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

Wpływ doświadczenia podróży na świadomość statusu obiektu światowego dziedzictwa UNESCO wśród turystów odwiedzających Delhi

Awareness of World Heritage Sites (WHS) is a marketing tool used to promote a destination. Once a tourist arrives, the ‘trip experience’ becomes a vital tool to ensure repeat visits and showcase a positive image of a destination to potential tourists. This study has tried to link the impact of the ‘trip experience’ of tourists to awareness of WHS aiming to understand the relationship of the six ‘domains’ and forming a proposed model. The data was collected from an on-site survey of 309 tourists from July to December 2019 using a structured questionnaire following a pilot study. For data analysis, logistic regression analysis was used. This revealed that four out of six domains increase the probability of tourists’ awareness of WHS status during a trip, namely: welcoming, local travel, tour leader and tour guide. The earlier model for using WHS awareness only for promotional purposes has been shifted by adding the trip experience of the tourists. The findings can be applied by tourism and hospitality facilitators in providing services to tourists.Świadomość istnienia miejsc i obiektów światowego dziedzictwa UNESCO (World Heritage Sites – WHS) to narzędzie marketingowe wykorzystywane w promowaniu destynacji turystycznych. Przeżycia turysty w czasie podróży stają się ważnym instrumentem zachęcającym do powtórnych wizyt oraz przedstawiającym pozytywny wizerunek danej miejscowości innym potencjalnym odwiedzającym. Celem autorów artykułu było wykazanie wpływu doświadczenia podróży turystów na ich świadomość statusu światowego dziedzictwa, zrozumienie jej sześciu składowych oraz stworzenie zaproponowanego modelu. Dane zostały zebrane podczas lokalnego badania ankietowego obejmującego 309 turystów, w okresie od czerwca do grudnia 2019 r., przy użyciu ustrukturyzowanego kwestionariusza, po przeprowadzeniu badania pilotażowego. Do analizy danych zastosowano metodę analizy regresji logistycznej. Wykazała ona, że cztery spośród sześciu składowych potencjalnie zwiększają podczas podróży u odwiedzających świadomość statusu światowego dziedzictwa. Są to: powitanie, podróżowanie po okolicy, pilot wycieczki i miejscowy przewodnik. Wcześniejszy model, w którym świadomość przebywania w miejscu światowego dziedzictwa była wykorzystywana wyłącznie do celów promocyjnych, został zmodyfikowany przez dodanie do niego elementu doświadczenia podróżniczego turystów. Wyniki mogą być przydatne dla osób zajmujących się turystyką i hotelarstwem przy organizacji usług turystycznych

Design and Synthesis of Redox-Switched Lariat Ethers and Their Application for Transport of Alkali and Alkaline-Earth Metal Cations Across Supported Liquid Membrane

A new class of redox-switched anthraquinone derived lariat ethers 1-(1-anthraquinonyloxy) 3, 6, 9 trioxaundecane 11-ol (M1)

Effect of side arm chain length of redox ionophores on uptake of some metal ions

1170-1172Synthesis of redox switched ionophores 1-[1-anthraquinonyloxy) 3, 6 dioxaoctane-8-methane (A1) and 1-[1-anthraquinonyloxy] 3 oxapentane-5-methane (A2) has been reported. These ionophores have been used as carriers in liquid membrane transport and extraction studies of alkali and alkaline earth metal ions. The sequence of metal ions extracted and transported in oxidised and reduced state by ionophore A1 is: Ca2+>K+>Li+>Mg2+ and Li+>K+>Ca2+>Mg2+  respectively. The order of ex traction and transport of metal ions with respect to ionophore A2 is Li+>K+>Ca2+ and Ca2+>K+>Li+ respectively. Ionophore A1 is selective for Ca2+ while ionophore A2 is selective for Li+ ions. This selectivity may be used in ion selective electrode and redox switch able devices

Design and Synthesis of Redox-Switched Lariat Ethers and Their Application for Transport of Alkali and Alkaline-Earth Metal Cations Across Supported Liquid Membrane Ionophore M 1 is selective for Na + , Li + , and K + and ionophores (M 2 -M 6 ) are select

