1
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Yıldız SS, Hekimoğlu CH, Sucaklı MB, Bakkaloğlu Z, Çevik YN, Ünaldı Ö, Arslantürk H, Zikusooka M, Keçik M, Nellums L, Elci OC. Community-acquired antimicrobial resistance among Syrian refugees and the local population in Türkiye. Eur J Public Health 2023; 33:809-814. [PMID: 37464952 PMCID: PMC10567246 DOI: 10.1093/eurpub/ckad119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The long-standing antimicrobial resistance (AMR) pandemic has proven difficult to resolve and is becoming more complex, especially in the context of increasing forced migration, with little evidence around patterns of AMR in migrant communities. This study aimed to determine the frequency in the carriage of common types of antimicrobial-resistant bacteria between Syrian refugees and the local communities in Türkiye: extended-spectrum β-lactamase (ESBL), methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). METHODS We collected nasal swabs and stool samples from the study participants, the local community members, and refugees, between September 2020 and March 2021. We screened clinical samples for the presence of ESBL, MRSA and VRE. Antimicrobial-resistant bacterial isolates were tested by phenotypic analysis to determine the AMR status. RESULTS The study included a total of 3960 participants: 1453 individuals in the local community (36.2%) and 2525 Syrian refugees (63.8%). Overall, a significantly greater proportion of refugees (6.7%) carried MRSA compared to the local community (3.2%) (P < 0.001). The ESBL-positivity rate was 17.9% in Syrian refugees and 14.3% in the local community (P = 0.041). Carbapenemase activity was detected in three isolates from Syrian refugees. No VRE was detected in Syrian refugees or the local community. CONCLUSIONS This large, community-based study on the frequency and the distribution of AMR among Syrian refugees and the local population is the first study in Türkiye.
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Affiliation(s)
- Serap Süzük Yıldız
- Department of Microbiology Reference Laboratory and Biological Product, Ministry of Health, General Directorate of Public Health, Ankara, Türkiye
| | - Can Hüseyin Hekimoğlu
- Department of Microbiology Reference Laboratory and Biological Product, Ministry of Health, General Directorate of Public Health, Ankara, Türkiye
| | | | - Zekiye Bakkaloğlu
- Department of Microbiology Reference Laboratory and Biological Product, Ministry of Health, General Directorate of Public Health, Ankara, Türkiye
| | - Yasemin Numanoğlu Çevik
- Department of Microbiology Reference Laboratory and Biological Product, Ministry of Health, General Directorate of Public Health, Ankara, Türkiye
| | - Özlem Ünaldı
- Department of Microbiology Reference Laboratory and Biological Product, Ministry of Health, General Directorate of Public Health, Ankara, Türkiye
| | - Hayal Arslantürk
- Department of Microbiology Reference Laboratory and Biological Product, Ministry of Health, General Directorate of Public Health, Ankara, Türkiye
| | - Monica Zikusooka
- World Health Organization, Türkiye Country Office, Ankara, Türkiye
| | - Melda Keçik
- World Health Organization, Türkiye Country Office, Ankara, Türkiye
| | - Laura Nellums
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Omur Cinar Elci
- World Health Organization, Türkiye Country Office, Ankara, Türkiye
- Clinical & Behavioral Medicine, Western Atlantic University School of Medicine Freeport, Grand Bahama, The Bahamas
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2
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Yusuff SI, Tajudeen YA, Oladunjoye IO, Oladipo HJ, Bolarinwa OV, Popoola OT, Ahmed AF, Olana MD. The need to increase antimicrobial resistance surveillance among forcibly displaced persons (FDPs). Trop Dis Travel Med Vaccines 2023; 9:12. [PMID: 37653439 PMCID: PMC10472691 DOI: 10.1186/s40794-023-00198-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 06/19/2023] [Indexed: 09/02/2023] Open
Abstract
Antimicrobial resistance (AMR) poses a significant threat to human health as 4.95 million deaths were associated with bacterial AMR in 2019 and is projected to reach 10 million by 2050. To mitigate AMR, surveillance is an essential tool for determining the burden of AMR and providing the necessary information for its control. However, the global AMR surveillance is inadequate and particularly limited among forcibly displaced persons (FDPs) despite having higher risks of harboring these pathogens. Predisposing factors among this group include poor living conditions, limited access to treatment and diagnostic tests, and inadequate trained health professionals in refugee camps. Strengthening AMR surveillance among FDPs would address the identified gaps and facilitate formulation and implementation of evidence-based policies on AMR control and prevention response. This article provides information on the growing population of FDPs, factors contributing to the AMR burden and AMR surveillance gaps in FDPs and highlighted recommendations for control.
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Affiliation(s)
- Sodiq Inaolaji Yusuff
- Department of Medicine, Faculty of Clinical Sciences, Obafemi Awolowo University, Ibadan-Ife Rd, Ife, 220101, Osun State, Nigeria
| | - Yusuf Amuda Tajudeen
- Department of Microbiology, Faculty of Life Sciences, University of Ilorin, P.M.B. 1515, Ilorin, 240003, Nigeria
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, P.M.B 5017 G.P.O, Ibadan, Oyo State, Nigeria
| | - Iyiola Olatunji Oladunjoye
- Department of Microbiology, Faculty of Life Sciences, University of Ilorin, P.M.B. 1515, Ilorin, 240003, Nigeria
| | - Habeebullah Jayeola Oladipo
- Department of Microbiology, Faculty of Life Sciences, University of Ilorin, P.M.B. 1515, Ilorin, 240003, Nigeria
- Faculty of Pharmaceutical Sciences, University of Ilorin, P.M.B. 1515, Ilorin, 240003, Nigeria
| | | | - Olalekan Tolulope Popoola
- Department of Public Health, Health Sciences Centre, University College, Dublin, 4 Stillorgan Rd, Belfield, Dublin 4, Ireland
| | - Abdulhakeem Funsho Ahmed
- Faculty of Health Sciences, Department of Public Health, Al-Hikmah University, Ilorin, 240281, Kwara State, Nigeria
- Institute of Basic and Applied Science, Department of Science Laboratory Technology, Kwara State Polytechnic, P.M.B 1375, Ilorin, Kwara State, Nigeria
| | - Matifan Dereje Olana
- Department of Medical Laboratory Sciences, Collage of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia.
- Department of Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia.
