1
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Nielsen RT, Andersen CØ, Schønheyder HC, Petersen JH, Knudsen JD, Jarløv JO, Norredam M. Differences in the distribution of pathogens and antimicrobial resistance in bloodstream infections in migrants compared with non-migrants in Denmark. Infect Dis (Lond) 2023; 55:165-174. [PMID: 36548010 DOI: 10.1080/23744235.2022.2151643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND We wish to study disparities in bloodstream infections in migrants and non-migrants by comparing the distribution of pathogens and their resistance patterns in long-term migrants with that in non-migrants in Denmark. METHODS The study is based on a cohort of migrants, who received residency in Denmark between 1993 and 2015 and a control group of non-migrants. The cohort was linked to a database of bloodstream infections from 2000 to 2015 covering two regions in Denmark. First-time bloodstream infections in individuals ≥18 years of age at the time of sampling were included. We calculated odds ratios adjusted for age, sex, year of sampling, comorbidity, and place of acquisition (hospital- or community-acquired). RESULTS We identified 4,703 bloodstream infection cases. Family-reunified migrants and refugees had higher odds of Escherichia coli than non-migrants (OR 1.89 95%CI: 1.46-2.44 and OR 1.55 95%CI: 1.25-1.92) and lower odds of Streptococcus pneumoniae (OR 0.38 95%CI: 0.21-0.67 and OR 0.52 95%CI: 0.34-0.81). Differences in pathogen distribution were only prevalent in community-acquired bloodstream infections. Refugees had higher odds of Escherichia coli resistant to piperacillin-tazobactam, ciprofloxacin, and gentamicin compared with non-migrants. Family-reunified migrants had higher odds of Escherichia coli and other Enterobacterales resistant to ciprofloxacin. CONCLUSIONS Migrants had a higher proportion of community-acquired bloodstream infections with Escherichia coli as well as higher odds of bloodstream infections with resistant Escherichia coli compared with non-migrants. These novel results are relevant for improving migrant health by focussing on preventing and treating infections especially with Escherichia coli such as urinary tract and abdominal infections.
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Affiliation(s)
- Rikke Thoft Nielsen
- Department of Clinical Microbiology, Copenhagen University Hospital - Amager Hvidovre, Hvidovre, Denmark.,Research Centre for Migration, Ethnicity and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Jørgen Holm Petersen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | | | - Jens Otto Jarløv
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Marie Norredam
- Research Centre for Migration, Ethnicity and Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital - Amager Hvidovre, Hvidovre, Denmark
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2
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Maund M, Gray J. Experience of multi-drug-resistant bacterial screening of Ukrainian refugee paediatric cancer patients arriving in England. J Hosp Infect 2023; 133:107-108. [PMID: 36473556 DOI: 10.1016/j.jhin.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Affiliation(s)
- M Maund
- Birmingham Women's & Children's NHS Foundation Trust, Birmingham, UK
| | - J Gray
- Birmingham Women's & Children's NHS Foundation Trust, Birmingham, UK.
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3
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Lemoine JP, Pasquier C, Rabier V, Binder AM, Auffray Y, de Gentile L, Eveillard M. Colonization with extended-spectrum beta-lactamase-producing Enterobacteriaceae in unaccompanied refugee minors on arrival in France. J Travel Med 2022; 29:6591168. [PMID: 35608400 DOI: 10.1093/jtm/taac064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/26/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022]
Abstract
In a prospective observational study, we recorded that 25.7% of 139 unaccompanied migrant minors arriving in Angers, Western France were colonized with extended-spectrum β-lactamase producing Enterobacteriaceae (ESBL-PE). Concurrently, we highlighted that some minors had acquired ESBL-PE after their arrival in France.
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Affiliation(s)
| | | | - Valérie Rabier
- Service de médecine interne, Maladies Infectieuses, Saint-Brieuc, France
| | | | - Yseult Auffray
- Département de Biologie des Agents Infectieux, CHU, Angers, France
| | | | - Matthieu Eveillard
- Département de Biologie des Agents Infectieux, CHU, Angers, France.,Univ Angers, Nantes Université, CHU Angers, Inserm, CNRS, INCIT, Angers, France
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4
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Pfeil J, Assaad K, von Both U, Janda A, Kitz C, Kobbe R, Kunze M, Lindert J, Ritz N, Trapp S, Hufnagel M. [Updated recommendations on the treatment of infectious diseases in refugees in childhood and adolescence in Germany (situation as of 30 March 2022), registered as S1 guidelines (AWMF-Register Nr. 048-017)]. Monatsschr Kinderheilkd 2022; 170:632-647. [PMID: 35645410 PMCID: PMC9130691 DOI: 10.1007/s00112-022-01499-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 11/08/2022]
Abstract
Background Based on 190,000 applications for asylum, Germany remains a top destination for refugees and asylum seekers in Europe. The updated recommendations are considered evidence-based and targeted guidelines for the diagnosis and prevention of infectious diseases in underage refugees and asylum seekers. Objective The objective of these recommendations is to guide medical staff in the care of minor refugees, in particular to:1. assure early recognition and completion of incomplete vaccination status,2. diagnose and treat common infectious diseases,3. recognize and treat imported infectious diseases that are considered uncommon to the German healthcare system. Material and methods The recommendations have been formally written to be published as AWMF S1 guidelines.This includes a representative expert panel appointed by several professional societies, and formal adoption of the recommendations by the board of directors of all societies concerned. Results Recommendations are given for the medical evaluation of minor refugees, including medical history and physical examination. A blood count as well as screening for tuberculosis and hepatitis B should be offered to all minor refugees. In addition, screening for other infectious diseases like hepatitis C, HIV or schistosomiasis should be considered depending on age and country of origin. Vaccinations are recommended based on both age and country of origin. Conclusion As thousands of minor refugees continue to seek shelter in Germany every year, professional health care with adequate financial support needs to be established to ensure an appropriate medical treatment of this particularly vulnerable population.