A new class of redox-switched anthraquinone derived lariat ethers 1-(1-anthraquinonyloxy) 3, 6, 9 trioxaundecane 11-ol (M 1 ), 1-(1-anthraquinonyloxy) 3, 6 dioxaoctane 9-ol (M 2 ), 1-(1-anthraquinonyloxy) 3 oxapentane 5-ol (M 3 ), 1-(1-anthraquinonyloxy) 3 oxapentane 5-butane (M 4 ), 1-(1-anthraquinonyloxy) 3, 6 dioxaoctane 9-methane (M 5 ) and 1-(1-anthraquinonyloxy) 3 oxapentane 5-methane (M 6 ) have been synthesized and characterized by spectral analysis. These ionophores were used in liquid membrane carrier facilitated transport of main group metal cations across supported liquid membrane (SLM). Cellulose nitrate membrane was used as membrane support. Effect of various parameters such as variation in concentration of metal as well as ionophore, effect of chain length and end group of ionophore have been studied. The molecular architecture of lariat ether side arm holds the metal ions,and selectivity and carrier ability of redoxswitched lariat ethers will be helpful in constructing ionselective electrodes EXPERIMENTAL Synthesis of redox-switched lariat ethers We have synthesized ionophores (M 1 -M 6 ) as shown in Scheme 1. Preparation of 1-[1-anthraquinonyloxy]-3, 6, 9-trioxaundecane-11-ol (M 1 )- A solution of tetraethylene glycol (2.89 mL) in THF (10 mL) was added to vigorously stirred suspension of NaH (60% oil dispersion, 0.29 g, and 7.25 mmol) in THF and the mixture was refluxed for 30 minutes. Then a solution of 1-chloroanthraquinone (1.28 g, 5.28 mmol in THF) was added to it and refluxed at 80 • C for 10 hours with stirring. This reaction was performed under nitrogen atmosphere. The reaction mixture was concentrated and the residue was mixed with CH 2 Cl 2 and then washed with water (twice) followed by brine. The organic phase was separated and dried (over MgSO4), filtered, and concentrated. Column chromatography (silica gel, 2% MeOH/CH 2 Cl 2 ) followed by recrystallization (CH 2 Cl 2 /hexane then EtOH) gave 2.73 g (80%) of Chemicals Metal salts as metal picrate (MPic) were prepared as reported earlier Preparation of membrane Commercially available synthetic membrane Merck (cellulose nitrate) has been used as a support in SLM studies. The membrane pore size was 0.2 μm. Membranes were impregnated with redox-switched ionophores (M 1 -M 6 ), dipped overnight, and used as a membrane support. These impregnated membranes were used for carrier-facilitated transport studies of alkali and alkaline-metal cations. Electron microscope studies are under process Carrier-mediated transport across supported liquid membrane where C is the concentration of cation in receiving phase in mol/dm 3 , V is the volume of receiving phase in dm 3 , A is the effective area of membrane in m 2 , and t is the time in seconds. RESULTS AND DISCUSSION Transport studies of metal ion across SLM were carried out by ionophores (M 1 -M 6 ) using cellulose nitrate membrane as a support. Blank experiments were also carried out for transport studies of metal salts in which membrane was devoid of carrier. No leakage of cation in the membrane was noted. The optimum concentration of metal ion and ionophore was found to be 1×10 −1 M and 1×10 −4 M, respectivel

Partial phenotyping in voluntary blood donors of Gujarat State

Introduction: Partial phenotyping of voluntary blood donors has vital role in transfusion practice, population genetic study and in resolving legal issues.The Rh blood group is one of the most complex and highly immunogenic blood group known in humans. The Kell system, discovered in 1946, is the third most potent system at triggering hemolytic transfusion reactions and consists of 25 highly immunogenic antigens. Knowledge of Rh & Kell phenotypes in given population is relevant for better planning and management of blood bank; the main goal is to find compatible blood for patients needing multiple blood transfusions. The aim of this study was to evaluate the frequency of Rh & Kell phenotype of voluntary donors in Gujarat state. Materials and Methods: The present study was conducted by taking 5670 samples from random voluntary blood donors coming in blood donation camp. Written consent was taken for donor phenotyping. The antigen typing of donors was performed by Qwalys-3(manufacturer: Diagast) by using electromagnetic technology on Duolys plates. Results: Out of 5670 donors, the most common Rh antigen observed in the study population was e (99.07%) followed by D (95.40%), C (88.77%), c (55.89%) and E (17.88%). The frequency of the Kell antigen (K) was 1.78 %. Discussion: The antigen frequencies among blood donors from Gujarat were compared with those published for other Indian populations. The frequency of D antigen in our study (95.4%) and north Indian donors (93.6) was significantly higher than in the Caucasians (85%) and lower than in the Chinese (99%). The frequencies of C, c and E antigens were dissimilar to other ethnic groups while the ′e′ antigen was present in high frequency in our study as also in the other ethnic groups. Kell antigen (K) was found in only 101 (1.78 %) donors out of 5670. Frequency of Kell antigen in Caucasian and Black populations is 9% & 2% respectively. The most common Kell phenotype was K-k+, not just in Indians (96.5%) but also in Caucasians (91%), Blacks (98%) and Chinese (100%). Conclusion: Phenotype and probable genotype showed wide range of variations in different races and religion. Reliable population based frequency data of Rh & Kell antigens has vital role in population genetic study, in resolving medico legal issues and in transfusion practice