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3
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Stabler S, Paccoud O, Duchesne L, Piot MA, Valin N, Decré D, Girard PM, Lalande V, Lacombe K, Surgers L. Prevalence of Antimicrobial Resistance and Infectious Diseases in a Hospitalised Migrant Population in Paris, France, a Retrospective Study. Int J Public Health 2022; 67:1604792. [PMID: 36589475 PMCID: PMC9797533 DOI: 10.3389/ijph.2022.1604792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 11/23/2022] [Indexed: 12/16/2022] Open
Abstract
Objectives: The aim of this study was to estimate the prevalence of anti-microbial resistance (AMR) carriage and its risk factors in hospitalized migrants. Additionally, the prevalence of infectious diseases was evaluated, as well as symptoms of psychological trauma. Methods: We conducted a retrospective monocentric cross-sectional study including all migrant patients recently arrived and hospitalised over a one-year period. Results: Among 101 patients, seventy-nine percent originated from Sub-Saharan Africa. The overall AMR carriage rate was 20.7% [95% CI: 12.4; 28.9%]. We isolated 5/92 methicillin-resistant Staphylococcus aureus strains (5.4%) and 15/92 extended-spectrum beta-lactamase-producing Enterobacteriaceae (16.4%). AMR carriage was associated with older age, region of origin and length of migration. Rates of HIV, HBV, and HCV infection were 39.6%, 32.7%, and 5%, reflecting sampling bias linked to reasons for hospitalization. Eleven percent had serological evidence of treponemasis and 7.8% had Chlamydia trachomatis infection. Symptoms of depression or post-traumatic stress disorder were observed for more than half the patients. Conclusion: It appears essential to offer a systematic and comprehensive post-arrival screening of AMR carriage, infectious diseases and psychological trauma to subjects who experienced migration.
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Affiliation(s)
- Sarah Stabler
- GHU APHP. Sorbonne Université, Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, Paris, France,*Correspondence: Sarah Stabler,
| | - Olivier Paccoud
- GHU APHP. Sorbonne Université, Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, Paris, France
| | - Léa Duchesne
- Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique, Paris, France
| | - Marie-Aude Piot
- Département de Psychiatrie, Institut Mutualiste Montsouris, Paris, France,Sorbonne Universités, Université Paris Descartes, UMR 1018/INSERM 1178, Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Paris, France
| | - Nadia Valin
- GHU APHP. Sorbonne Université, Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, Paris, France
| | - Dominique Decré
- APHP, Hôpital Saint-Antoine, Département de Bactériologie, Paris, France,Sorbonne Université, UPMC Univ Paris 06 CR7, INSERM U1135, CIMI, Team E13, Paris, France
| | - Pierre-Marie Girard
- GHU APHP. Sorbonne Université, Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, Paris, France
| | - Valérie Lalande
- APHP, Hôpital Saint-Antoine, Département de Bactériologie, Paris, France
| | - Karine Lacombe
- GHU APHP. Sorbonne Université, Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, Paris, France,Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique, Paris, France
| | - Laure Surgers
- GHU APHP. Sorbonne Université, Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, Paris, France,Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique, Paris, France
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4
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Cascading Risks for Preventable Infectious Diseases in Children and Adolescents during the 2022 Invasion of Ukraine. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127005. [PMID: 35742254 PMCID: PMC9223098 DOI: 10.3390/ijerph19127005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/05/2022] [Accepted: 06/06/2022] [Indexed: 01/25/2023]
Abstract
Russia’s military incursion into Ukraine triggered the mass displacement of two-thirds of Ukrainian children and adolescents, creating a cascade of population health consequences and producing extraordinary challenges for monitoring and controlling preventable pediatric infectious diseases. From the onset of the war, infectious disease surveillance and healthcare systems were severely disrupted. Prior to the reestablishment of dependable infectious disease surveillance systems, and during the early months of the conflict, our international team of pediatricians, infectious disease specialists, and population health scientists assessed the health implications for child and adolescent populations. The invasion occurred just as the COVID-19 Omicron surge was peaking throughout Europe and Ukrainian children had not received COVID-19 vaccines. In addition, vaccine coverage for multiple vaccine-preventable diseases, most notably measles, was alarmingly low as Ukrainian children and adolescents were forced to migrate from their home communities, living precariously as internally displaced persons inside Ukraine or streaming into European border nations as refugees. The incursion created immediate impediments in accessing HIV treatment services, aimed at preventing serial transmission from HIV-positive persons to adolescent sexual or drug-injection partners and to prevent vertical transmission from HIV-positive pregnant women to their newborns. The war also led to new-onset, conflict-associated, preventable infectious diseases in children and adolescents. First, children and adolescents were at risk of wound infections from medical trauma sustained during bombardment and other acts of war. Second, young people were at risk of sexually transmitted infections resulting from sexual assault perpetrated by invading Russian military personnel on youth trapped in occupied territories or from sexual assault perpetrated on vulnerable youth attempting to migrate to safety. Given the cascading risks that Ukrainian children and adolescents faced in the early months of the war—and will likely continue to face—infectious disease specialists and pediatricians are using their international networks to assist refugee-receiving host nations to improve infectious disease screening and interventions.
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5
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Nimer NA. Nosocomial Infection and Antibiotic-Resistant Threat in the Middle East. Infect Drug Resist 2022; 15:631-639. [PMID: 35241915 PMCID: PMC8887909 DOI: 10.2147/idr.s351755] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/08/2022] [Indexed: 12/13/2022] Open
Abstract
The prevalence of nosocomial infections (NIs) is associated with different bacteria found in hospitals. These infections in their extreme conditions result in morbidity and mortality. This study aims to provide a detailed review of literary studies to identify the prevalence of nosocomial infections and antibiotic-resistance specifically in Middle Eastern countries. A literature review approach is followed in this study. It further identifies different causes and effects associated with nosocomial infections in the given regions. Relevant studies were used to extract important information, specifically related to the Middle Eastern countries. The findings indicated that nosocomial infections following antibiotic resistance are an emerging problem in Middle Eastern countries, leading to significant morbidity and mortality. Most frequently reported NIs in Middle East in our review are bloodstream infections (BSIs) (50%) and surgical site infections (SSIs) (50%) followed by urinary tract infections (UTIs). Escherichia coli and Klebsiella species among gram-negative bacteria, Staphylococcus aureus among gram-positive bacterial and fungal pathogens such as Candida species are most reported pathogens involved in nosocomial infections and resistance to penicillins, cephalosporins, carbapenems and fluoroquinolones antibiotics were significantly reported. However, most studies showed minimum resistance of pathogens against drug colistin. To control the growth rate of the given condition, government officials are suggested to ensure that hospitals follow adequate healthcare mechanisms. Also, sufficient education must be provided to the hospital staff about the causes and effects of the given disease.
