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

Recent Advancements in Microbial Polysaccharides: Synthesis and Applications

Polysaccharide materials are widely applied in different applications including food, food packaging, drug delivery, tissue engineering, wound dressing, wastewater treatment, and bioremediation sectors. They were used in these domains due to their efficient, cost-effective, non-toxicity, biocompatibility, and biodegradability. As is known, polysaccharides can be synthesized by different simple, facile, and effective methods. Of these polysaccharides are cellulose, Arabic gum, sodium alginate, chitosan, chitin, curdlan, dextran, pectin, xanthan, pullulan, and so on. In this current article review, we focused on discussing the synthesis and potential applications of microbial polysaccharides. The biosynthesis of polysaccharides from microbial sources has been considered. Moreover, the utilization of molecular biology tools to modify the structure of polysaccharides has been covered. Such polysaccharides provide potential characteristics to transfer toxic compounds and decrease their resilience to the soil. Genetically modified microorganisms not only improve yield of polysaccharides, but also allow economically efficient production. With the rapid advancement of science and medicine, biosynthesis of polysaccharides research has become increasingly important. Synthetic biology approaches can play a critical role in developing polysaccharides in simple and facile ways. In addition, potential applications of microbial polysaccharides in different fields with a particular focus on food applications have been assessed

New chitosan derivatives induced resistance to fusarium wilt disease through phytoalexin (Gossypol) production

The present investigation studied the mechanism of resistance to Fusarium oxysporum f.sp.vasinfectum induced by some chitosan derivatives in susceptible cotton plants. Pretreating cotton seeds with chitosan markedly increased cotton resistance to vascular wilt caused by Fusarium oxysporum f.sp. vasinfectum. The five chitosan derivatives tested repressed the pathogen mycelial growth. Chitosans 3, 4 and 8 had a disease score of 0.5:tO.02, 0.6:tO.5 and 0.0 respectively, indicating that the host plants were free from visual symptoms and that these chitosans were the most effective in controlling Fusarium wilt disease. Phytoalexin (gossypol) production was greatly increased with a maximum of 1.16 mg/5gmfresh root tissue in chitosan-treated plants. The level of gossypol was higher in the roots than in the stems and the maximum production of gossypol was achieved in cotton plants treated with the chitosan 3, 4 and 8 and inoculated with the pathogen spores as compared with uninoculated plants

Synthesis and antimicrobial activities of novel sugar (2-phenylquinazolin-4-yl)hydrazones and their osazones

368-376Condensation of equimolar amounts of 4-hydrazino-2-phenylquinazoline 1 and a number of monosaccharides 2 (-glucose, -galactose, -xylose, -arabinose and -ribose) affords the corresponding hydrazones 3-7 in good yields. However, when three molar equivalents of 1 is allowed to react with 2 in the presence of glacial acetic acid, the corresponding osazones 13-16 are obtained in fair yields. Acetylation of the hydrazones 3-7 and osazones 13-16 give the corresponding acetyl derivatives 8-12 and 17-20. The products obtained have been characterized by spectral data and elemental analyses. Some of the compounds show antifungal and antibacterial activities

ChemInform Abstract: Synthesis and Antimicrobial Activities of Novel Sugar (2-Phenylquinazolin-4-yl)hydrazones and Their Osazones.

Condensation of equimolar amounts of 4-hydrazino-2-phenylquinazoline 1 and a number of monosaccharides 2 (D-glucose, D-galactose, D-xylose, D-arabinose and D-ribose) affords the corresponding hydrazones 3-7 in good yields. However, whem three molar equivalents of 1 is allowed to react with 2 in the presence of glacial acetic acid, the corresponding osazones 13-16 are obtained. Acetylation of the hydrazones 3-7 and osazones 13-16 give the corresponding acetyl derivatives 8-12 and 17-20. The products obtained have been characterised by spectral data and elemental analyses. Some of the compounds show antifungal and antibacterial activities

Synthesis and Biological Activities of Novel (3-Methylquinoxalin-2-YL)Hydrazones and Osazones of Aldoses