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Affiliation(s)
- Johannes Pfeil
- Kinder- und Hausarztpraxis im Ärztehaus, Schnellerstr. 2, 74193 Schwaigern, Deutschland
| | - Kholoud Assaad
- Gesundheitsamt Rhein-Neckar Kreis, Kurfürsten-Anlage 38–40, 69115 Heidelberg, Deutschland
| | - BVÖGD
- Kinder- und Hausarztpraxis im Ärztehaus, Schnellerstr. 2, 74193 Schwaigern, Deutschland
- Gesundheitsamt Rhein-Neckar Kreis, Kurfürsten-Anlage 38–40, 69115 Heidelberg, Deutschland
- Abteilung für Pädiatrische Infektiologie, Dr. von Haunersches Kinderspital, Lindwurmstr. 4, 80337 München, Deutschland
- Universitätsklinik für Kinder- und Jugendmedizin, Eythstr. 24, 89075 Ulm, Deutschland
- Praxis für Kinder- und Jugendmedizin, Erwin-Vornberger-Platz 2, 97209 Veitshöchheim, Deutschland
- Zentrum für Innere Medizin, Institut für Infektionsforschung und Impfstoffentwicklung, STAKOB, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Deutschland
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106 Freiburg, Deutschland
- Klinik für Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Deutschland
- Kinderspital, Luzerner Kantonsspital, Spitalstr., 6000 Luzern 16, Schweiz
- Praxis für Kinder- und Jugendmedizin, Huchtinger Heerstr. 26, 28259 Bremen, Deutschland
- Abteilung Pädiatrische Infektiologie und Rheumatologie, Klinik für Allgemeine Pädiatrie und Jugendmedizin, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Mathildenstr. 1, 79106 Freiburg, Deutschland
| | - Ulrich von Both
- Abteilung für Pädiatrische Infektiologie, Dr. von Haunersches Kinderspital, Lindwurmstr. 4, 80337 München, Deutschland
| | - DAKJ/Bündnis Kinder- und Jugendgesundheit
- Kinder- und Hausarztpraxis im Ärztehaus, Schnellerstr. 2, 74193 Schwaigern, Deutschland
- Gesundheitsamt Rhein-Neckar Kreis, Kurfürsten-Anlage 38–40, 69115 Heidelberg, Deutschland
- Abteilung für Pädiatrische Infektiologie, Dr. von Haunersches Kinderspital, Lindwurmstr. 4, 80337 München, Deutschland
- Universitätsklinik für Kinder- und Jugendmedizin, Eythstr. 24, 89075 Ulm, Deutschland
- Praxis für Kinder- und Jugendmedizin, Erwin-Vornberger-Platz 2, 97209 Veitshöchheim, Deutschland
- Zentrum für Innere Medizin, Institut für Infektionsforschung und Impfstoffentwicklung, STAKOB, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Deutschland
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106 Freiburg, Deutschland
- Klinik für Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Deutschland
- Kinderspital, Luzerner Kantonsspital, Spitalstr., 6000 Luzern 16, Schweiz
- Praxis für Kinder- und Jugendmedizin, Huchtinger Heerstr. 26, 28259 Bremen, Deutschland
- Abteilung Pädiatrische Infektiologie und Rheumatologie, Klinik für Allgemeine Pädiatrie und Jugendmedizin, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Mathildenstr. 1, 79106 Freiburg, Deutschland
| | - Aleš Janda
- Universitätsklinik für Kinder- und Jugendmedizin, Eythstr. 24, 89075 Ulm, Deutschland
| | - Christa Kitz
- Praxis für Kinder- und Jugendmedizin, Erwin-Vornberger-Platz 2, 97209 Veitshöchheim, Deutschland
| | - Robin Kobbe
- Zentrum für Innere Medizin, Institut für Infektionsforschung und Impfstoffentwicklung, STAKOB, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Deutschland
| | - GTP
- Kinder- und Hausarztpraxis im Ärztehaus, Schnellerstr. 2, 74193 Schwaigern, Deutschland
- Gesundheitsamt Rhein-Neckar Kreis, Kurfürsten-Anlage 38–40, 69115 Heidelberg, Deutschland
- Abteilung für Pädiatrische Infektiologie, Dr. von Haunersches Kinderspital, Lindwurmstr. 4, 80337 München, Deutschland
- Universitätsklinik für Kinder- und Jugendmedizin, Eythstr. 24, 89075 Ulm, Deutschland
- Praxis für Kinder- und Jugendmedizin, Erwin-Vornberger-Platz 2, 97209 Veitshöchheim, Deutschland
- Zentrum für Innere Medizin, Institut für Infektionsforschung und Impfstoffentwicklung, STAKOB, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Deutschland
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106 Freiburg, Deutschland
- Klinik für Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Deutschland
- Kinderspital, Luzerner Kantonsspital, Spitalstr., 6000 Luzern 16, Schweiz
- Praxis für Kinder- und Jugendmedizin, Huchtinger Heerstr. 26, 28259 Bremen, Deutschland
- Abteilung Pädiatrische Infektiologie und Rheumatologie, Klinik für Allgemeine Pädiatrie und Jugendmedizin, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Mathildenstr. 1, 79106 Freiburg, Deutschland
| | - Mirjam Kunze
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106 Freiburg, Deutschland
| | - DGGG
- Kinder- und Hausarztpraxis im Ärztehaus, Schnellerstr. 2, 74193 Schwaigern, Deutschland
- Gesundheitsamt Rhein-Neckar Kreis, Kurfürsten-Anlage 38–40, 69115 Heidelberg, Deutschland
- Abteilung für Pädiatrische Infektiologie, Dr. von Haunersches Kinderspital, Lindwurmstr. 4, 80337 München, Deutschland
- Universitätsklinik für Kinder- und Jugendmedizin, Eythstr. 24, 89075 Ulm, Deutschland
- Praxis für Kinder- und Jugendmedizin, Erwin-Vornberger-Platz 2, 97209 Veitshöchheim, Deutschland
- Zentrum für Innere Medizin, Institut für Infektionsforschung und Impfstoffentwicklung, STAKOB, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Deutschland
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106 Freiburg, Deutschland
- Klinik für Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Deutschland
- Kinderspital, Luzerner Kantonsspital, Spitalstr., 6000 Luzern 16, Schweiz
- Praxis für Kinder- und Jugendmedizin, Huchtinger Heerstr. 26, 28259 Bremen, Deutschland
- Abteilung Pädiatrische Infektiologie und Rheumatologie, Klinik für Allgemeine Pädiatrie und Jugendmedizin, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Mathildenstr. 1, 79106 Freiburg, Deutschland
| | - Judith Lindert
- Klinik für Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Deutschland
| | - DGKCH
- Kinder- und Hausarztpraxis im Ärztehaus, Schnellerstr. 2, 74193 Schwaigern, Deutschland
- Gesundheitsamt Rhein-Neckar Kreis, Kurfürsten-Anlage 38–40, 69115 Heidelberg, Deutschland
- Abteilung für Pädiatrische Infektiologie, Dr. von Haunersches Kinderspital, Lindwurmstr. 4, 80337 München, Deutschland
- Universitätsklinik für Kinder- und Jugendmedizin, Eythstr. 24, 89075 Ulm, Deutschland
- Praxis für Kinder- und Jugendmedizin, Erwin-Vornberger-Platz 2, 97209 Veitshöchheim, Deutschland
- Zentrum für Innere Medizin, Institut für Infektionsforschung und Impfstoffentwicklung, STAKOB, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Deutschland
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106 Freiburg, Deutschland
- Klinik für Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Deutschland
- Kinderspital, Luzerner Kantonsspital, Spitalstr., 6000 Luzern 16, Schweiz
- Praxis für Kinder- und Jugendmedizin, Huchtinger Heerstr. 26, 28259 Bremen, Deutschland
- Abteilung Pädiatrische Infektiologie und Rheumatologie, Klinik für Allgemeine Pädiatrie und Jugendmedizin, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Mathildenstr. 1, 79106 Freiburg, Deutschland
| | - Nicole Ritz
- Kinderspital, Luzerner Kantonsspital, Spitalstr., 6000 Luzern 16, Schweiz
| | - PIGS
- Kinder- und Hausarztpraxis im Ärztehaus, Schnellerstr. 2, 74193 Schwaigern, Deutschland
- Gesundheitsamt Rhein-Neckar Kreis, Kurfürsten-Anlage 38–40, 69115 Heidelberg, Deutschland
