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Patjas A, Martelius A, Ollgren J, Kantele A. International travel increases risk of urinary tract infection caused by extended-spectrum beta-lactamase-producing Enterobacterales-three-arm case-control study. J Travel Med 2024; 31:taad155. [PMID: 38123504 DOI: 10.1093/jtm/taad155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-PE) have worldwide become increasingly prevalent as pathogens causing urinary tract infections (UTIs), posing challenges in their treatment. Of particular concern are travellers to low- and middle-income countries (LMICs), a substantial proportion of whom become colonized by ESBL-PE, with UTIs as the most common clinical manifestation. Seeking tools for preventing ESBL-PE UTI, we explored factors associated with (i) any UTI (versus control), (ii) ESBL-PE UTI (versus control) and (iii) ESBL-PE versus non-ESBL-PE UTI. METHODS During 2015-20, we recruited patients with recent ESBL-PE or non-ESBL-PE UTIs, and controls with no UTI to fill in questionnaires covering potential (ESBL-PE-)UTI risk factors. RESULTS Of our 430 participants, 130 had ESBL-PE UTI and 187 non-ESBL-PE UTI; 113 were controls. Our three comparisons showed several risk factors as exemplified for any UTI versus controls by female sex, lower education, age, diabetes, antibiotic use, diarrhoea; for ESBL-PE UTI versus controls by travel to LMICs, antibiotic use, swimming; and ESBL-PE versus non-ESBL-PE UTI by male sex, higher education, LMIC travel (participant/household member), pets and antibiotic use. Weekly fish meals appeared protective against both UTI and ESBL-PE UTI. CONCLUSIONS Of the numerous factors predisposing to UTI and/or ESBL-PE UTI, our study highlights antibiotic use and LMIC travel. Household members' LMIC travel appears to pose a risk of ESBL-PE UTI, pointing to household transmission of travel-acquired uropathogens. As predisposing factors to multidrug-resistant UTI, international travel and antibiotic use constitute practical targets for prevention efforts.
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Affiliation(s)
- Anu Patjas
- Meilahti Vaccine Research Centre, MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Unit, University of Helsinki, Helsinki, Finland
- Centre of Excellence in Antimicrobial Resistance Research, FIMAR, Helsinki, Finland
| | - Antti Martelius
- Meilahti Vaccine Research Centre, MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Unit, University of Helsinki, Helsinki, Finland
| | - Jukka Ollgren
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Anu Kantele
- Meilahti Vaccine Research Centre, MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Unit, University of Helsinki, Helsinki, Finland
- Centre of Excellence in Antimicrobial Resistance Research, FIMAR, Helsinki, Finland
- Travel Clinic, Aava Medical Centre, Helsinki, Finland
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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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Acute respiratory infections in an adult refugee population: an observational study. NPJ Prim Care Respir Med 2021; 31:50. [PMID: 34934070 PMCID: PMC8692464 DOI: 10.1038/s41533-021-00261-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 11/03/2021] [Indexed: 11/08/2022] Open
Abstract
The presence of acute infectious respiratory diseases (ARD) is one of the main reasons why recently arrived refugees seek medical help. This paper investigates the incidence rates of acute respiratory diseases in an adult refugee population as well as associated sociodemographic factors and drug treatments. We conducted a retrospective observational study of deidentified medical records. The data were collected between 2015 and 2019 in the health care centers of two large German initial reception centers for refugees. Multivariable analyses controlling for sociodemographics were carried out using generalized estimating equations. Out of 10,431 eligible residents, 6965 medical encounters of 2840 adult patients were recorded over 30 months. Of all the adult patients, 34.4% sought medical help for a respiratory symptom or diagnosis at least once. Older patients and patients from Sub-Saharan Africa sought help less often. The occurrence of ARD showed a typical distribution over the course of the year. Facility occupancy was not associated with ARD occurrence. Acute respiratory symptoms are a leading cause for adult refugee patients to seek medical care. The doctor contact rates due to ARD were consistently two to three times higher among refugees than among German residents.