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Affiliation(s)
- Nabil A Nimer
- Faculty of Pharmacy, Philadelphia University, Amman, Jordan
- Correspondence: Nabil A Nimer, Email
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6
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Scott P, Zhang J, Anderson T, Priest PC, Chambers S, Smith H, Murdoch DR, French N, Biggs PJ. Whole-genome sequencing and ad hoc shared genome analysis of Staphylococcus aureus isolates from a New Zealand primary school. Sci Rep 2021; 11:20328. [PMID: 34645857 PMCID: PMC8514452 DOI: 10.1038/s41598-021-99080-8] [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: 01/26/2021] [Accepted: 09/09/2021] [Indexed: 11/09/2022] Open
Abstract
Epidemiological studies of communicable diseases increasingly use large whole-genome sequencing (WGS) datasets to explore the transmission of pathogens. It is important to obtain an initial overview of datasets and identify closely related isolates, but this can be challenging with large numbers of isolates and imperfect sequencing. We used an ad hoc whole-genome multi locus sequence typing method to summarise data from a longitudinal study of Staphylococcus aureus in a primary school in New Zealand. Each pair of isolates was compared and the number of genes where alleles differed between isolates was tallied to produce a matrix of "allelic differences". We plotted histograms of the number of allelic differences between isolates for: all isolate pairs; pairs of isolates from different individuals; and pairs of isolates from the same individual. 340 sequenced isolates were included, and the ad hoc shared genome contained 445 genes. There were between 0 and 420 allelic differences between isolate pairs and the majority of pairs had more than 260 allelic differences. We found many genetically closely related S. aureus isolates from single individuals and a smaller number of closely-related isolates from separate individuals. Multiple S. aureus isolates from the same individual were usually very closely related or identical over the ad hoc shared genome. Siblings carried genetically similar, but not identical isolates. An ad hoc shared genome approach to WGS analysis can accommodate imperfect sequencing of the included isolates, and can provide insights into relationships between isolates in epidemiological studies with large WGS datasets containing diverse isolates.
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Affiliation(s)
- Pippa Scott
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand.
| | - Ji Zhang
- School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - Trevor Anderson
- Canterbury Health Laboratories, Canterbury District Health Board, Christchurch, New Zealand
| | - Patricia C Priest
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Stephen Chambers
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Helen Smith
- School of Fundamental Sciences, Massey University, Palmerston North, New Zealand
| | - David R Murdoch
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Nigel French
- School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - Patrick J Biggs
- School of Veterinary Science, Massey University, Palmerston North, New Zealand.,School of Fundamental Sciences, Massey University, Palmerston North, New Zealand
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7
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Nurjadi D, Klein S, Hannesen J, Heeg K, Boutin S, Zanger P. Molecular analysis of an increase in trimethoprim/sulfamethoxazole-resistant MRSA reveals multiple introductions into a tertiary care hospital, Germany 2012-19. J Antimicrob Chemother 2021; 77:38-48. [PMID: 34529777 DOI: 10.1093/jac/dkab341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/23/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Increasing spread of resistance could jeopardize the use of antifolates against MRSA infections. METHODS We compared the prevalence of phenotypic trimethoprim/sulfamethoxazole resistance in 20 534 clinical Staphylococcus aureus isolates (19 096 MSSA and 1438 MRSA) of non-redundant patients at Heidelberg University Hospital over 8 years and performed WGS on trimethoprim/sulfamethoxazole-resistant MRSA. RESULTS From 2012 to 2019, trimethoprim/sulfamethoxazole resistance in MSSA (674/19 096; 3.5%) ranged between 1.5% and 7.2% and in MRSA (135/1438; 9.4%) between 0.5% and 20.2%, reaching a peak in 2016 and 2018, respectively (Ptrend < 0.001). Trimethoprim/sulfamethoxazole resistance was more likely in outpatients than inpatients (P = 0.005), younger patients (P < 0.001), skin and soft tissue infections (SSTIs) (MRSA only, P = 0.05), submissions from pulmonology (MRSA only, P = 0.001), the upper respiratory tract (MSSA only, P < 0.001) and general surgery (MSSA only, P = 0.001). WGS of 76 trimethoprim/sulfamethoxazole-resistant MRSA revealed that 59% belonged to major pandemic CA-MRSA clones (ST22, ST8, ST398, ST772, ST30), 47% harboured Panton-Valentine leucocidin (PVL), 97% SCCmec IV/V, 71% dfrG and 28% dfrA. SNP-based phylogeny of trimethoprim/sulfamethoxazole-resistant MRSA core genomes favoured independent introduction over clonal expansion as the source, most prominently of dfrA+ trimethoprim/sulfamethoxazole-resistant ST22 MRSA from the Gaza Strip. CONCLUSIONS The presented results support that trimethoprim/sulfamethoxazole-resistant S. aureus, formerly associated with SSTI from outpatients and S. aureus in the (sub)tropics, is on the rise in the temperate zone, potentially due to migration. Closer monitoring of trimethoprim/sulfamethoxazole resistance in S. aureus is recommended to safeguard the effectiveness of antifolate compounds.
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Affiliation(s)
- Dennis Nurjadi
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
| | - Sabrina Klein
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
| | - Julius Hannesen
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
| | - Klaus Heeg
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
| | - Sébastien Boutin
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
| | - Philipp Zanger
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany.,Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
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8
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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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9
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Kenfak-Foguena A, Nahimana Tessemo I, Bertelli C, Merz L, Cometta A, Blanc D, Senn L, Petignat C. Prevalence of multidrug-resistant bacteria colonisation among asylum seekers in western Switzerland. J Infect Prev 2021; 22:173-176. [PMID: 34295379 DOI: 10.1177/1757177420982033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/08/2020] [Indexed: 11/15/2022] Open
Abstract
The recent increase of migration to Europe represents a risk of increased the prevalence of multidrug-resistant (MDR) bacteria. We conducted a cross-sectional study among asylum seekers admitted at two hospitals in Switzerland. Of the 59 patients included, 9 (14%) were colonised by a MDR bacteria, including 5 (8.5%) methicilin-resistant Staphylococcus aureus (MRSA) and 4 (6.8%) extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. No patient carried both ESBL-producing bacteria and MRSA. None of the patients carried a vancomycin-resistant Enterococcus (VRE) or a carbapenem-resistant Enterobacteriaceae (CRE). Colonisation with MDR bacteria was not associated with hospitalisation abroad or recent arrival in Switzerland. Whole genome sequencing analysis allowed us to exclude transmission between patients. The prevalence of MDR bacteria carriage is moderate among asylum seekers in western Switzerland. Further surveillance studies are necessary to determine if there is a risk of dissemination of pathogens into the local population.
