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

Low-Temperature CO Oxidation Over CuO-TiO2 Nanocatalysts

Among the diverse catalytic processes, the heterogeneous catalytic CO oxidation is an important reaction for removal of small amounts of poisoning CO in fuel cell applications and environmental remediation. Therefore, there is a great need to develop highly active and stable nanocatalysts for catalytic CO oxidation at low temperature. Plasmonic nanocatalysts supported on reducible metal oxide such as CeO2 and TiO2 have been known for their superior catalytic activity at very low temperature but they are expensive and could suffer from particle agglomeration and sintering at high operating temperature (Veith, Lupini et al. 2009). Transition metals supported on reducible metal oxides are good substituents catalysts because of their low cost and wide-use along with activities per unit surface area similar to those of noble metal catalysts. They been shown to possess high oxygen release capacity at high range of temperature and have been shown as good candidate materials for oxygen storage and to provide oxygen for combustion and oxidation reaction at high temperature. (Royer and Duprez 2011; Hedayati, Azad et al. 2012; Song, Liu et al. 2013). In particular, supported CuO nanostructures have received a great deal of attention as non-expensive and non-plasmonic catalysts for oxidation reaction. (Caputo, Lisi et al. 2007; Hornes, Hungria et al. 2009; Royer and Duprez 2011; In, Vaughn et al. 2012; Komarneni, Shan et al. 2012; Chen, Xu et al. 2015; Fang, Xing et al. 2015; Kim and Liu 2015) In this study, we have developed a highly stable and active CuO-TiO2 nanocatalyst that can catalyze the CO oxidation at low temperature window between 80–200°C. The CuO-TiO2 nanocatalysts were prepared by the hydrothermal synthesis of TiO2 nanotubes followed by the deposition precipitation of CuO nanoparticles in alkaline conditions. We first prepared the TiO2 nanotube support by the hydrothermal treatment of TiO2 spherical particles in strong alkaline solution at 140°C. We then synthesized a series of CuO-TiO2 catalysts by deposition precipitation at constant pH, with sodium carbonate as the alkali precipitating agent and different loading ratios of Cu to TiO2 between 2% and 30 wt.%. We studied the morphological and structural properties of prepared nanocatalysts using standard physical techniques including SEM, EDX, TEM, TGA, XRD and XPS in order to understand the structure-property relationship and to optimize their catalytic activity. We carried out multiple catalytic CO oxidation cycles in a continuous flow fixed-bed reactor at low temperature range (25–300°C) and studied the catalytic activity of the different CuO-TiO2 nanocatalysts and their stability under stream. We also studied the effect of shape of the TiO2 support and the effect of the mole ratio of CuO loading on the CO conversion rates. The catalytic activity of the single counterparts of CuO and TiO2 were measured for comparison. The experimental results revealed that the CuO nanoparticles supported on TiO2 nanostructures exhibited higher activity and enhanced CO conversion rates at lower temperature, compared to un-supported CuO nanoparticles. The increased activity at lower activation temperature is probably due to the increased degree of dispersion of the active CuO phase on the TiO2 support as concluded from the EDX mapping study. Moreover, the results showed that the correlation between the catalytic activity of CuO-TiO2 nanocatalysts and both the shape and crystalline phase of the TiO2 support. The CuO supported on TiO2 nanotubes demonstarted enhanced CO conversion rates at lower temperature compared to that supported on TiO2 nanospheres. In all samples the CuO-TiO2 nanocatalysts calcined at 400°C exhibited the anatase phase of the TiO2 nanotubes support and demonstrated higher activity. The results also showed that increasing the Cu to Ti ratio could lower the activation temperature needed for CO to CO2 conversion probably due to the enhanced synergetic effect of the two mixed metal oxides. In addition, the XPS study of the CuO-TiO2 composite oxide structure indicated high degree of oxygen deficiency in CuO-TiO2 nanocatalysts with higher Cu to TiO2 loading and this could result in CO oxidation rates. The prepared CuO-TiO2 nanocatalyst demonstrated a high stability for CO oxidation for test periods of up to 5 h under stream at 200°C. The prepared CuO-TiO2 nanocatalysts could have potential applications in hydrogen purification in fuel cell systems and for CO removal in carbon dioxide lasers and in air quality industries.qscienc

