) decrease in concentration (based on a data subset); d) the precision of the four methods using a subset data is 8.617( 6.2% for an edited subset); e) the repeatability of the four methods using the subset data is 9.2% (7.2%; for an edited subset, and f) the reproducibility of the four methods using the subset data is 21.31% (15.0% for an edited subset)

An Intercomparison of HPLC Phytoplankton Pigment Methods Using In Situ Samples. Application to Remote Sensing and Database Activities.

Abstract not availableJRC.H-Institute for environment and sustainability (Ispra

Impact of culture conditions on the behavior of mesenchymal stem cells: choosing critical parameters related to cell quality

International audienceMesenchymal stromal/stem cells (MSCs) are of great interest in developing new therapies because of their capacity of self-renewal, differentiation and modulation of inflammation or even immunosuppression. However, in vitro expansion is essential before the use of these cells in the clinic, which can lead to changes in the cell properties. The challenge is to optimize the culture conditions and to choose the most appropriate media for the culture of MSC to ensure that they retain their functional properties and thus their therapeutic potential. Moreover, it is necessary to fix parameters related to cell quality that could allow the selection of samples to be used. Currently, the main sources of media supplements used are fetal calf serum (FCS) and human platelet lysate (hPL). The aim of our study was to compare the characteristics and potential of bone marrow and Wharton jelly MSCs cultured in parallel in FCS and in hPL-containing medium. Experiments were performed under hypoxia (2% O2) or normoxia (21% O2) conditions. This study revealed differences in cell behavior depending on the culture condition. The behavior of the cells was related to differential expression of some surface markers and morphological alterations. Cell differentiation capacities were found to be equivalent. These first results confirm the modification of the characteristics of MSCs according to the medium used. These observations must be combined with other functional tests depending on the intended therapeutic application before being able to conclude on the superiority of one culture method over the other

An insulator with barrier-element activity promotes α-spectrin gene expression in erythroid cells

Understanding mechanisms controlling expression of the α-spectrin gene is important for understanding erythropoiesis, membrane biogenesis, and spectrin-linked hemolytic anemia. We showed previously that a minimal α-spectrin promoter directed low levels of expression only in early erythroid development, indicating elements outside the promoter are required for expression in adult erythrocytes. Addition of noncoding exon 1′ and intron 1′ conferred a 10-fold increase in activity in reporter gene assays. In this report, we used a transgenic mouse model to show that addition of exon 1′ and intron 1′ to the α-spectrin promoter conferred tissue-specific expression of a linked Aγ-globin gene in erythroid cells at all developmental stages. Expression was nearly position-independent, as 21 of 23 lines expressed the transgene, and γ-globin protein was present in 100% of erythrocytes, indicating uniform expression. Additional in vivo studies revealed that exon 1′ functions as an insulator with barrier-element activity. Chromatin immunoprecipitation assays demonstrated that this region was occupied by the upstream stimulatory factors 1/2 (USF1/USF2), similar to the well-characterized chicken HS4 insulator. These data identify the first barrier element described in an erythrocyte membrane protein gene and indicate that exon 1′ and intron 1′ are excellent candidate regions for mutations in patients with spectrin-linked hemolytic anemia