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

Interlaminar Fracture Toughness of CFRP Laminates Incorporating Multi-Walled Carbon Nanotubes

Carbon fiber reinforced polymer (CFRP) laminates exhibit limited fracture toughness due to characteristic interlaminar fiber-matrix cracking and delamination. In this article, we demonstrate that the fracture toughness of CFRP laminates can be improved by the addition of multi-walled carbon nanotubes (MWCNTs). Experimental investigations and numerical modeling were performed to determine the effects of using MWCNTs in CFRP laminates. The CFRP specimens were produced using an epoxy nanocomposite matrix reinforced with carboxyl functionalized multi-walled carbon nanotubes (COOH–MWCNTs). Four MWCNTs contents of 0.0%, 0.5%, 1.0%, and 1.5% per weight of the epoxy resin/hardener mixture were examined. Double cantilever beam (DCB) tests were performed to determine the mode I interlaminar fracture toughness of the unidirectional CFRP composites. This composite material property was quantified using the critical energy release rate, GIC. The experimental results show a 25%, 20%, and 17% increase in the maximum interlaminar fracture toughness of the CFRP composites with the addition of 0.5, 1.0, and 1.5 wt% MWCNTs, respectively. Microstructural investigations using Fourier transform infrared (FTIR) spectroscopy and X-ray photoelectron spectroscopy (XPS) verify that chemical reactions took place between the COOH–MWCNTs and the epoxy resin, supporting the improvements experimentally observed in the interlaminar fracture toughness of the CFRP specimens containing MWCNTs. Finite element (FE) simulations show good agreement with the experimental results and confirm the significant effect of MWCNTs on the interlaminar fracture toughness of CFRP

Effect of fiber loading on the mechanical and physical properties of “green” bagasse–polyester composite

The main aim of this work is to fill unsaturated polyester resin with bagasse agricultural waste, as reinforcement, to prepare green wooden–polymer composites. Bagasse fibers were treated with 5% sodium hydroxide and then with dilute sulfuric acid. Bagasse–polyester composites were prepared by addition of 5, 10 and 15% of untreated and alkali treated bagasse fibers to polyester. The crosslinking reaction was performed using methyl ethyl ketone peroxide as a catalyst and cobalt octoate as an accelerator. The prepared composites were then exposed to post-curing at elevated temperature for completely crosslinking. The flexural behavior of the prepared composites was studied. An enhancement in the mechanical properties was achieved after chemical treatment. In addition, water absorption and chemical resistance were conducted showing that the produced bagasse–polyester composite with appreciable mechanical and physical properties is a new partner and cost effective material for many advanced industrial applications in addition to their environmental friendly behavior

The overall effect of reactive rubber nanoparticles and nano clay on the mechanical properties of epoxy resin

Epoxy resin, a thermoset polymer matrix used for technical applications; exhibit some outstanding properties such as high modulus, high chemical resistance and high dimension stability. However, the high crosslink density of epoxy makes this material brittle with low impact strength and poor resistance to crack propagation, which limits their many end use applications. It is an important objective to explore new routes toward toughening of epoxy resins without affecting stiffness, strength, and glass temperature. The main objective of this work is to incorporate reactive rubber nanoparticles (RRNP) and organically modified nanoclay (Cloisite-30B) into epoxy matrix with the aim of obtaining improved material with higher toughness without compromising the other desired mechanical properties. Epoxy hybrids nanocomposites containing RRNP, Cloisite-30B and RRNP/Cloisite-30B mixture were synthesized and characterized to compare the different properties which normally result from the use of single filler and hence aiming to improve toughness/stiffness balance

New Polymer Concrete with Superior Ductility and Fracture Toughness Using Alumina Nanoparticles

Emiroglu, Mehmet/0000-0002-0214-4986WOS: 000400522100010This study investigates the effect of alumina nanoparticles (ANPs) on tension and fracture characteristics of polymer concrete (PC). ANPs with a maximum particle size of 50nm were used at 0.5, 1.0, 2.0, and 3.0wt.% of epoxy resin. Tensile strength, tensile failure strain, and fracture toughness (KIC, GIC, and JIC) were determined experimentally. A PC with superior ductility showing a tensile failure strain of 4.89% (compared with 2.56% for neat PC) was observed at ANP content of 3.0wt.%. Using ANPs in producing epoxy PC can significantly improve ductility (+60.6%) and fracture toughness (+131.8%) compared with neat PC. Scanning electron microscope (SEM), dynamic mechanical analyzer (DMA), and Fourier transform infrared (FTIR) observations were conducted to understand the role ANPs play to manifest the observed improvements in tension and fracture characteristics of PC.Southern Plains Transportation Center (SPTC); Scientific and Technological Research Council of Turkey (TUBITAK)Turkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [BIDEB-2219]; Egyptian Science and Technology FundScience and Technology Development Fund (STDF) [STDF-CSE 5213]Southern Plains Transportation Center (SPTC) has funded this research work. The authors greatly acknowledge this support. The first author acknowledges financial support from the Scientific and Technological Research Council of Turkey (TUBITAK) BIDEB-2219 Postdoctoral Research program. Finally, support to the fourth author by the Egyptian Science and Technology Fund (STDF-CSE 5213) is also appreciated

Thermo-mechanical properties improvement of asphalt binder by using methylmethacrylate/ethylene glycol dimethacrylate

Various polymer-modified asphalt compositions for paving and roofing applications are known since several years ago. The degree to which a polymer improves the asphalt’s properties depends on the compatibility of the polymer and the asphalt. Highly compatible polymers are more effective in providing property improvements. In this research, the influence of in situ polymerization of methylmethacrylate monomer with asphalt in presence of ethylene glycol dimethacrylate (EGDM) as a crosslinker on the rheological and thermal properties of asphalt binder of type penetration grade 60/70 was studied. To achieve this aim, MMA/EGDM(MC) in different ratios as 5, 10 and 15% (w/w) were used to modify the thermo-mechanical properties of asphalt via forming chemical bond, and the changing in mechanical and thermal properties, of the mixes as well as the storage stability were studied. Also, the morphology (SEM), thermal characterization (TGA), dynamic mechanical analysis (DMA), bending and rheological tests were detected. The obtained experimental results revealed that the addition of MC causes both the rheological and thermal properties of the binder to improve and the prepared PMAs has high temperature susceptibility and low curing time. The improvement in the properties of the virgin asphalt will be effective in using this soft type in coating applications instead of highly expensive oxidized one