Quinoa Response to Application of Phosphogypsum and Plant Growth-Promoting Rhizobacteria under Water Stress Associated with Salt-Affected Soil

The aim of the study was to estimate the impact of soil amendments (i.e., phosphogypsum and plant growth-promoting rhizobacteria (PGPR)) separately or their combination on exchangeable sodium percentage (ESP), soil enzymes’ activity (urease and dehydrogenase), pigment content, relative water content (RWC), antioxidant enzymatic activity, oxidative stress, productivity, and quality of quinoa under deficient irrigation conditions in two field experiments during the 2019–2020 and 2020–2021 seasons under salt-affected soil. Results revealed that ESP, soil urease activity, soil dehydrogenase activity, leaf chlorophyll a, b, and carotenoids, leaf K content, RWC, SOD (superoxide dismutase), CAT (catalase), and POD (peroxidase) activities were declined, resulting in overproduction of leaf Na content, proline content, and oxidative stress indicators (H2O2, malondialdehyde (MDA) and electrolyte leakage) under water stress and soil salinity, which negatively influence yield-related traits, productivity, and seed quality of quinoa. However, amendment of salt-affected soil with combined phosphogypsum and seed inoculation with PGPR under deficient irrigation conditions was more effective than singular application and control plots in ameliorating the harmful effects of water stress and soil salinity. Additionally, combined application limited Na uptake in leaves and increased K uptake and leaf chlorophyll a, b, and carotenoids as well as improved SOD, CAT, and POD activities to ameliorate oxidative stress indicators (H2O2, MDA, and electrolyte leakage), which eventually positively reflected on productivity and quality in quinoa. We conclude that the potential utilization of phosphogypsum and PGPR are very promising as sustainable eco-friendly strategies to improve quinoa tolerance to water stress under soil salinity

Sowing Date and Genotype Influence on Yield and Quality of Dual-Purpose Barley in a Salt-Affected Arid Region

Dual-purpose barley is an alternative approach to producing high-quality forage yield plus an acceptable grain yield in marginal environments of arid regions that are characterized by lack of forage. Field experiment was performed in two consecutive growing seasons at an arid region affected by salinity in irrigation water and soil at Western Sinai Peninsula in Egypt. The study aimed to optimize sowing date and screen salt-tolerant barley genotypes that perform better in terms of forage yield and quality as well as grain and biomass yield production in salt-affected environment. Sowing dates, genotypes, and their interaction significantly impacted most of the studied variables such as forage yield, crude protein yield, and grain and biomass yields. The early sowing in late October yielded higher than intermediate sowing in mid-November and late sowing in early December. Some of the tested genotypes performed better than others as indicated by about 50% higher forage yield, 6% crude protein content, 39% grain and 21% biological yields (total aboveground dry matter), suggesting higher adaptation capacity. Interestingly, grain and biological yields did not differ significantly between dual-purpose approach and grain-only pattern. In conclusion, dual-purpose barley was found favorable for producing grain and forage production in similar environments under early sowing date

Factors related to time of stroke onset versus time of hospital arrival: A SITS registry-based study in an Egyptian stroke center.