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Affiliation(s)
| | - Immaculée Nahimana Tessemo
- Cantonal Unit for Infection Control and Prevention, Public Health Service, Lausanne, Switzerland.,Service of Hospital preventive medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Claire Bertelli
- Institute of Microbiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Laurent Merz
- Division of internal medicine, Etablissement Hospitalier du Nord Vaudois, Yverdon-les-Bains, Switzerland
| | - Alain Cometta
- Division of internal medicine, Etablissement Hospitalier du Nord Vaudois, Yverdon-les-Bains, Switzerland
| | - Dominique Blanc
- Service of Hospital preventive medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Laurence Senn
- Service of Hospital preventive medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Christiane Petignat
- Cantonal Unit for Infection Control and Prevention, Public Health Service, Lausanne, Switzerland.,Service of Hospital preventive medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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10
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Danielsen AS, Elstrøm P, Arnesen TM, Gopinathan U, Kacelnik O. Targeting TB or MRSA in Norwegian municipalities during 'the refugee crisis' of 2015: a framework for priority setting in screening. ACTA ACUST UNITED AC 2020; 24. [PMID: 31552819 PMCID: PMC6761574 DOI: 10.2807/1560-7917.es.2019.24.38.1800676] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction In 2015, there was an increase in the number of asylum seekers arriving in Europe. Like in other countries, deciding screening priorities for tuberculosis (TB) and meticillin-resistant Staphylococcus aureus (MRSA) was a challenge. At least five of 428 municipalities chose to screen asylum seekers for MRSA before TB; the Norwegian Institute for Public Health advised against this. Aim To evaluate the MRSA/TB screening results from 2014 to 2016 and create a generalised framework for screening prioritisation in Norway through simulation modelling. Methods This is a register-based cohort study of asylum seekers using data from the Norwegian Surveillance System for Communicable Diseases from 2014 to 2016. We used survey data from municipalities that screened all asylum seekers for MRSA and denominator data from the Directorate of Immigration. A comparative risk assessment model was built to investigate the outcomes of prioritising between TB and MRSA in screening regimes. Results Of 46,090 asylum seekers, 137 (0.30%) were diagnosed with active TB (notification rate: 300/100,000 person-years). In the municipalities that screened all asylum seekers for MRSA, 13 of 1,768 (0.74%) were found to be infected with MRSA. The model estimated that screening for MRSA would prevent eight MRSA infections while prioritising TB screening would prevent 24 cases of active TB and one death. Conclusion Our findings support the decision to advise against screening for MRSA before TB among newly arrived asylum seekers. The model was an effective tool for comparing screening priorities and can be applied to other scenarios in other countries.
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Affiliation(s)
- Anders Skyrud Danielsen
- Department of Antibiotic Resistance and Infection Prevention, Norwegian Institute of Public Health, Oslo, Norway
| | - Petter Elstrøm
- Department of Antibiotic Resistance and Infection Prevention, Norwegian Institute of Public Health, Oslo, Norway
| | - Trude Margrete Arnesen
- Department of Tuberculosis, Blood Borne and Sexually Transmitted Infections, Norwegian Institute of Public Health, Oslo, Norway
| | - Unni Gopinathan
- Cluster for Global Health, Norwegian Institute of Public Health & Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Oliver Kacelnik
- Department of Antibiotic Resistance and Infection Prevention, Norwegian Institute of Public Health, Oslo, Norway
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Wüthrich D, Gautsch S, Spieler-Denz R, Dubuis O, Gaia V, Moran-Gilad J, Hinic V, Seth-Smith HM, Nickel CH, Tschudin-Sutter S, Bassetti S, Haenggi M, Brodmann P, Fuchs S, Egli A. Air-conditioner cooling towers as complex reservoirs and continuous source of Legionella pneumophila infection evidenced by a genomic analysis study in 2017, Switzerland. ACTA ACUST UNITED AC 2020; 24. [PMID: 30696527 PMCID: PMC6351994 DOI: 10.2807/1560-7917.es.2019.24.4.1800192] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Introduction Water supply and air-conditioner cooling towers (ACCT) are potential sources of Legionella pneumophila infection in people. During outbreaks, traditional typing methods cannot sufficiently segregate L. pneumophila strains to reliably trace back transmissions to these artificial water systems. Moreover, because multiple L. pneumophila strains may be present within these systems, methods to adequately distinguish strains are needed. Whole genome sequencing (WGS) and core genome multilocus sequence typing (cgMLST), with their higher resolution are helpful in this respect. In summer 2017, the health administration of the city of Basel detected an increase of L. pneumophila infections compared with previous months, signalling an outbreak. Aim We aimed to identify L. pneumophila strains populating suspected environmental sources of the outbreak, and to assess the relations between these strains and clinical outbreak strains. Methods An epidemiological and WGS-based microbiological investigation was performed, involving isolates from the local water supply and two ACCTs (n = 60), clinical outbreak and non-outbreak related isolates from 2017 (n = 8) and historic isolates from 2003–2016 (n = 26). Results In both ACCTs, multiple strains were found. Phylogenetic analysis of the ACCT isolates showed a diversity of a few hundred allelic differences in cgMLST. Furthermore, two isolates from one ACCT showed no allelic differences to three clinical isolates from 2017. Five clinical isolates collected in the Basel area in the last decade were also identical in cgMLST to recent isolates from the two ACCTs. Conclusion Current outbreak-related and historic isolates were linked to ACCTs, which form a complex environmental habitat where strains are conserved over years.