- Abteilung für Pädiatrische Infektiologie, Dr. von Haunersches Kinderspital, Lindwurmstr. 4, 80337 München, Deutschland
- Universitätsklinik für Kinder- und Jugendmedizin, Eythstr. 24, 89075 Ulm, Deutschland
- Praxis für Kinder- und Jugendmedizin, Erwin-Vornberger-Platz 2, 97209 Veitshöchheim, Deutschland
- Zentrum für Innere Medizin, Institut für Infektionsforschung und Impfstoffentwicklung, STAKOB, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Deutschland
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106 Freiburg, Deutschland
- Klinik für Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Deutschland
- Kinderspital, Luzerner Kantonsspital, Spitalstr., 6000 Luzern 16, Schweiz
- Praxis für Kinder- und Jugendmedizin, Huchtinger Heerstr. 26, 28259 Bremen, Deutschland
- Abteilung Pädiatrische Infektiologie und Rheumatologie, Klinik für Allgemeine Pädiatrie und Jugendmedizin, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Mathildenstr. 1, 79106 Freiburg, Deutschland
| | - Stefan Trapp
- Praxis für Kinder- und Jugendmedizin, Huchtinger Heerstr. 26, 28259 Bremen, Deutschland
| | - Markus Hufnagel
- Abteilung Pädiatrische Infektiologie und Rheumatologie, Klinik für Allgemeine Pädiatrie und Jugendmedizin, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Mathildenstr. 1, 79106 Freiburg, Deutschland
| | - DGKJ
- Kinder- und Hausarztpraxis im Ärztehaus, Schnellerstr. 2, 74193 Schwaigern, Deutschland
- Gesundheitsamt Rhein-Neckar Kreis, Kurfürsten-Anlage 38–40, 69115 Heidelberg, Deutschland
- Abteilung für Pädiatrische Infektiologie, Dr. von Haunersches Kinderspital, Lindwurmstr. 4, 80337 München, Deutschland
- Universitätsklinik für Kinder- und Jugendmedizin, Eythstr. 24, 89075 Ulm, Deutschland
- Praxis für Kinder- und Jugendmedizin, Erwin-Vornberger-Platz 2, 97209 Veitshöchheim, Deutschland
- Zentrum für Innere Medizin, Institut für Infektionsforschung und Impfstoffentwicklung, STAKOB, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Deutschland
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106 Freiburg, Deutschland
- Klinik für Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Deutschland
- Kinderspital, Luzerner Kantonsspital, Spitalstr., 6000 Luzern 16, Schweiz
- Praxis für Kinder- und Jugendmedizin, Huchtinger Heerstr. 26, 28259 Bremen, Deutschland
- Abteilung Pädiatrische Infektiologie und Rheumatologie, Klinik für Allgemeine Pädiatrie und Jugendmedizin, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Mathildenstr. 1, 79106 Freiburg, Deutschland
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5
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Najem S, Eick D, Boettcher J, Aigner A, Aboutara M, Fenner I, Reinshagen K, Koenigs I. High prevalence of multidrug-resistant Gram-negative bacteria carriage in children screened prospectively for multidrug resistant organisms at admission to a paediatric hospital, Hamburg, Germany, September 2018 to May 2019. Euro Surveill 2022; 27. [PMID: 35426366 PMCID: PMC9012092 DOI: 10.2807/1560-7917.es.2022.27.15.2001567] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background
Increasing resistance to antibiotics poses medical challenges worldwide. Prospective data on carriage prevalence of multidrug resistant organisms (MDRO) in children at hospital admission are limited and associated risk factors are poorly defined.
Aim
To determine prevalence of MDRO carriage in children at admission to our paediatric hospital in Hamburg and to identify MDRO carriage risk factors.
Methods
We prospectively obtained and cultured nasal/throat and inguinal/anal swabs from children (≤ 18 years) at admission between September 2018 and May 2019 to determine prevalence of meticillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant Gram-negative bacteria (MRGN) and vancomycin-resistant enterococcus (VRE) and associated species. We collected medical histories using a questionnaire and evaluated 31 risk factors using logistic regression models.
Results
MDRO carriage prevalence of 3,964 children was 4.31% (95% confidence interval (CI): 3.69–5.00). MRSA carriage prevalence was 0.68% (95% CI: 0.44–0.99), MRGN prevalence was 3.64% (95% CI: 3.07–4.28) and VRE prevalence 0.08% (95% CI: 0.02–0.22). MDRO carriage was associated with MRGN history (odds ratio (OR): 6.53; 95% CI: 2.58–16.13), chronic condition requiring permanent care (OR: 2.67; 95% CI: 1.07–6.13), antibiotic therapy (OR: 1.92, 95% CI: 1.24–2.94), living in a care facility (OR: 3.34; 95% CI: 0.72–12.44) and refugee status in previous 12 months (OR: 1.91; 95% CI: 0.27–8.02). Compared to established practice, screening using risk-factors had better diagnostic sensitivity (86.13%; 95% CI: 80.89–91.40) and specificity (73.54%; 95% CI: 72.12–74.97).
Conclusion
MRGN carriage was higher than MRSA and VRE. Extended risk-factor-based admission screening system seems warranted.
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Affiliation(s)
- Safiullah Najem
- Department of Paediatric Surgery, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Paediatric Surgery, Altona Children's Hospital, Hamburg, Germany
| | - Dorothée Eick
- Department of Paediatric Surgery, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Paediatric Surgery, Altona Children's Hospital, Hamburg, Germany
| | - Johannes Boettcher
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Annette Aigner
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Biometry and Clinical Epidemiology, Charité – Universitaetsmedizin Berlin, Berlin, Germany
| | - Mona Aboutara
- Department of General Paediatrics, Altona Children's Hospital, Hamburg, Germany
| | - Ines Fenner
- Laboratory Dr. Fenner and colleagues, Hamburg, Germany
| | - Konrad Reinshagen
- Department of Paediatric Surgery, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Paediatric Surgery, Altona Children's Hospital, Hamburg, Germany
| | - Ingo Koenigs
- Department of Paediatric Surgery, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Paediatric Surgery, Altona Children's Hospital, Hamburg, Germany
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6
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Osman M, Rafei R, Ismail MB, Omari SA, Mallat H, Dabboussi F, Cazer C, Karah N, Abbara A, Hamze M. Antimicrobial resistance in the protracted Syrian conflict: halting a war in the war. Future Microbiol 2021; 16:825-845. [PMID: 34223789 DOI: 10.2217/fmb-2021-0040] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The Syrian conflict has damaged key infrastructure and indirectly affected almost all parts of the Middle East and Europe, with no end in sight. Exhausting conditions created by the Syrian crisis and related massive displacement promote the emergence of numerous public health problems that fuel antimicrobial resistance (AMR) development. Here, we explore the current situation of the Syrian displaced population, and AMR inside Syria and among refugees in host countries. We then suggest a roadmap of selected key interventions and strategies to address the threat of AMR in the context of the Syrian crisis. These recommendations are intended to urge health policy-makers in governments and international health organizations to optimize and push for implementing an effective policy taking into consideration the current obstacles.