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4
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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: 10] [Impact Index Per Article: 3.3] [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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Wilder-Smith A, Osman S. Public health emergencies of international concern: a historic overview. J Travel Med 2020; 27:6025447. [PMID: 33284964 PMCID: PMC7798963 DOI: 10.1093/jtm/taaa227] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/24/2020] [Accepted: 12/01/2020] [Indexed: 12/19/2022]
Abstract
RATIONALE The International Health Regulations (IHR) have been the governing framework for global health security since 2007. Declaring public health emergencies of international concern (PHEIC) is a cornerstone of the IHR. Here we review how PHEIC are formally declared, the diseases for which such declarations have been made from 2007 to 2020 and justifications for such declarations. KEY FINDINGS Six events were declared PHEIC between 2007 and 2020: the 2009 H1N1 influenza pandemic, Ebola (West African outbreak 2013-2015, outbreak in Democratic Republic of Congo 2018-2020), poliomyelitis (2014 to present), Zika (2016) and COVID-19 (2020 to present). Poliomyelitis is the longest PHEIC. Zika was the first PHEIC for an arboviral disease. For several other emerging diseases a PHEIC was not declared despite the fact that the public health impact of the event was considered serious and associated with potential for international spread. RECOMMENDATIONS The binary nature of a PHEIC declaration is often not helpful for events where a tiered or graded approach is needed. The strength of PHEIC declarations is the ability to rapidly mobilize international coordination, streamline funding and accelerate the advancement of the development of vaccines, therapeutics and diagnostics under emergency use authorization. The ultimate purpose of such declaration is to catalyse timely evidence-based action, to limit the public health and societal impacts of emerging and re-emerging disease risks while preventing unwarranted travel and trade restrictions.
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Affiliation(s)
- Annelies Wilder-Smith
- Global Health and Epidemiology, University of Umea, 901 87 Umea, Sweden.,Heidelberg Institute of Global Health, University of Heidelberg, Im Neuenheimer Feld 365, 6900 Heidelberg, Germany
| | - Sarah Osman
- Global Health and Epidemiology, University of Umea, 901 87 Umea, Sweden
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Yam ELY. COVID-19 will further exacerbate global antimicrobial resistance. J Travel Med 2020; 27:5857111. [PMID: 32539142 PMCID: PMC7313869 DOI: 10.1093/jtm/taaa098] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Esabelle Lo Yan Yam
- College of Health and Medicine, Australian National University, Canberra, ACT 2600, Australia
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Sloth LB, Hargreaves S, Nellums LB, Nielsen RT, Norredam M. Extended-spectrum β-lactamase-producing Escherichia coli. THE LANCET. INFECTIOUS DISEASES 2020; 20:405. [PMID: 32222204 DOI: 10.1016/s1473-3099(20)30116-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/13/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Louise B Sloth
- Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital Hvidovre, DK-2650, Hvidovre, Denmark
| | - Sally Hargreaves
- Infection and Immunity, St. George's, University of London, London, UK
| | - Laura B Nellums
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Rikke T Nielsen
- Department of Clinical Microbiology, University Hospital Hvidovre, DK-2650, Hvidovre, Denmark; Research Centre for Migration, Ethnicity and Health, University of Copenhagen, Copenhagen, Denmark
| | - Marie Norredam
- Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital Hvidovre, DK-2650, Hvidovre, Denmark; Research Centre for Migration, Ethnicity and Health, University of Copenhagen, Copenhagen, Denmark.
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Holubar M. Antimicrobial resistance: a global public health emergency further exacerbated by international travel. J Travel Med 2020; 27:5644975. [PMID: 31776565 DOI: 10.1093/jtm/taz095] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 11/24/2019] [Indexed: 01/21/2023]
Abstract
This is an invited editorial for the JTM issue focused on antimicrobial resistance.
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Affiliation(s)
- Marisa Holubar
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA 94305-5105, USA
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