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Affiliation(s)
- Daniel Wüthrich
- Swiss Institute of Bioinformatics, Basel, Switzerland.,Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland.,Division of Clinical Microbiology, University Hospital Basel, Basel, Switzerland
| | | | - Ruth Spieler-Denz
- Department of Health, Medical Services, Canton of Basel-Stadt, Basel, Switzerland
| | | | - Valeria Gaia
- National Reference Center for Legionella, Department of Laboratory medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Jacob Moran-Gilad
- Public Health Services, Ministry of Health, Jerusalem, Israel.,Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Vladimira Hinic
- Division of Clinical Microbiology, University Hospital Basel, Basel, Switzerland
| | - Helena Mb Seth-Smith
- Swiss Institute of Bioinformatics, Basel, Switzerland.,Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland.,Division of Clinical Microbiology, University Hospital Basel, Basel, Switzerland
| | - Christian H Nickel
- Division of Emergency Medicine, University Hospital Basel, Basel, Switzerland
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Stefano Bassetti
- Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Monika Haenggi
- Department of Health, Medical Services, Canton of Basel-Country, Liestal, Switzerland
| | | | - Simon Fuchs
- Department of Health, Medical Services, Canton of Basel-Stadt, Basel, Switzerland
| | - Adrian Egli
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland.,Division of Clinical Microbiology, University Hospital Basel, Basel, Switzerland
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12
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Methicillin-resistant Staphylococcus aureus carriage rate and molecular characterization of the staphylococcal cassette chromosome mec among Syrian refugees in Iraq. Int J Infect Dis 2020; 91:218-222. [DOI: 10.1016/j.ijid.2019.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/03/2019] [Accepted: 12/05/2019] [Indexed: 01/02/2023] Open
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Sloth LB, Nielsen RT, Østergaard C, Nellums LB, Hargreaves S, Friedland JS, Norredam M. Antibiotic resistance patterns of Escherichia coli in migrants vs non-migrants: a study of 14 561 urine samples. J Travel Med 2019; 26:taz080. [PMID: 31651032 PMCID: PMC6927324 DOI: 10.1093/jtm/taz080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 10/10/2019] [Accepted: 10/10/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND To investigate the distribution of urine isolates and antibiotic resistance patterns in the predominant uropathogen Escherichia coli in migrant and non-migrant individuals. METHODS We linked a cohort consisting of all migrants obtaining residence as refugees or family-reunited migrants in Denmark between January 1993 and December 2015 to hospital urine samples examined from January 2000 to December 2015 at the Department of Microbiology, University Hospital Hvidovre, Denmark. Samples from non-migrant individuals, Danish-born from Danish parents, were included as comparison. Analysis was carried out using multivariate logistic regression. RESULTS There were 14 561 first-time urine samples included, with E. coli being the most prevalent bacterial pathogen. Of the identified isolates, 4686/11 737 were E. coli among non-migrants and 1032/2824 among migrants.Sulfamethoxazol-Trimethoprim (SXT) resistance was found in 34.3% (350/1020) of E. coli isolates among migrants and 23.2% (1070/4619) among non-migrant patients [odds ratio (OR) 1.73, 95% confidence interval (CI): 1.47-2.03]. Ciprofloxacin resistance was found in 5.8% (36/618) of isolates among migrants and 2.2% (67/3092) among non-migrants (OR 2.20, 95% CI: 1.37-3.53). Gentamicin (GEN) resistance was seen in 10.8% (61/565) and 4.7% (110/2328) of isolates (OR 2.33, 95% CI:1.63-3.34), Cefuroxime resistance in 8.5% (87/1019) and 3.4% (158/4618) (OR 2.40, 95% CI:1.77-3.24), Ampicillin (AMP) resistance in 51.4% and 40.8% (OR 1.65, 95% CI: 1.42-1.92) and Piperacillin-Tazobactam resistance in 6.9% (30/432) and 4.2% (65/1532) for migrant and non-migrant patients, respectively. When stratifying according to migrant status, family-reunited had higher odds of resistance than refugees for SXT, GEN and AMP. CONCLUSIONS Prevalence of antibiotic resistance was significantly higher in E. coli isolates among migrants, both refugees and family-reunited, than non-migrant patients. Differences could not be explained by comorbidity or income. The results emphasize the importance of urine sample testing in both local-born and migrants before antibiotic start-up and point to the benefit of considering migration to secure individual treatment and equal health outcomes.
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Affiliation(s)
- Louise B Sloth
- Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital Hvidovre, Hvidovre, Denmark
| | - Rikke T Nielsen
- Department of Clinical Microbiology, University Hospital Hvidovre, Hvidovre, Denmark
- Research Centre for Migration, Ethnicity and Health, University of Copenhagen, Copenhagen, Denmark
| | - Christian Østergaard
- Department of Clinical Microbiology, University Hospital Hvidovre, Hvidovre, Denmark
| | - Laura B Nellums
- Infection and Immunity, St. George’s, University of London, London, UK
| | - Sally Hargreaves
- Infection and Immunity, St. George’s, University of London, London, UK
| | - Jon S Friedland
- Infection and Immunity, St. George’s, University of London, London, UK
| | - Marie Norredam
- Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital Hvidovre, Hvidovre, Denmark
- Research Centre for Migration, Ethnicity and Health, University of Copenhagen, Copenhagen, Denmark
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Abstract
Antimicrobial resistance (AMR) is on the rise and spreading rapidly worldwide. Low- and middle-income countries, because of weak health systems, are particularly vulnerable to this increase. Population mobility further fuels the globalization of AMR, with travelers and migrants at significant risk of harboring drug-resistant organisms. This article provides an overview of the factors that contribute to the emergence, spread, and persistence of AMR, particularly antibiotic-resistance, in the tropics. Also addressed are clinical implications of this emergent global crisis for migrants and travelers, using specific scenarios commonly encountered in those populations.
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Meyer Sauteur PM, Stevens MJA, Paioni P, Wüthrich D, Egli A, Stephan R, Berger C, Bloemberg GV. Siblings with typhoid fever: An investigation of intrafamilial transmission, clonality, and antibiotic susceptibility. Travel Med Infect Dis 2019; 34:101498. [PMID: 31580900 DOI: 10.1016/j.tmaid.2019.101498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/27/2019] [Accepted: 09/28/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Typhoid fever usually manifests as an acute disease. However, asymptomatic carriage with Salmonella Typhi may occur. This study investigated a family setting of severe typhoid fever in Switzerland months after return from Bangladesh. METHOD Standard microbiological procedures were performed. Testing for S. Typhi IgM antibodies was done using a novel immunochromographic lateral flow assay. Whole genome sequencing (WGS) followed by comparative core genome multilocus sequence typing (cgMLST) was performed on the S. Typhi isolates. RESULTS Four months after returning from a visit to Bangladesh sibling 1 (9 months) was diagnosed with a S. Typhi meningitis and sibling 3 (8 years) was identified as asymptomatic S. Typhi carrier. Sibling 2 (2 years) was retrospectively diagnosed with typhoid fever by IgM serology at the time point of admission to the hospital. Parents were asymptomatic and culture-negative. WGS analysis of family S. Typhi isolates showed clonality and strongest homology with S. Typhi strains occurring in Bangladesh. The S. Typhi strain showed resistance against fluoroquinolones. A 4-week course of ceftriaxone resulted in full recovery of sibling 1. S. Typhi was eradicated from sibling 3 following azithromycin treatment for 14 days. CONCLUSION S. Typhi, acquired from a visit to Bangladesh, was most likely transmitted within the family from one brother as asymptomatic shedder to his 9-month-old brother who manifested S. Typhi meningitis as a very rare and life-threatening presentation of typhoid fever. S. Typhi infection should be considered even in case of uncommon manifestations and irrespective of the interval between disease presentation and travel to an endemic area.