Condensation of equimolar amounts of 2-hydrazino-3- methylquinoxaline (I) and monosaccharides II (D-glucose, Dgalactose, D-xylose, D-arabinose and D-ribose) in boiling ethanol in the presence of glacial acetic acid afforded the corresponding hydrazones III in good yields. However, when the reaction was conducted with three molar equivalents of I the corresponding osazones V was obtained in fair yields. Acetylation of the hydrazones III and osazones V using acetic anhydride in the presence of pyridine at room temperature gave the corresponding acetyl derivatives IV and VI, respectively in excellent yields. The antimicrobial activities of the synthesised compounds were examined against a variety of tested organisms. Some of the synthesised compounds showed antimicrobial activities

Recent Advancements in Microbial Polysaccharides: Synthesis and Applications

Polysaccharide materials are widely applied in different applications including food, food packaging, drug delivery, tissue engineering, wound dressing, wastewater treatment, and bioremediation sectors. They were used in these domains due to their efficient, cost-effective, non-toxicity, biocompatibility, and biodegradability. As is known, polysaccharides can be synthesized by different simple, facile, and effective methods. Of these polysaccharides are cellulose, Arabic gum, sodium alginate, chitosan, chitin, curdlan, dextran, pectin, xanthan, pullulan, and so on. In this current article review, we focused on discussing the synthesis and potential applications of microbial polysaccharides. The biosynthesis of polysaccharides from microbial sources has been considered. Moreover, the utilization of molecular biology tools to modify the structure of polysaccharides has been covered. Such polysaccharides provide potential characteristics to transfer toxic compounds and decrease their resilience to the soil. Genetically modified microorganisms not only improve yield of polysaccharides, but also allow economically efficient production. With the rapid advancement of science and medicine, biosynthesis of polysaccharides research has become increasingly important. Synthetic biology approaches can play a critical role in developing polysaccharides in simple and facile ways. In addition, potential applications of microbial polysaccharides in different fields with a particular focus on food applications have been assessed

Biocidal Polymers: Synthesis, Characterization and Antimicrobial Activity of Bis-Quaternary Onium Salts of Poly(aspartate-co-succinimide)

Microbial multidrug resistance presents a real problem to human health. Therefore, water-soluble polymers based on poly(aspartate-co-succinimide) were synthesized via reaction of poly(aspartate-co-succinimide) with bis-quaternary ammonium or quaternary salts. The resultant copolymers were characterized by various techniques such as FTIR, TGA, 1HNMR, 13CNMR and elemental microanalysis. Antimicrobial activities of the new onium salts were investigated against Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, and Salmonella typhi, and the fungi; Candida albicans,Aspergillus niger, Cryptococcus neoformans and Aspergillus flavus by agar diffusion method. Antimicrobial activity was studied in terms of inhibition zone diameters, in addition to the estimation of minimal inhibitory concentration (MIC) of the prepared compounds. A. niger and E. coli were the most affected microorganisms among the tested microorganisms with an inhibition zone of 19&ndash;21 (mm) in case of biocides, (V) and (VII). The obtained results showed that the quaternary onium salts have higher activity compared to the aspartate copolymer with MIC concentrations of 25 mg/mL for (VII) and (V) and 50 mg/mL for (VI) and (IV)

Exploring the biomedical potential of a novel modified glass ionomer cement against the pandrug-resistant oral pathogen Candida albicans SYN-01

ABSTRACTDental caries is an infectious disease that is a major concern for dentists. Streptococci and Lactobacilli were long thought to be the primary etiology responsible for caries. Candida albicans with acidogenic and aciduric characteristics has recently been implicated in the onset and progression of cariogenic lesions. Moreover, due to the increased resistance to common antimicrobials, the discovery of innovative candidates is in high demand. Therefore, our study might be the first report that explores the efficacy of glass ionomer cement (GIC) incorporated with a newly modified carboxylated chitosan derivative (CS-MC) against multidrug-resistant (MDR) and/or pandrug resistant (PDR) C. albicans isolated from the oral cavity. In this work, four CS-MC-GIC groups with different concentrations were formulated. Group four (CS-MC-GIC-4) gave a significant performance as an anticandidal agent against selected PDR Candida strain, with an obvious decrease in its cell viability and high antibiofilm activity. It also, enhanced all the mechanical properties and supports cell viability of Vero cells as a nontoxic compound. Moreover, CS-MC-GIC-4 inhibited neuraminidases completely, which might provide a novel mechanism to prevent dental/oral infections. Thus, findings in this study open up new prospect of the utilization of CS-MC-GIC as a novel dental filling material against oral drug-resistant Candida. [Figure: see text