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Affiliation(s)
- Marwan Osman
- Laboratoire Microbiologie, Santé et Environnement (LMSE), Doctoral School of Sciences & Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon.,Department of Population Medicine & Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14850, USA
| | - Rayane Rafei
- Laboratoire Microbiologie, Santé et Environnement (LMSE), Doctoral School of Sciences & Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Mohamad Bachar Ismail
- Laboratoire Microbiologie, Santé et Environnement (LMSE), Doctoral School of Sciences & Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon.,Faculty of Sciences, Lebanese University, Tripoli, Lebanon
| | - Sarah Al Omari
- Department of Epidemiology & Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Hassan Mallat
- Laboratoire Microbiologie, Santé et Environnement (LMSE), Doctoral School of Sciences & Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Fouad Dabboussi
- Laboratoire Microbiologie, Santé et Environnement (LMSE), Doctoral School of Sciences & Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Casey Cazer
- Department of Population Medicine & Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14850, USA
| | - Nabil Karah
- Department of Molecular Biology, Umeå Centre for Microbial Research, Umeå University, Umeå, Sweden
| | - Aula Abbara
- Department of Infection, Imperial College, London, UK
| | - Monzer Hamze
- Laboratoire Microbiologie, Santé et Environnement (LMSE), Doctoral School of Sciences & Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
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7
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Hertting O, Luthander J, Giske CG, Bennet R, Eriksson M. Acute infection as cause of hospitalization of asylum-seeking children and adolescents in Stockholm, Sweden 2015-2016. Eur J Pediatr 2021; 180:893-898. [PMID: 32974759 PMCID: PMC7886722 DOI: 10.1007/s00431-020-03795-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 07/04/2020] [Accepted: 08/26/2020] [Indexed: 11/27/2022]
Abstract
We aimed to identify hospitalizations due to infectious diseases among asylum seekers and compare them to those of the resident population 1.6.2015-31.10.2016. Administrative numbers assigned to hospitalized non-resident children made them identifiable in the discharge register. The examined populations, expressed as person-years, were 334,573 residents and 7565 asylum seekers. There were 2500 episodes of infectious disease in 2240 resident children and 139 episodes in 121 asylum seekers. Among prevalent infections contracted before or during migration, there were 33 cases of tuberculosis, four of malaria, and one of louse-borne relapsing fever, all of which occurred in 13-17-year-old unaccompanied minors. Among younger asylum seekers, there were no significant differences in the spectrum of infectious discharge diagnoses compared to residents, but across all incident infections, 0-6-year-old asylum seekers had 3.2-fold and 7-12-year-old a 4.7-fold greater risk of being admitted. Screening for multidrug-resistant bacteria showed that 45/160 (28%) of the asylum seekers were colonized, but clinical infections caused by these species were rare.Conclusion: There was a high rate of hospitalizations for acute infectious diseases in asylum-seeking children, but the spectrum and severity of infections were similar to that in resident children. What is known: • Mental and physical health problems are common in immigrant children and adolescents. What is new: • Hospitalizations due to acute infections in asylum-seeking children and adolescents are common. In the context of this study, the severity and spectrum of infectious diseases seemed to be the same in the two groups; the increased hospitalization rate in asylum seekers may be due to social factors and perceived need for more support.
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Affiliation(s)
- Olof Hertting
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden. .,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Joachim Luthander
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden ,Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Christian G. Giske
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden ,Division of Clinical microbiology, Department of Laboratory medicine, Karolinska Institutet, Stockholm, Sweden
| | - Rutger Bennet
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Margareta Eriksson
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
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8
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Bartels MD, Worning P, Andersen LP, Bes M, Enger H, Ås CG, Hansen TA, Holzknecht BJ, Larssen KW, Laurent F, Mäkitalo B, Pichon B, Svartström O, Westh H. Repeated introduction and spread of the MRSA clone t304/ST6 in northern Europe. Clin Microbiol Infect 2020; 27:284.e1-284.e5. [PMID: 32439595 DOI: 10.1016/j.cmi.2020.05.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/13/2020] [Accepted: 05/03/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES During the last decades several methicillin-resistant Staphylococcus aureus (MRSA) clones with the capability of global spread have emerged in the community. Here, we have investigated a large collection of clinical isolates belonging to MRSA clone t304/ST6, which has emerged in many European countries over the last years, in order to retrace its phylogeny and its spread. METHODS We characterized 466 ST6 isolates from Denmark (n = 354), France (n = 10), Norway (n = 24), Sweden (n = 27) and the UK (n = 51). All had spa-type t304 (n = 454) or t304-related spa-types (n = 12) and whole genome sequencing (WGS) was carried out on Illumina Miseq or Hiseq with 100-300 bp reads. cgMLST was performed using Ridom SeqSphere. RESULTS A minimum spanning tree (MST) of all 466 isolates showed one large cluster including 182 isolates collected only from Denmark and related to a long-term neonatal outbreak in Copenhagen. This cluster contrasted with numerous small clusters, including the remaining Danish isolates and isolates from the other countries that interspersed throughout the tree. Most isolates were Panton-Valentine leukocidin (PVL) negative (95%) and harboured SCCmec IVa. One genome was closed using Oxford Nanopore technology and Illumina MiSeq. It contained a plasmid of 19.769 bp including the blaZ gene. A similar plasmid was found in 78% of all isolates. DISCUSSION t304/ST6 is a successful emerging clone and the fact that isolates from five countries are interspersed throughout the MST indicates a common origin. This clone is commonly described in the Middle East and its emergence in Europe coincides with influx of refugees from the Syrian Civil War.
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Affiliation(s)
- M D Bartels
- Department of Clinical Microbiology, MRSA Knowledge Centre, Hvidovre Hospital, Denmark.
| | - P Worning
- Department of Clinical Microbiology, MRSA Knowledge Centre, Hvidovre Hospital, Denmark
| | - L P Andersen
- Department of Clinical Microbiology, Rigshospitalet, Denmark
| | - M Bes
- Institute for Infectious Agents - Department of Bacteriology, French National Reference Centre for Staphylococci, Lyon, France
| | - H Enger
- Norwegian MRSA Reference Laboratory, Department of Medical Microbiology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - C G Ås
- Norwegian MRSA Reference Laboratory, Department of Medical Microbiology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - T A Hansen
- Department of Clinical Microbiology, MRSA Knowledge Centre, Hvidovre Hospital, Denmark
| | - B J Holzknecht
- Department of Clinical Microbiology, Herlev Gentofte Hospital, Denmark
| | - K W Larssen
- Department of Medical Microbiology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - F Laurent
- Institute for Infectious Agents - Department of Bacteriology, French National Reference Centre for Staphylococci, Lyon, France
| | - B Mäkitalo
- Public Health Agency of Sweden, Solna, Sweden
| | - B Pichon
- Public Health England, National Infection Service, London, UK
| | | | - H Westh
- Department of Clinical Microbiology, MRSA Knowledge Centre, Hvidovre Hospital, Denmark; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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9
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Abd El Ghany M, Fouz N, Hill-Cawthorne GA. Human Movement and Transmission of Antimicrobial-Resistant Bacteria. THE HANDBOOK OF ENVIRONMENTAL CHEMISTRY 2020:311-344. [DOI: 10.1007/698_2020_560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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10
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Antibiotic-resistant pathogens in different patient settings and identification of surveillance gaps in Switzerland - a systematic review. Epidemiol Infect 2019; 147:e259. [PMID: 31466538 PMCID: PMC6805757 DOI: 10.1017/s0950268819001523] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The prevalence of antimicrobial resistance (AMR) varies significantly among different patient populations. We aimed to summarise AMR prevalence data from screening studies in different patient settings in Switzerland and to identify surveillance gaps. We performed a systematic review, searching Pubmed, MEDLINE, Embase (01/2000–05/2017) and conference proceedings for Swiss studies reporting on carbapenemase-producing Enterobacteriaceae (CPE), extended-spectrum beta-lactamases (ESBL), mobilised colistin-resistance, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE) within different patient settings. We identified 2345 references and included 46 studies. For acute care patients, most screening data come from admission screenings, whereas AMR prevalence among hospitalised patients is largely unknown. Universal admission screenings showed ESBL-prevalences of 5–8% and MRSA-prevalences of 2–5%. For targeted screening, ESBL-prevalence ranged from 14–21%; MRSA-prevalence from 1–4%. For refugees, high ESBL (9–24%) and MRSA (16–24%) carriage rates were reported; returning travellers were frequently (68–80%) colonised with ESBL. Screening data for other pathogens, long-term care facility (LTCF) residents and pediatric populations were scarce. This review confirms high ESBL- and MRSA-carriage rates for risk populations in Switzerland. Emerging pathogens (CPE and VRE) and certain populations (inpatients, LTCF residents and children) are understudied. We encourage epidemiologists and public health authorities to consider these findings in the planning of future surveillance studies.