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Affiliation(s)
- Patrick M Meyer Sauteur
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Switzerland
| | - Marc J A Stevens
- Institute for Food Safety and Hygiene, University of Zurich, Switzerland
| | - Paolo Paioni
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Switzerland
| | - Daniel Wüthrich
- Clinical Bacteriology & Mycology, University Hospital Basel, Basel, Switzerland; Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland; Swiss Institute of Bioinformatics, Basel, Switzerland
| | - Adrian Egli
- Clinical Bacteriology & Mycology, University Hospital Basel, Basel, Switzerland; Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Roger Stephan
- Swiss National Center for Enteropathogenic Bacteria and Listeria (NENT), Institute for Food Safety and Hygiene, University of Zurich, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Switzerland
| | - Guido V Bloemberg
- Swiss National Center for Enteropathogenic Bacteria and Listeria (NENT), Institute for Food Safety and Hygiene, University of Zurich, Switzerland.
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16
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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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17
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Egli A, Koch D, Danuser J, Hendriksen RS, Driesen S, Schmid DC, Neher R, Mäusezahl M, Seth-Smith HMB, Bloemberg G, Tschudin-Sutter S, Endimiani A, Perreten V, Greub G, Schrenzel J, Stephan R. Symposium report: One Health meets sequencing. Microbes Infect 2019; 22:1-7. [PMID: 31401354 DOI: 10.1016/j.micinf.2019.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 07/20/2019] [Accepted: 07/21/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Adrian Egli
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland; Applied Microbiology Research, University of Basel, Basel, Switzerland.
| | - Daniel Koch
- Federal Office of Public Health, Liebefeld, Switzerland
| | - Jürg Danuser
- Federal Food Safety and Veterinary Office, Bern, Switzerland
| | | | | | | | - Richard Neher
- Swiss Institute of Bioinformatics (SIB), Basel, Switzerland; Biozentrum, University of Basel, Basel, Switzerland
| | | | - Helena M B Seth-Smith
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland; Applied Microbiology Research, University of Basel, Basel, Switzerland; Swiss Institute of Bioinformatics (SIB), Basel, Switzerland
| | - Guido Bloemberg
- National Center for Enteropathogenic Bacteria and Listeria (NENT), Institute for Food Safety and Hygiene, University of Zurich, Zurich, Switzerland
| | - Sarah Tschudin-Sutter
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Andrea Endimiani
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Vincent Perreten
- Institute of Veterinary Bacteriology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Gilbert Greub
- Institute of Microbiology, University Hospital Lausanne, Lausanne, Switzerland
| | - Jacques Schrenzel
- Bacteriology and Genomics Research Laboratories, University Hospital Geneva, Geneva, Switzerland
| | - Roger Stephan
- Institute for Food Safety and -hygiene, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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18
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Ergönül Ö, Tülek N, Kayı I, Irmak H, Erdem O, Dara M. Profiling infectious diseases in Turkey after the influx of 3.5 million Syrian refugees. Clin Microbiol Infect 2019; 26:307-312. [PMID: 31284037 PMCID: PMC7129060 DOI: 10.1016/j.cmi.2019.06.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 02/07/2023]
Abstract
Background Since 2011, the conflict in Syria has led to over five million refugees. Turkey hosts the highest number of Syrian refugees in the world. By February 2019 over 3.6 million people had fled to Turkey to seek safety. Only 6.1% of Syrian refugees live in temporary shelters. Owing to the disrupted healthcare services, many children coming from the conflict zones are less likely to have received vaccination. In temporary shelters immunization coverage is >95% and the refugee population is receptive to vaccination. Aims The objective of this study was to review the infectious diseases situation among Syrian refugees in Turkey. Sources We have reviewed the reports and studies provided by the governmental and non-governmental organizations and obtained more detailed data from the Ministry of Health in Turkey. Content Between 2012 and 2016, 1 299 209 cases of respiratory tract infection and 158 058 episodes of diarrhoea with 59 bloody diarrhoeas were reported; 1354 hepatitis A cases and 108 active tuberculosis cases were detected and treated in the temporary shelters for Syrian refugees. Overall in Turkey, 7794 cutaneous leishmaniasis have been reported. Implications Since the influx of Syrian refugees, there has been an increase in cases of leishmaniasis and measles. No significant increase was detected for tuberculosis, other vector-borne infections, and healthcare associated or sexually transmitted infections. The Syrian refugees can be considered as a vulnerable group in Turkey due to their living and working conditions. Based on available data and our detailed analysis, the numbers show a stable situation regarding infectious diseases.
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Affiliation(s)
- Ö Ergönül
- Koç University, School of Medicine, Infectious Diseases Department, Istanbul, Turkey.
| | - N Tülek
- Atılım University, Faculty of Medicine, Ankara, Turkey
| | - I Kayı
- Koç University, School of Medicine, Department of Public Health, Istanbul, Turkey
| | - H Irmak
- Ministry of Health, Public Health Institute, Ankara, Turkey
| | - O Erdem
- Ministry of Health, Public Health Institute, Ankara, Turkey
| | - M Dara
- Communicable Diseases, WHO Regional Office for Europe, Copenhagen, Denmark
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19
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Abstract
Migration is increasing and practitioners need to be aware of the unique health needs of this population. The prevalence of infectious diseases among migrants varies and generally mirrors that of their countries of origin, but is modified by the circumstance of migration, the presence of pre-arrival screening programs and post arrival access to health care. To optimize the health of migrants practitioners; (1) should take all opportunities to screen migrants at risk for latent infections such as tuberculosis, chronic hepatitis B and C, HIV, strongyloidiasis, schistosomiasis and Chagas disease, (2) update routine vaccines in all age groups and, (3) be aware of "rare and tropical infections" related to migration and return travel.