BackgroundHigh-quality data on time of stroke onset and time of hospital arrival is required for proper evaluation of points of delay that might hinder access to medical care after the onset of stroke symptoms.PurposeBased on (SITS Dataset) in Egyptian stroke patients, we aimed to explore factors related to time of onset versus time of hospital arrival for acute ischemic stroke (AIS).Material and methodsWe included 1,450 AIS patients from two stroke centers of Ain Shams University, Cairo, Egypt. We divided the day to four quarters and evaluated relationship between different factors and time of stroke onset and time of hospital arrival. The factors included: age, sex, duration from stroke onset to hospital arrival, type of management, type of stroke (TOAST classification), National Institute of Health Stroke Scale (NIHSS) on admission and favorable outcome modified Rankin Scale (mRS ≤2).ResultsPre-hospital: highest stroke incidence was in the first and fourth quarters. There was no significant difference in the mean age, sex, type of stroke in relation to time of onset. NIHSS was significantly less in onset in third quarter of the day. Percentage of patients who received thrombolytic therapy was higher with onset in the first 2 quarters of the day (p = ConclusionPre-hospital factors still need adjustment to improve percentage of thrombolysis, while in-hospital factors showed consistent performance

Aspergillus Niger thermostable Cytosine deaminase-dextran conjugates with enhanced structure stability, proteolytic resistance, and Antiproliferative activity

Abstract Cytosine deaminase (CDA) is a prodrug mediating enzyme converting 5-flurocytosine into 5-flurouracil with profound broad-range anticancer activity towards various cell lines. Availability, molecular stability, and catalytic efficiency are the main limiting factors halting the clinical applications of this enzyme on prodrug and gene therapies, thus, screening for CDA with unique biochemical and catalytic properties was the objective. Thermotolerant/ thermophilic fungi could be a distinctive repertoire for enzymes with affordable stability and catalytic efficiency. Among the recovered thermotolerant isolates, Aspergillus niger with optimal growth at 45 °C had the highest CDA productivity. The enzyme was purified, with purification 15.4 folds, molecular mass 48 kDa and 98 kDa, under denaturing and native PAGE, respectively. The purified CDA was covalently conjugated with dextran with the highest immobilization yield of 75%. The free and CDA-dextran conjugates have the same optimum pH 7.4, reaction temperature 37 °C, and pI 4.5, and similar response to the inhibitors and amino acids suicide analogues, ensuring the lack of effect of dextran conjugation on the CDA conformational structure. CDA-Dextran conjugates had more resistance to proteolysis in response to proteinase K and trypsin by 2.9 and 1.5 folds, respectively. CDA-Dextran conjugates displayed a dramatic structural and thermal stability than the free enzyme, authenticating the acquired structural and catalytic stability upon dextran conjugation. The thermal stability of CDA was increased by about 1.5 folds, upon dextran conjugation, as revealed from the half-life time (T 1/2 ). The affinity of CDA-conjugates (K m 0.15 mM) and free CDA (K m 0.22 mM) to deaminate 5-fluorocytosine was increased by 1.5 folds. Upon dextran conjugation, the antiproliferative activity of the CDA towards the different cell lines “MDA-MB, HepG-2, and PC-3” was significantly increased by mediating the prodrug 5-FC. The CDA-dextran conjugates strongly reduce the tumor size and weight of the Ehrlich cells (EAC), dramatically increase the titers of Caspase-independent apoptotic markers PARP-1 and AIF, with no cellular cytotoxic activity, as revealed from the hematological and biochemical parameters

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

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\ub75%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31\ub72%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10\ub72%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12\ub73%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9\ub74%] of 7339 patients), middle (549 [14\ub70%] of 3918 patients), and low (298 [23\ub72%] of 1282) HDI (p&lt;0\ub7001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17\ub78%] of 574 patients in high-HDI countries; 74 [31\ub74%] of 236 patients in middle-HDI countries; 72 [39\ub78%] 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\ub760, 95% credible interval 1\ub705\u20132\ub737; p=0\ub7030). 132 (21\ub76%) 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\ub76%) of 295 patients in high-HDI countries, in 37 (19\ub78%) of 187 patients in middle-HDI countries, and in 46 (35\ub79%) of 128 patients in low-HDI countries (p&lt;0\ub7001). 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. Funding: DFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant, National Institute of Health Research Global Health Research Unit Grant