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11
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Reinheimer C, Abdollahi P, Zacharowski K, Meybohm P, Mutlak H, Klingebiel T, Wichelhaus TA, Kempf VAJ. Prevalence of multidrug-resistant organisms in refugee patients admitted to a German university hospital depending on duration of stay in Germany. GMS HYGIENE AND INFECTION CONTROL 2019; 14:Doc07. [PMID: 31293878 PMCID: PMC6606948 DOI: 10.3205/dgkh000323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Refugees have a significant risk of carrying multidrug-resistant organisms (MDRO), including multidrug-resistant gram-negative organisms (MDRGN) and methicillin-resistant Staphylococcus aureus (MRSA). Since the duration of MDRGN colonization has been shown to last for several months, we hypothesize that the prevalence of MDRO in refugees gradually declines during their stay in Germany to the level of MDRO prevalence in non-refugee patients. Knowledge about the dynamics of refugees' MDRO prevalence might provide the basis for appropriate infection control measures for refugees in hospitals as well as refugees' MDRO epidemiology in general. Material and methods: MDRO prevalence in 109 refugees admitted to the University Hospital Frankfurt, Germany, were compared to 819 adult controls and 224 pediatric patients admitted to the intensive care unit between June 2016 and May 2017. Results: 41.3% (95% confidence interval=31.9-51.1) of the refugees, 5.7% (4.2-7.6) of the adult controls and 8.9% (5.5-13.5) of the pediatric controls were positive for at least one MDRGN. The highest MDRGN prevalence was found in refugees who recently arrived (≤3 months) in Germany (72.4%; 52.8-87.3). Refugees' MDRGN prevalence declined continuously over time, reaching the adult and pediatric controls' MDRGN prevalence 18 months at the earliest after their arrival in Germany, i.e., 14.9% (1.8-42.8). Conclusion: This study demonstrates that refugees' MDRGN prevalence is declining over time since their arrival in Germany. 18 months after their arrival, refugees' and locals' MDRGN prevalence no longer differs significantly, although the refugees' MDRGN prevalence is still higher. A decline of MRSA prevalence was found 18 months after refugees' arrival. However, MRSA prevalence was still 14%, and thus 8 times higher than that of controls, indicating that precautionary measures continue to be necessary to prevent MRSA transmission.
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Affiliation(s)
- Claudia Reinheimer
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Germany
- University Center of Infectious Diseases, University Hospital Frankfurt, Germany
- University Center of Competence for Infection Control of the State of Hesse, Frankfurt Main, Germany
| | - Parisa Abdollahi
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Germany
- University Center of Infectious Diseases, University Hospital Frankfurt, Germany
| | - Kai Zacharowski
- University Center of Infectious Diseases, University Hospital Frankfurt, Germany
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Germany
| | - Patrick Meybohm
- University Center of Infectious Diseases, University Hospital Frankfurt, Germany
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Germany
| | - Haitham Mutlak
- University Center of Infectious Diseases, University Hospital Frankfurt, Germany
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Germany
| | - Thomas Klingebiel
- University Center of Infectious Diseases, University Hospital Frankfurt, Germany
- Department of Pediatric and Adolescent Medicine, University Hospital Frankfurt, Germany
| | - Thomas A. Wichelhaus
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Germany
- University Center of Infectious Diseases, University Hospital Frankfurt, Germany
- University Center of Competence for Infection Control of the State of Hesse, Frankfurt Main, Germany
| | - Volkhard A. J. Kempf
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Germany
- University Center of Infectious Diseases, University Hospital Frankfurt, Germany
- University Center of Competence for Infection Control of the State of Hesse, Frankfurt Main, Germany
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12
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Special Aspects in Pediatric Surgical Inpatient Care of Refugee Children: A Comparative Cohort Study. CHILDREN-BASEL 2019; 6:children6050062. [PMID: 31052220 PMCID: PMC6560456 DOI: 10.3390/children6050062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/10/2019] [Accepted: 04/28/2019] [Indexed: 11/16/2022]
Abstract
Background: Recently, the number of refugees in Germany has skyrocketed, leading to a marked increase in refugee children admitted to hospitals. This study describes the special characteristics encountered in pediatric surgical inpatient refugees compared to locally residing patients. Methods: Hospital records of minor refugees admitted to our department from 2005 up to and including 2015 were retrospectively reviewed. Demographic data, diagnoses, comorbidities, body mass indexes, hemoglobin values, and lengths of stay were extracted and statistically compared to local patients. Results: A total of 63 refugee children were analyzed and compared to 24,983 locally residing children. There was no difference in median body mass index (16.2 vs. 16.3, respectively, p = 0.26). However, refugee children had significantly lower hemoglobin values (11.95 vs. 12.79 g/dL, p < 0.0001) and were more likely to be colonized with methicillin-resistant Staphylococcus. aureus (8% vs. 0.04%, p < 0.01). Refugees were much more likely to present with burn injuries (16% versus 3% of admissions, p < 0.001), esophageal foreign bodies (4% vs. 0.5%, p < 0.001), as well as trauma, except for closed head injury. Conclusion: The cohort of refugee children in this study was found to be at a particular risk for suffering from burn injuries, trauma, foreign body aspirations, and anemia. Appropriate preventive measures and screening programs should be implemented accordingly.
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Aro T, Kantele A. High rates of meticillin-resistant Staphylococcus aureus among asylum seekers and refugees admitted to Helsinki University Hospital, 2010 to 2017. Euro Surveill 2018; 23:1700797. [PMID: 30424828 PMCID: PMC6234530 DOI: 10.2807/1560-7917.es.2018.23.45.1700797] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IntroductionAntimicrobial resistance is increasing rapidly in countries with low hygiene levels and poorly controlled antimicrobial use. The spread of resistant bacteria poses a threat to healthcare worldwide. Refugees and migrants from high-prevalence countries may add to a rise in multidrug-resistant (MDR) bacteria in low-prevalence countries. However, respective data are scarce.MethodsWe retrospectively collected microbiological and clinical data from asylum seekers and refugees treated at Helsinki University Hospital between January 2010 and August 2017.ResultsOf 447 asylum seekers and refugees (Iraq: 46.5%; Afghanistan: 10.3%; Syria: 9.6%, Somalia: 6.9%); 45.0% were colonised by MDR bacteria: 32.9% had extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE), 21.3% meticillin-resistant Staphylococcus aureus (MRSA), 0.7% carbapenemase-producing Enterobacteriaceae (CPE), 0.4% multiresistant Pseudomonas aeruginosa (MRPA), 0.4% multiresistant Acinetobacter baumannii (MRAB); no vancomycin-resistant Enterococcus (VRE) were found. Two or more MDR bacteria strains were recorded for 12.5% of patients. Multivariable analysis revealed geographical region and prior surgery outside Nordic countries as risk factors of MRSA colonisation. Young age (< 6 years old), short time from arrival to first sample, and prior hospitalisation outside Nordic countries were risk factors of ESBL-PE colonisation.ConclusionWe found MDR bacterial colonisation to be common among asylum seekers and refugees arriving from current conflict zones. In particular we found a high prevalence of MRSA. Refugees and migrants should, therefore, be included among risk populations requiring MDR screening and infection control measures at hospitals.