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Affiliation(s)
- Christina Greenaway
- Division of Infectious Diseases, Jewish General Hospital, Room E0057, 3755 Côte Ste-Catherine Road, Montreal, Quebec H3T 1E2, Canada; Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, 3755 Côte Ste-Catherine Road, Montreal, Quebec H3T 1E2, Canada; J.D. MacLean Center for Tropical Diseases at McGill, McGill University Health Centre, Glen Site, 1001 Décarie Boulevard, Montreal, Quebec H4A 3J1, Canada.
| | - Francesco Castelli
- University Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili, Piazza del Mercato, 15, Lombardy, Brescia 25121, Italy; UNESCO Chair "Training and Empowering Human Resources for Health Development in Resource-Limited Countries", University of Brescia, Brescia, Italy
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Methicillin-Resistant Staphylococcus aureus (MRSA): Prevalence and Antimicrobial Sensitivity Pattern among Patients-A Multicenter Study in Asmara, Eritrea. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2019; 2019:8321834. [PMID: 30881532 PMCID: PMC6381584 DOI: 10.1155/2019/8321834] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/08/2018] [Accepted: 12/17/2018] [Indexed: 12/04/2022]
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) is a well-recognized public health problem throughout the world. The evolution of new genetically distinct community-acquired and livestock-acquired MRSA and extended resistance to other non-β-lactams including vancomycin has only amplified the crisis. This paper presents data on the prevalence of MRSA and resistance pattern to other antibiotics on the selected specimen from two referral hospitals in Asmara, Eritrea. Method A cross-sectional study was conducted among 130 participants recruited from two referral hospitals in Asmara, Eritrea. Isolation of S. aureus was based on culture and biochemical profiles. Standard antimicrobial disks representing multiple drug classes were subsequently set for oxacillin, gentamicin, erythromycin, and vancomycin. Data were analyzed using SPSS version 20 software. Results S. aureus isolation rate from the 130 samples was 82 (63.1%). Patients <18 years of age were more likely to be colonized by S. aureus compared to patients above 61 years. The proportion of MRSA among the isolates was 59 (72%), methicillin-intermediate S. aureus (MISA) was 7 (8.5%), and methicillin-sensitive S. aureus (MSSA) was 15 (19.5%). The isolates were mostly from the pus specimen in burn, diabetic, and surgical wound patients. Antimicrobial susceptibility test showed that 13 (15.9%) of the isolates were resistant to vancomycin, 9 (11.0%) to erythromycin, and 1 (1.2%) to gentamicin. Coresistance of MRSA isolates to some commonly used antibiotics was also noted: oxacillin/erythromycin 5 (6.1%) and oxacillin/vancomycin 9 (11%). A few isolates were resistant to oxacillin/vancomycin/erythromycin 2 (2.4%) and oxacillin/gentamicin and erythromycin 1 (1.2%). Conclusion This study reports a relatively high prevalence of MRSA. Isolates that are resistant to other tested antibiotics including vancomycin are also reported. The data have important implication for quality of patients care in the two settings: antibiotic selection and infection control practices, and the need for additional studies.
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Fily F, Ronat JB, Malou N, Kanapathipillai R, Seguin C, Hussein N, Fakhri RM, Langendorf C. Post-traumatic osteomyelitis in Middle East war-wounded civilians: resistance to first-line antibiotics in selected bacteria over the decade 2006-2016. BMC Infect Dis 2019; 19:103. [PMID: 30704410 PMCID: PMC6357381 DOI: 10.1186/s12879-019-3741-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 01/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND War-wounded civilians in Middle East countries are at risk of post-traumatic osteomyelitis (PTO). We aimed to describe and compare the bacterial etiology and proportion of first-line antibiotics resistant bacteria (FLAR) among PTO cases in civilians from Syria, Iraq and Yemen admitted to the reconstructive surgical program of Médecins Sans Frontières (MSF) in Amman, Jordan, and to identify risk factors for developing PTO with FLAR bacteria. METHODS We retrospectively analyzed the laboratory database of the MSF program. Inclusion criteria were: patients from Iraq, Yemen or Syria, admitted to the Amman MSF program between October 2006 and December 2016, with at least one bone biopsy sample culture result. Only bone samples taken during first orthopedic surgery were included in the analysis. To assess factors associated with FLAR infection, logistic regression was used to estimate odds ratio (ORs) and 95% confidence intervals (CI). RESULTS 558 (76.7%) among 727 patients included had ≥1 positive culture results. 318 were from Iraq, 140 from Syria and 100 from Yemen. Median time since injury was 19 months [IQR 8-40]. Among the 732 different bacterial isolates, we identified 228 Enterobacteriaceae (31.5%), 193 Staphylococcus aureus (26.3%), 99 Pseudomonas aeruginosa (13.5%), and 21 Acinetobacter baumanii (2.8%). Three hundred and sixty four isolates were FLAR: 86.2% of Enterobacteriaceae, 53.4% of Pseudomonas aeruginosa, 60.5% of S. aureus and 45% of Acinetobacter baumannii. There was no difference in bacterial etiology or proportion of FLAR according to the country of origin. In multivariate analysis, a FLAR infection was associated with an infection of the lower extremity, with a time since the injury ≤12 months compared with time > 30 months and with more than 3 previous surgeries. CONCLUSIONS Enterobacteriaceae were frequently involved in PTO in war wounded civilians from Iraq, Yemen and Syria between 2006 and 2016. Proportion of FLAR was high, particularly among Enterobacteriaceae, regardless of country of origin.
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Affiliation(s)
- Fabien Fily
- Epicentre, 55 rue Crozatier, 75012, Paris, France. .,Infectious Diseases Unit, Broussais Hospital, Saint Malo, France.
| | | | - Nada Malou
- Médecins Sans Frontières, 8 rue St Sabin, 75011, Paris, France
| | | | - Caroline Seguin
- Médecins Sans Frontières, 8 rue St Sabin, 75011, Paris, France
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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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Hajj A, Adaimé A, Hayajneh W, Abdallah A, Itani T, Hakimé N, Mallah M, Alsamarneh R, Badal R, Sarkis DK. Post Syrian war impact on susceptibility rates and trends in molecular characterization of Enterobacteriaceae. Future Microbiol 2018; 13:1419-1430. [DOI: 10.2217/fmb-2018-0109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective: Describe susceptibility and molecular profiles among Enterobacteriaceae pathogens and to explore if war, among other factors, can affect antimicrobial resistance. Methods: Clinical isolates from the Study for Monitoring Antimicrobial Resistance Trends associated with urinary tract and intra-abdominal infections between 2011 and 2015 were identified in Lebanon and Jordan. Susceptibility testing and molecular characterization were performed as per standard methods. Results: A total of 1486 Enterobacteriaceae pathogens (including unusual pathogens) were identified. Incidence rates of extended spectrum β-lactamases were high with an overall higher prevalence of resistance in Jordan compared with Lebanon. CTX-M-15 was the most prevalent extended spectrum β-lactamases produced and OXA-48 the most reported carbapenemases subtype. Conclusion: Changes in healthcare system due to war could impact regional resistance patterns and which requires a continuous surveillance program and containment plan.
