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

JPN Guidelines for the management of acute pancreatitis: epidemiology, etiology, natural history, and outcome predictors in acute pancreatitis

Acute pancreatitis is a common disease with an annual incidence of between 5 and 80 people per 100 000 of the population. The two major etiological factors responsible for acute pancreatitis are alcohol and cholelithiasis (gallstones). The proportion of patients with pancreatitis caused by alcohol or gallstones varies markedly in different countries and regions. The incidence of acute alcoholic pancreatitis is considered to be associated with high alcohol consumption. Although the incidence of alcoholic pancreatitis is much higher in men than in women, there is no difference in sexes in the risk involved after adjusting for alcohol intake. Other risk factors include endoscopic retrograde cholangiopancreatography, surgery, therapeutic drugs, HIV infection, hyperlipidemia, and biliary tract anomalies. Idiopathic acute pancreatitis is defined as acute pancreatitis in which the etiological factor cannot be specified. However, several studies have suggested that this entity includes cases caused by other specific disorders such as microlithiasis. Acute pancreatitis is a potentially fatal disease with an overall mortality of 2.1%–7.8%. The outcome of acute pancreatitis is determined by two factors that reflect the severity of the illness: organ failure and pancreatic necrosis. About half of the deaths in patients with acute pancreatitis occur within the first 1–2 weeks and are mainly attributable to multiple organ dysfunction syndrome (MODS). Depending on patient selection, necrotizing pancreatitis develops in approximately 10%–20% of patients and the mortality is high, ranging from 14% to 25% of these patients. Infected pancreatic necrosis develops in 30%–40% of patients with necrotizing pancreatitis and the incidence of MODS in such patients is high. The recurrence rate of acute pancreatitis is relatively high: almost half the patients with acute alcoholic pancreatitis experience a recurrence. When the gallstones are not treated, the risk of recurrence in gallstone pancreatitis ranges from 32% to 61%. After recovering from acute pancreatitis, about one-third to one-half of acute pancreatitis patients develop functional disorders, such as diabetes mellitus and fatty stool; the incidence of chronic pancreatitis after acute pancreatitis ranges from 3% to 13%. Nevertheless, many reports have shown that most patients who recover from acute pancreatitis regain good general health and return to their usual daily routine. Some authors have emphasized that endocrine function disorders are a common complication after severe acute pancreatitis has been treated by pancreatic resection

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

Ar Ion Irradiation Effects on the Characteristics of Ru|Pt|n-GaN Schottky Barrier Diodes

The present study reports the effects of 650-keV Ar2+ ion irradiation on the structural, optical, and device characteristics of Ru|Pt|n-GaN Schottky barrier diodes (SBDs). Ion irradiation induces the broadening of the GaN X-ray diffraction peaks due to induced structural deformities. The photoluminescence spectroscopy intensity decreases with the increase in the fluence of ions. The recombination of charge carriers induced by the geometrical distortions, and the formation of defects states, shifts the peak positions to shorter wavelengths. The electrical characteristics of these devices exhibit significant changes due to modification at the interface and charge transport properties after Ar2+ ion irradiation. The charge-transport properties are affected by these deformities at higher fluences and attributed to the contributions of various current conduction mechanisms, including defect-assisted tunnelling and generation-recombination (G-R) currents along with thermionic emission

Synchronous twin track percutaneous nephrolithotomy: A preliminary experience

Percutaneous nephrolithotripsy is the treatment of choice for large renal calculi. Total stone clearance as the treatment goal remains elusive, despite staged procedures and multiple tracks. There is also the morbidity of multiple sittings and tracks. We investigated the feasibility of a synchronized approach to clearing these difficult stones with two teams operating through two or more tracks in tandem and also the ergonomic and logistic issues involved

Effect of particle shape on the mechanical response of a granular ensemble

The mechanical behaviour of a granular ensemble at a macro scale is an integration of the interparticle interactions. Even though manifold parameters at multiple length scales govern the behaviour of granular materials, particle shape and size are considered paramount in governing the ensemble level mechanical response such as the strength, stiffness and packing fraction (e(max), e(min)), friction angle etc. In this research programme, an experimental study using hollow cylinder apparatus is undertaken in order to study the effect of particle shape on the ensemble material behaviour. Two model materials are chosen for these series of experiments - angular sand and spherical glass ballotini. The mean grain size of both sand and glass ballotini used in this study is 0.5 mm. Also the specimens are prepared at a relative density of 30% using the same preparation technique, ensuring almost similar initial fabric. These specimens are subjected to a gamut of stresses by varying the intermediate principal stress ratio (b) such that the critical state surface (or yield locus) could be traced on an octahedral plane (in the principal stress space). The angular particles showed increased critical state strength when compared to the glass ballotini at different intermediate principal stress ratio. The volume change in the angular sand particles are seen to be mostly contractive, while at the same relative density, the glass ballotini showed a dilative response. Finally, the particle shape controls the size of the critical state locus on the octahedral plane, in that, the angular particles show an increased size when compared to the spherical particles

Origin of microscopically coupled ferromagnetic Cu-ions in a distorted system of Cu-doped ZnO and their synchrotron-based electronic structures

Spintronics-based studies have produced significant attention in the last decade while claiming the observation of room temperature ferromagnetism (RTFM). Nevertheless, there is a lack of consensus on a mechanism responsible for this phenomenon. In this study, we focus on Cu-doped ZnO (ZCO) to understand the microscopic origin of RTFM and the role of different oxidation states of Cu in RTFM. We have performed different spectroscopic techniques using synchrotron facilities. The values of spin-moment obtained from x-ray magnetic circular dichroism sum-rule truly exhibit a ferromagnetic interaction in the nanocrystalline powder of ZCO with ∼0.58 μB for 5% of Cu concentration in the total fluorescence yield mode. Such an enhanced magnetization is attributed to the presence of Cu2+, which is mainly localized in the bulk region. Cu in ZCO is mostly dominated by the presence of Cu2+. This is clearly reflected by the profiles of x-ray photoemission spectroscopy. Consequently, the weakly magnetized total electron yield mode is attributed to a state of magnetic frustration as the majority of Cu3+ is found on the surface. Some of these Cu3+ when come in the vicinity of Cu2+ ions result in a highly correlated state of double exchange mechanism, which is the microscopic origin of RTFM in ZCO. The coupling between Cu2+-Cu3+ is mediated via oxygen vacancies (VO), the presence of which is confirmed through the features of electron energy loss spectroscopy over different edges. The confirmation of VO is also supported by the deconvolution of E2high-phonon in the Raman spectra. Moreover, the defects in the local electronic structures of ZCO are demonstrated by the deconvoluted spectra of Cu L3 x-ray absorption spectroscopy. The images obtained from high-resolution transmission electron microscopy confirm the incorporation of Cu into the wurtzite crystal of ZnO. A clear enhancement in magnetization upon an increase in carriers of Cu in ZCO indicates carrier-induced ferromagnetism. Cu2+ and VO are the two attributes of RTFM in ZCO