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Affiliation(s)
- Tuomas Aro
- Department of Internal Medicine, Clinicum, Medical Faculty, University of Helsinki, Helsinki, Finland,Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anu Kantele
- Department of Internal Medicine, Clinicum, Medical Faculty, University of Helsinki, Helsinki, Finland,Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland,Karolinska Institutet, Stockholm, Sweden
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14
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[Pediatric urological challenges in refugee children]. Urologe A 2018; 57:1185-1190. [PMID: 30167727 DOI: 10.1007/s00120-018-0761-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In recent years, the number of refugees to Germany has risen dramatically. Nearly half of the refugees are under 18, and a large percentage of them have acute or chronic medical problems. This situation poses a unique challenge to pediatric hospitals. Interprofessional teams in pediatric urology departments must care for an increasing number of patients with genetic abnormalities and diseases, unusual urogenital trauma, as well as frequent multiresistent organisms. In addition, communication problems due to language barriers and intercultural differences abound. Successful urological care for these patients requires not only high technical skills, dedication and empathy, but also the ability to reflect on and adapt to different cultural perspectives.
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15
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Kamenshchikova A, Wolffs PFG, Hoebe CJ, Penders J, Horstman K. Complex narratives of health, stigma and control: Antimicrobial resistance screening among non-hospitalized refugees. Soc Sci Med 2018; 212:43-49. [PMID: 30005223 DOI: 10.1016/j.socscimed.2018.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 06/27/2018] [Accepted: 07/06/2018] [Indexed: 01/23/2023]
Abstract
Antimicrobial resistance (AMR) is often presented as a major public health problem globally. Screening for AMR usually takes place in clinical settings. Recent developments in microbiology stimulated a series of studies focusing on AMR in communities, and particularly in travelers (any mobile individual), which was argued to be important for identifying potential public health risks. Against this background, microbiologists have become interested in non-hospitalized refugees as one of the traveler groups. However, this attention to refugees has provoked some professional debates on potential stigmatization of refugees as dangerous "others". To contribute to these debates, and to explore the idea of AMR screening of non-hospitalized refugees from different perspectives, we conducted a qualitative study among four groups of stakeholders who were chosen because of their associations with potential microbiological screening: microbiologists, public health physicians, public health nurses, and refugees. The study took place in a Dutch city from June to August 2016 and had 17 participants: five microbiologists, two public health nurses, four public health physicians, and six refugees. While microbiologists and public health physicians demonstrated a de-contextualized biomedical narrative in arguing that AMR screening among non-hospitalized refugees could be important for scientific research as well as for AMR prevention in communities, public health nurses displayed a more contextualized narrative bringing the benefits for individuals at the center and indicating that screening exclusively among refugees may provoke fear and stigmatization. Refugees were rather positive about AMR screening but stressed that it should particularly contribute to their individual health. We conclude that to design AMR prevention strategies, it is important to consider the complex meanings of AMR screening, and to design these strategies as a process of co-production by diverse stakeholders, including the target populations.
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Affiliation(s)
- A Kamenshchikova
- Department of Health, Ethics and Society, School of Public Health and Primary Care (CAPHRI), Maastricht University, Postbus 616, 6200, MD, Maastricht, the Netherlands; Research Centre for Policy Analysis and Studies of Technologies (PAST-Centre), National Research Tomsk State University, Tomsk, Russian Federation.
| | - P F G Wolffs
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - C J Hoebe
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands; Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service (GGD South Limburg), Heerlen, the Netherlands
| | - J Penders
- Department of Medical Microbiology, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands; Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - K Horstman
- Department of Health, Ethics and Society, School of Public Health and Primary Care (CAPHRI), Maastricht University, Postbus 616, 6200, MD, Maastricht, the Netherlands
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16
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Nellums LB, Thompson H, Holmes A, Castro-Sánchez E, Otter JA, Norredam M, Friedland JS, Hargreaves S. Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2018; 18:796-811. [PMID: 29779917 PMCID: PMC6032478 DOI: 10.1016/s1473-3099(18)30219-6] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 01/12/2018] [Accepted: 03/13/2018] [Indexed: 12/11/2022]
Abstract
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.
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Affiliation(s)
| | | | - Alison Holmes
- Department of Medicine, Imperial College London, London, UK
| | | | | | - Marie Norredam
- Danish Research Centre for Migration Ethnicity and Health, University of Copenhagen, Copenhagen, Denmark; Section of Immigrant Medicine, Department of Infectious Disease, Copenhagen University Hospital, Hvidovre, Denmark
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17
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Abstract
PURPOSE OF REVIEW The rise in antimicrobial resistance is an urgent public health threat which, in the absence of intervention, may result in a post-antibiotic era limiting the effectiveness of antibiotics to treat both common and serious infections. Globalization and human migration have profoundly contributed to the spread of drug-resistant bacteria. In this review, we summarize the recent literature on the importance of travelers in the spread of drug-resistant bacterial organisms. Our goal was to describe the importance of travel on a variety of clinically relevant drug-resistant bacterial organisms including extended-spectrum β-lactamase-producing Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae, methicillin-resistant Staphylococcus aureus, Salmonella species, as well as other enteric infections. RECENT FINDINGS Travelers from high income countries, visiting low and middle income countries, frequently acquire drug-resistant bacteria, particularly extended-spectrum β-lactamase-producing Enterobacteriaceae. The highest risk is associated with travel to the Indian subcontinent. Multidrug-resistant enteric infections in travelers from Salmonella spp., Campylobacter spp., and Shigella spp. are increasing. Refugees, pilgrimages, and medical tourists are associated with considerable risk of multiple forms of drug resistance. This review highlights the importance of antimicrobial stewardship, infection control, and surveillance; particularly in low and middle income countries. International leadership with global coordination is vital in the battle against antimicrobial resistance.