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Affiliation(s)
- Aline Hajj
- Faculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon
- Laboratoire de Pharmacologie, Pharmacie Clinique et Contrôle de Qualité des Médicaments, Saint-Joseph University, Beirut, Lebanon
| | - André Adaimé
- Faculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon
- Molecular Microbiology Laboratory, Saint-Joseph University, Beirut, Lebanon
| | - Wail Hayajneh
- Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan
| | | | - Tarek Itani
- Faculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon
- Molecular Microbiology Laboratory, Saint-Joseph University, Beirut, Lebanon
| | - Noha Hakimé
- Department of Clinical Laboratory, Saint George Hospital, University Medical Center, Beirut, Lebanon
| | - May Mallah
- Molecular Microbiology Laboratory, Saint-Joseph University, Beirut, Lebanon
| | - Reema Alsamarneh
- Laboratory Department, King Abdullah University Hospital, Irbid, Jordan
| | - Robert Badal
- International Health Management Associates, Inc., Schaumburg, Illinois, USA
| | - Dolla K Sarkis
- Faculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon
- Molecular Microbiology Laboratory, Saint-Joseph University, Beirut, Lebanon
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Jakovljevic M, Al Ahdab S, Jurisevic M, Mouselli S. Antibiotic Resistance in Syria: A Local Problem Turns Into a Global Threat. Front Public Health 2018; 6:212. [PMID: 30116726 PMCID: PMC6084506 DOI: 10.3389/fpubh.2018.00212] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 07/09/2018] [Indexed: 11/20/2022] Open
Abstract
Pharmaceutical sector of Syrian Arab Republic before the war was characterized by bold and successful development since the late 1980s. With the beginning of war in the country back in March 2011, momentum has changed significantly. Traumatism, communicable diseases related to morbidity and mortality as well as wound infections became particularly hot public health concern. This relates not only to the direct victims of military conflict but also to the displaced civilians, refugees, and ordinary citizens alike. Evolving legislative framework in Syria since 1980s tolerated dispensing of antibiotics without appropriate prescription. Such practice led to spreading of antibiotic resistance among the local bacteria frequently causing both community-acquired and nosocomial infections. Laboratory findings of resistant bacteria strains among the Syrian refugees in some European countries serve as evidence of concern spreading far beyond Middle East. Practice of self-diagnosis and self-medication with antibiotics by patients themselves and restraint to pharmacist advice is widespread. A number of recommendations is presented to stakeholders to compact antibiotic resistance after the peace is established in the country. The successful implementation of such recommendations is the way to preserve shrinking golden reserve of highly potent antibiotics as it is the last defense line against resistant bacterial strains causing severe life—threatening infections.
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Affiliation(s)
- Mihajlo Jakovljevic
- Global Health, Economics and Policy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Sanaa Al Ahdab
- Faculty of Pharmacy, Arab International University, Daraa, Syria
| | - Milena Jurisevic
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Sulaiman Mouselli
- Faculty of Business Administration, Arab International University, Daraa, Syria
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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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Frickmann H, Köller T, Hagen RM, Ebert KP, Müller M, Wenzel W, Gatzer R, Schotte U, Binder A, Skusa R, Warnke P, Podbielski A, Rückert C, Kreikemeyer B. Molecular Epidemiology of Multidrug-Resistant Bacteria Isolated from Libyan and Syrian Patients with War Injuries in Two Bundeswehr Hospitals in Germany. Eur J Microbiol Immunol (Bp) 2018; 8:1-11. [PMID: 29760959 PMCID: PMC5944420 DOI: 10.1556/1886.2018.00002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 01/31/2018] [Indexed: 12/16/2022] Open
Abstract
Introduction We assessed the molecular epidemiology of multidrug-resistant bacteria colonizing or infecting war-injured patients from Libya and Syria who were treated at the Bundeswehr hospitals Hamburg and Westerstede, Germany. Methods Enterobacteriaceae and Gram-negative rod-shaped nonfermentative bacteria with resistance against third-generation methoxyimino cephalosporins or carbapenems as well as methicillin-resistant Staphylococcus aureus (MRSA) from war-injured patients from Libya and Syria were assessed by molecular typing, i.e., spa typing for MRSA strains and rep-PCR and next-generation sequencing (NGS) for Gram-negative isolates. Results A total of 66 isolates were assessed – comprising 44 Enterobacteriaceae, 16 nonfermentative rod-shaped bacteria, and 6 MRSA from 22 patients – and 8 strains from an assessment of the patient environment comprising 5 Enterobacteriaceae and 3 nonfermentative rod-shaped bacteria. Although 24 out of 66 patient strains were isolated more than 3 days after hospital admission, molecular typing suggested only 7 likely transmission events in the hospitals. Identified clonal clusters primarily suggested transmission events in the country of origin or during the medical evacuation flights. Conclusions Nosocomial transmissions in hospital can be efficiently prevented by hygiene precautions in spite of heavy colonization. Transmission prior to hospital admission like on evacuation flights or in crises zones needs further assessment.
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Affiliation(s)
- Hagen Frickmann
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, Hamburg, Germany.,Institute of Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
| | - Thomas Köller
- Institute of Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
| | - Ralf Matthias Hagen
- Department of Preventive Medicine, Bundeswehr Medical Academy, Munich, Germany
| | - Klaus-Peter Ebert
- Hygiene Department, Bundeswehr Hospital Westerstede, Westerstede, Germany
| | - Martin Müller
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Werner Wenzel
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, Hamburg, Germany.,Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Renate Gatzer
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Ulrich Schotte
- Laboratory Department II, Central Institute of the Bundeswehr Kiel, Kiel-Kronshagen, Germany
| | - Alfred Binder
- Laboratory Department II, Central Institute of the Bundeswehr Kiel, Kiel-Kronshagen, Germany
| | - Romy Skusa
- Institute of Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
| | - Philipp Warnke
- Institute of Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
| | - Andreas Podbielski
- Institute of Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
| | - Christian Rückert
- Centrum for Biotechnology (CeBiTec), University Bielefeld, Bielefeld, Germany
| | - Bernd Kreikemeyer
- Institute of Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
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Correction: A Cross-Sectional Study of Colonization Rates with Methicillin-Resistant Staphylococcus aureus (MRSA) and Extended-Spectrum Beta-Lactamase (ESBL) and Carbapenemase-Producing Enterobacteriaceae in Four Swiss Refugee Centres. PLoS One 2017; 12:e0174911. [PMID: 28346533 PMCID: PMC5367827 DOI: 10.1371/journal.pone.0174911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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