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

Dynamics of ion beam emission in a low pressure plasma focus device

The plasma that accelerates and compresses in the formation of the pinch in dense plasma focus devices has been found to be an abundant source of multiple radiations like ion beams and x-rays. In this work, the ion beam and x-ray emissions from a 2.7 kJ (13.5 kV, 30 µF) plasma focus device operated at pressure below 1 mbar were investigated. The time profile of the ion beam emission was analysed from the simultaneously measured ion beam, soft and hard x-ray signals using biased ion collectors, BPX 65 silicon PIN diode and a scintillator-photomultiplier tube assembly. Time resolved analysis of the emissions revealed that the emission of the ion beam corresponded to several different pinching instances. Two components of the ion beam were identified. An ion beam of lower energy but higher intensity was emitted followed by an ion beam of higher energy but lower intensity in the first plasma pinch. The ion beam emitted from the first plasma pinch also has higher energy than subsequent plasma pinches. The emission was found to be associated with the amplitude of voltage spike. The results from ion beam and electron beams suggest that they were emitted by the same localized electric field induced in the pinched plasma. The strongest plasma focus discharge indicated by sharp voltage spike of high amplitude and highest ion beam energy were both observed at 0.2 mbar. The average energy of the ion beam obtained is (53 ± 13) keV. At this optimum condition, the ions beam with the highest energy also led to the highest hard x-ray emission

Femtosecond Laser Filamentation in Liquid for Nanomaterials Synthesis

Ultrafast laser open up new possibilities for nanomaterials synthesis in laser ablation process that typically involve an opaque solid target. In transparent media, nonlinear optical process occurred and led to laser filamentation [1]. Laser filament formed when an ultrashort laser pulses propagate in transparent media of gas, liquid or solid with energy exceeding the threshold. This is accompanied by the appearance of the characteristic conical emissions of white light and coloured rings and the occurrence of intensity clamping. The ultrafast laser pulses induced ‘filamentation’ where the surrounding is ionized and plasma is produced. The produced plasma may be useful for nanomaterials growth. In the current work, we investigated on the nanoparticles formed by ultrafast laser filamentation in liquid, where the liquid contain the precursor elements. We show that nanodiamonds with the size of <5 nm are formed directly from ethanol via 1025 nm femtosecond laser irradiation [2]. Ultrafast laser filamentation occurred and white light supercontinuum is detected in ethanol. In addition, emissions of C species are recorded by optical emission spectroscopy while the change in absorbance of the liquid medium is detected in-situ during ultrafast laser filamentation in ethanol [3]. The prepared samples are characterized by using Raman spectroscopy, XPS, TEM and photoluminescence measurements

Pulsed laser interference patterning of polyimide grating for dye-doped polymer laser

Direct laser interference patterning of polyimide (PI) films was performed by using a pulsed 355-nm laser. At laser fluence of 0.4  J/cm2, gratings with spatial periods of 3.8  μm to 344 nm were created. The highest aspect ratio of the grating structure (0.8) was obtained for the 344-nm grating. An all-polymer dye laser was then fabricated by spin-coating a layer of disodium fluorescein (DF)-doped polyvinyl alcohol (PVA) film on bare and patterned PI substrate. Green laser emission was obtained when transversely pumped by a 355-nm laser. The lasing threshold reduced by ∼10 times for the sample with 344-nm grating while the laser intensity was ∼18 times higher. The enhancements are ascribed to the 344-nm grating structures, which act as an efficient distributed feedback resonator and distributed Bragg reflector grating for DF-doped PVA emitting at ∼563  nm, on top of being a passive light-trapping structures

Cold plasma inactivation of chronic wound bacteria

Cold plasma is partly ionized non-thermal plasma generated at atmospheric pressure. It has been recognized as an alternative approach in medicine for sterilization of wounds, promotion of wound healing, topical treatment of skin diseases with microbial involvement and treatment of cancer. Cold plasma used in wound therapy inhibits microbes in chronic wound due to its antiseptic effects, while promoting healing by stimulation of cell proliferation and migration of wound relating skin cells. In this study, two types of plasma systems are employed to generate cold plasma: a parallel plate dielectric barrier discharge and a capillary-guided corona discharge. Parameters such as applied voltage, discharge frequency, treatment time and the flow of the carrier gas influence the cold plasma chemistry and therefore change the composition and concentration of plasma species that react with the target sample. Chronic wound that fails to heal often infected by multidrug resistant organisms makes them recalcitrant to healing. Methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (Pseudomonas aeruginosa) are two common bacteria in infected and clinically non-infected wounds. The efficacies of the cold plasma generated by the two designs on the inactivation of three different isolates of MRSA and four isolates of P. aeruginosa are reported here

Electrochemical stability and corrosion mechanism of fluorine-doped tin oxide film under cathodic polarization in near neutral electrolyte

Commercial fluorine-doped tin oxide (FTO) coated glass slides were subjected to different cathodic potentials for 15 min in 0.2 M Na2SO4 of pH 6.42 to study their electrochemical stability. Results showed that FTO could maintain its electrochemical stability until -1200 mV. However, when it was cathodically polarized from -1600 mV to more negative potentials, band structure positions started to shift upwards, the electrolyte became more acidic and a porous structure appeared on the FTO surface. At -2000 mV, a layer of metallic Sn was seen deposited on the FTO surface, verified by X-ray diffraction and scanning electron microscopy – energy dispersive X-ray spectroscopy. During the cathodic corrosion in near neutral electrolyte, the reduction of SnO2 to Sn involves water oxidation as well as hydrogen evolution reaction