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Affiliation(s)
- Kevin L Schwartz
- Public Health Ontario, 480 University Ave, suite 300, Toronto, Ontario, M5G 1V2, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. .,St. Joseph's Health Centre, Toronto, Ontario, Canada.
| | - Shaun K Morris
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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18
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Abbara A, Rawson TM, Karah N, El-Amin W, Hatcher J, Tajaldin B, Dar O, Dewachi O, Abu Sitta G, Uhlin BE, Sparrow A. A summary and appraisal of existing evidence of antimicrobial resistance in the Syrian conflict. Int J Infect Dis 2018; 75:26-33. [PMID: 29936319 DOI: 10.1016/j.ijid.2018.06.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 06/13/2018] [Accepted: 06/14/2018] [Indexed: 11/30/2022] Open
Abstract
Antimicrobial resistance (AMR) in populations experiencing war has yet to be addressed, despite the abundance of contemporary conflicts and the protracted nature of twenty-first century wars, in combination with growing global concern over conflict-associated bacterial pathogens. The example of the Syrian conflict is used to explore the feasibility of using existing global policies on AMR in conditions of extreme conflict. The available literature on AMR and prescribing behaviour in Syria before and since the onset of the conflict in March 2011 was identified. Overall, there is a paucity of rigorous data before and since the onset of conflict in Syria to contextualize the burden of AMR. However, post onset of the conflict, an increasing number of studies conducted in neighbouring countries and Europe have reported AMR in Syrian refugees. High rates of multidrug resistance, particularly Gram-negative organisms, have been noted amongst Syrian refugees when compared with local populations. Conflict impedes many of the safeguards against AMR, creates new drivers, and exacerbates existing ones. Given the apparently high rates of AMR in Syria, in neighbouring countries hosting refugees, and in European countries providing asylum, this requires the World Health Organization and other global health institutions to address the causes, costs, and future considerations of conflict-related AMR as an issue of global governance.
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Affiliation(s)
- Aula Abbara
- Department of Infection, Imperial College Healthcare NHS Trust, London, UK.
| | - Timothy M Rawson
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK.
| | - Nabil Karah
- Department of Molecular Biology, Laboratory for Molecular Infection Medicine Sweden, and Umeå Centre for Microbial Research, Umeå University, Umeå, Sweden.
| | - Wael El-Amin
- Department of Microbiology, Broomfield Hospital, Chelmsford, Essex, UK.
| | - James Hatcher
- Department of Infection, Imperial College Healthcare NHS Trust, London, UK
| | | | - Osman Dar
- Public Health England, London, UK; Chatham House Centre on Global Health Security, London, UK.
| | - Omar Dewachi
- Conflict and Health Program, American University of Beirut, Lebanon.
| | | | - Bernt Eric Uhlin
- Department of Molecular Biology, Laboratory for Molecular Infection Medicine Sweden, and Umeå Centre for Microbial Research, Umeå University, Umeå, Sweden
| | - Annie Sparrow
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, USA.
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Backhaus L, Hartwig S. Gerichtlich angeordnete Sektionen von Geflüchteten in Berlin (2015–2017). Rechtsmedizin (Berl) 2018. [DOI: 10.1007/s00194-017-0223-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Isenring E, Fehr J, Gültekin N, Schlagenhauf P. Infectious disease profiles of Syrian and Eritrean migrants presenting in Europe: A systematic review. Travel Med Infect Dis 2018; 25:65-76. [PMID: 29702253 DOI: 10.1016/j.tmaid.2018.04.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/23/2018] [Accepted: 04/23/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND In the past decade, a large influx of migrants presented in Europe. Their country of origin was mainly either Syria or Eritrea. Public health institutions in host countries in Europe are challenged to screen and care for migrant populations with regard to infectious diseases. METHODS We performed a systematic literature review (according to PRISMA guidelines) to define the infectious disease profile of migrants originating in Syria and Eritrea. RESULTS The search resulted in 825 papers of possible relevance for infectious diseases in migrants from Syria, of which, after screening, we included 35 in the systematic review. A further 265 papers of possible relevance for infectious diseases in Eritrean migrants were screened, of which we included 27 in the systematic review. In migrants from Syria, leishmaniasis was the most frequently reported infectious disease. In addition, colonisation with drug resistant, Gram-negativ bacteria was reported. In the Eritrean migrants the infectious disease most described in the selected papers was louse-borne relapsing fever. Other frequently reported infectious diseases were scabies and Plasmodium vivax malaria. CONCLUSION Our systematic analysis defines the profiles of infectious diseases for migrants from Syria and Eritrea and serves as an evidence base for public health screening and care of presenting migrants.
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Affiliation(s)
- Egon Isenring
- University of Zurich Centre for Travel Medicine, WHO Collaborating for Travellers' Health, Department of Public Health, Institute for Epidemiology, Biostatistics and Prevention, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Jan Fehr
- University of Zurich Centre for Travel Medicine, WHO Collaborating for Travellers' Health, Department of Public Health, Institute for Epidemiology, Biostatistics and Prevention, Hirschengraben 84, 8001 Zurich, Switzerland; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nejla Gültekin
- Centre of Competence for Military and Disaster Medicine, Federal Department of Defence, Civil Protection and Sport DDPS, Swiss Armed Forces, Armed Forces Staff, Medical Services, Worblentalstrasse 36, Ittigen, CH 3063, Switzerland
| | - Patricia Schlagenhauf
- University of Zurich Centre for Travel Medicine, WHO Collaborating for Travellers' Health, Department of Public Health, Institute for Epidemiology, Biostatistics and Prevention, Hirschengraben 84, 8001 Zurich, Switzerland; ESCMID Study Group for Infections in Travellers and Migrants, Switzerland.
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Katchanov J, Asar L, Klupp EM, Both A, Rothe C, König C, Rohde H, Kluge S, Maurer FP. Carbapenem-resistant Gram-negative pathogens in a German university medical center: Prevalence, clinical implications and the role of novel β-lactam/β-lactamase inhibitor combinations. PLoS One 2018; 13:e0195757. [PMID: 29649276 PMCID: PMC5896976 DOI: 10.1371/journal.pone.0195757] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 03/28/2018] [Indexed: 01/01/2023] Open
Abstract
Objectives To determine the spectrum of infections with multidrug-resistant Gram-negative bacteria (MDR-GNB) and the clinical impact of the newly available betalactam/betalactamase inhibitor combinations ceftolozane/tazobactam and ceftazidime/avibactam in a German academic tertiary care center. Methods Retrospective analysis. Results Between September 1, 2015 and August 31, 2016, 119 individual patients (0.22% of all hospital admissions) were colonized or infected with carbapenem-resistant MDR-GNB. The species distribution was Pseudomonas aeruginosa, n = 66; Enterobacteriaceae spp., n = 44; and Acinetobacter baumannii, n = 18. In 9 patients, carbapenem-resistant isolates belonging to more than one species were detected. Infection was diagnosed in 50 patients (total: 42.0%; nosocomial pneumonia: n = 23, 19.3%; bloodstream infection: n = 11, 9.2%). Antimicrobial treatment with broad-spectrum antibiotics prior to detection of a carbapenem-resistant isolate was documented in 105 patients (88.2%, prior administration of carbapenems: 62.2%). Nosocomial transmission was documented in 29 patients (24.4%). In 26 patients (21.8%), at least one carbapenem-susceptible, third-generation cephalosporin non-susceptible isolate was documented prior to detection of a carbapenem-resistant isolate belonging to the same species (median 38 days, IQR 23–78). 12 patients (10.1%) had documented previous contact to the healthcare system in a country with high burden of carbapenemase-producing strains. Genes encoding carbapenemases were detected in 60/102 patient isolates (58.8%; VIM-2, n = 25; OXA-48, n = 21; OXA-23-like, n = 10). Susceptibility to colistin was 94.3%. Ceftolozane/tazobactam and ceftazidime/avibactam were administered to 3 and 5 patients, respectively (in-hospital mortality: 66% and 100%). Development of drug-resistance under therapy was observed for both antimicrobials. Conclusions i) The major predisposing factors for acquisition of carbapenem-resistant MDR-GNB were selective pressure due to preceding antimicrobial therapy and nosocomial transmission. ii) Colistin remains the backbone of antimicrobial chemotherapy for infections caused by carbapenem-resistant MDR-GNB. iii) Novel β-lactam/β-lactamase inhibitor combinations are of limited usefulness in our setting because of the high prevalence of Ambler class B carbapenemases and the emergence of nonsusceptibility under therapy.
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Affiliation(s)
- Juri Katchanov
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lucia Asar
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eva-Maria Klupp
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Both
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Camilla Rothe
- Division of Infectious Diseases and Tropical Medicine, First Medical Department, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christina König
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Hospital Pharmacy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Holger Rohde
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Florian P. Maurer
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
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Kahl F, Kühlein T. Differences between the antibiotic prescribing pattern of newly arrived refugees in Germany and the German population. Confl Health 2018; 12:3. [PMID: 29422945 PMCID: PMC5787911 DOI: 10.1186/s13031-018-0139-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 01/12/2018] [Indexed: 11/12/2022] Open
Abstract
The number of refugees arriving in Europe increased dramatically in 2015, challenging the German health system. Amongst others, the treatment of infectious diseases is an important topic in refugee healthcare. A high prevalence of multi-drug-resistant organisms has been identified among the refugee population. Still, little is known about the prescription of antibiotic medication for refugees. We conducted a descriptive analysis of all antibiotics prescribed to newly arrived refugees who were treated as outpatients between 10/01/2014 and 09/30/2015 in Erlangen, an average sized German town. The City’s invoicing documents were used to collect data on prescriptions written for refugees. Basic penicillins, aminopenicillins with beta-lactamase inhibitor and cephalosporins constituted the largest proportion of antibiotics prescribed in the adult refugee group. Of these, both aminopenicillins with beta-lactamase-inhibitor as well as basic penicillins were prescribed significantly more often compared to non-refugees. We conclude that the high percentage of prescriptions of aminopenicillins with beta-lactamase inhibitor is striking and should be further investigated.
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Affiliation(s)
- Fabian Kahl
- 1Institut für Geschichte und Ethik der Medizin, Friedrich-Alexander Universität Erlangen-Nürnberg, Glückstraße 10, 91054 Erlangen, Germany
| | - Thomas Kühlein
- 2Allgemeinmedizinisches Institut, Friedrich-Alexander Universität Erlangen-Nürnberg, Universitätsstraße 29, 91054 Erlangen, Germany
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Maltezou HC, Elhadad D, Glikman D. Monitoring and managing antibiotic resistance in refugee children. Expert Rev Anti Infect Ther 2017; 15:1015-1025. [PMID: 29027495 DOI: 10.1080/14787210.2017.1392853] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The past decade the Middle East and Southeastern Europe have witnessed an enormous movement of refugees due to the Syrian war and conflicts in Asia and Africa. Although carriage of and infections with multi-drug resistant (MDR) pathogens in refugees have been reported, pediatric data are scarce. Areas covered: MDR bacterial carriage and infections, and MDR-tuberculosis (TB) in refugee children from 2010. Expert commentary: High MDR carriage rates in refugee children are attributed to high pre-civil war MDR rates, war-damaged infrastructure and healthcare systems, and poor hygiene conditions. Currently there are no international guidelines about MDR screening in refugee children. Given the medical importance of MDRs, challenging therapeutics and risk of importation in non/low-endemic countries, we recommend routine screening and contact isolation upon hospitalization of refugees. TB, including MDR-TB, is highly-endemic in many Asian and African countries, however, current data in refugee children are lacking. TB Screening in refugees is widely implemented but there is no consensus on methods and target populations. Coordinated TB detection and treatment, use of rapid molecular tests and drug-susceptibility testing, better access to healthcare, cross border TB care collaboration, and protection from deportation while on treatment should be integrated parts of TB control and prevention.
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Affiliation(s)
- Helena C Maltezou
- a Department for Interventions in Health Care Facilities , Hellenic Center for Disease Control and Prevention , Athens , Greece
| | - Dana Elhadad
- b The Faculty of Medicine in the Galilee , Bar-Ilan University , Safed , Israel
| | - Daniel Glikman
- b The Faculty of Medicine in the Galilee , Bar-Ilan University , Safed , Israel.,c Pediatric Infectious Diseases Unit , Galilee Medical Center , Nahariya , Israel
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Maltezou HC, Theodoridou M, Daikos GL. Antimicrobial resistance and the current refugee crisis. J Glob Antimicrob Resist 2017; 10:75-79. [DOI: 10.1016/j.jgar.2017.03.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 02/13/2017] [Accepted: 03/19/2017] [Indexed: 10/19/2022] Open
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Ravensbergen SJ, Berends M, Stienstra Y, Ott A. High prevalence of MRSA and ESBL among asylum seekers in the Netherlands. PLoS One 2017; 12:e0176481. [PMID: 28441421 PMCID: PMC5404783 DOI: 10.1371/journal.pone.0176481] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 04/11/2017] [Indexed: 11/19/2022] Open
Abstract
Migration is one of the risk factors for the spread of multidrug-resistant organisms (MDRO). The increasing influx of migrants challenges local health care systems. To provide evidence for both hospital hygiene measure and empirical antibiotic therapy, we analysed all cultures performed in asylum seekers between January 1st 2014 and December 31st 2015 for methicillin resistant Staphylococcus aureus (MRSA) and for multidrug-resistant Enterobacteriaceae (MDRE). We compared these with cultures from the Dutch patient population with risk factors for carriage of MDRO. A total of 7181 patients were screened for MRSA. 7357 S. aureus were isolated in clinical cultures. Of 898 screened asylum seekers, almost 10% were MRSA positive. Of 118 asylum seekers with S. aureus in clinical cultures almost 19% were MRSA positive. The general patient population had a 1.3% rate of MRSA in S. aureus isolates. A higher rate of Panton-Valentine leukocidin (PVL) positive strains (RR: 2.4; 95% CI: 1.6-3.4) was found in asylum seekers compared to the general patient population. In 33475 patients one or more Enterobacteriaceae were obtained. More than 21% of the asylum seekers were carrier of MDRE, most of them producing extended spectrum beta-lactamases (20.3%). 5.1% of the general patient population was MDRE carrier. It can be concluded that asylum seekers present with higher rate of MDRO compared to the general patient population. These results justify continued screening of asylum seekers to anticipate multidrug-resistant organisms during hospital care of patients.
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Affiliation(s)
- Sofanne J. Ravensbergen
- Department of Internal Medicine/Infectious Diseases, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
- * E-mail:
| | - Matthijs Berends
- Department of Medical Microbiology, Certe, Groningen, the Netherlands
| | - Ymkje Stienstra
- Department of Internal Medicine/Infectious Diseases, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Alewijn Ott
- Department of Medical Microbiology, Certe, Groningen, the Netherlands
- Department of Medical Microbiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
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Petersen E, Mohsin J. Should travelers be screened for multi-drug resistant (MDR) bacteria after visiting high risk areas such as India? Travel Med Infect Dis 2016; 14:591-594. [PMID: 27913311 DOI: 10.1016/j.tmaid.2016.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 11/27/2016] [Indexed: 01/05/2023]
Affiliation(s)
- Eskild Petersen
- Department of Infectious Diseases, The Royal Hospital, Muscat, Oman; Institute of Clinical Medicine, University of Aarhus, Denmark.
| | - Jalila Mohsin
- Department of Clinical Microbiology, The Royal Hospital, Muscat, Oman
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