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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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2
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Osman M, Cummings KJ, El Omari K, Kassem II. Catch-22: War, Refugees, COVID-19, and the Scourge of Antimicrobial Resistance. Front Med (Lausanne) 2022; 9:921921. [PMID: 35814789 PMCID: PMC9263824 DOI: 10.3389/fmed.2022.921921] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 05/27/2022] [Indexed: 12/03/2022] Open
Abstract
Wars have hidden repercussions beyond the immediate losses of life, well-being, and prosperity. Those that flee wars and seek refuge in safer locations are not immune to the tragic impacts. Of particular concern is the susceptibility of the refugee populations to infectious diseases and antimicrobial-resistant pathogens. This poses a detrimental risk to these disenfranchised populations, who often have limited access to medical care, sanitation, and nutritious and safe food. Furthermore, antimicrobial-resistant pathogens in refugees can be both transmitted to and acquired from their hosting communities. The latter is particularly problematic when the host countries suffer from serious challenges such as limited resources, pollution, and widespread antimicrobial resistance (AMR). Here, we discuss AMR in refugees of the ongoing Syrian war, a conflict that resulted in the largest population displacement in recent history. We argue that Syrian refugees and their hosting communities are at an elevated risk of complicated and life-threatening AMR infections. We also call on the international community to address this grievous problem that threatens the disenfranchised refugee populations and can spill over across geographic borders to affect multiple countries.
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Affiliation(s)
- Marwan Osman
- Cornell Atkinson Center for Sustainability, Cornell University, Ithaca, NY, United States
- Department of Public and Ecosystem Health, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
- *Correspondence: Marwan Osman
| | - Kevin J. Cummings
- Department of Public and Ecosystem Health, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Khaled El Omari
- Quality Control Center Laboratories at the Chamber of Commerce, Industry & Agriculture of Tripoli & North Lebanon, Tripoli, Lebanon
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Issmat I. Kassem
- Center for Food Safety, Department of Food Science and Technology, University of Georgia, Griffin, GA, United States
- Issmat I. Kassem
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3
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Eiset AH, Stensvold CR, Fuursted K, Nielsen HV, Wejse C. High prevalence of methicillin-resistant Staphylococcus aureus, Giardia, and Blastocystis in asymptomatic Syrian asylum seekers in Denmark during 2016 through 2018. J Migr Health 2021; 1-2:100016. [PMID: 34405169 PMCID: PMC8352168 DOI: 10.1016/j.jmh.2020.100016] [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] [Received: 11/06/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 11/30/2022] Open
Abstract
High prevalence of intestinal parasite colonisation; all were asymptomatic. High prevalence of MRSA; low prevalence of ESBL and CPO. Recommend attention to antimicrobial resistance when attending to Syrian refugees. Recommend no routine screening for parasites in asymptomatic adult Syrian refugees.
Introduction Concerns have been raised regarding the emergence of antimicrobial-resistance and parasitic infections in the European refugee population. Here, we estimated the prevalence of intestinal parasites and selected antimicrobial-resistant bacteria in newly arrived asylum seekers in Denmark. Materials and methods Using a cross-sectional one-stage cluster sample design, adult Syrian asylum seekers were included upon arrival in Denmark. Faecal samples were collected and tested for ova and parasites, extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) and carbapenemase-producing organisms (CPO). Throat swabs were collected and analysed for methicillin-resistant Staphylococcus aureus (MRSA) and Corynebacterium diphtheriae. Results We invited 121 eligible individuals (20% of the source population) from six different asylum centres to participate, of whom 113 agreed. Throat swabs and faecal samples were received from 104 and 48 participants, respectively. Seven individuals did not provide enough material for the entire panel of faecal analyses. Three individuals (7.3%, 95%CI: 2.5–19.4%) were colonised with Giardia intestinalis and 28 (68.3%, 95%CI: 53.0–80.4%) with Blastocystis sp. (subtypes 1 [n = 5], 2 [n = 9] and 3 [n = 14]). Seven individuals (6.7%, 95%CI: 3.3–13.3%) were colonised with MRSA and one with ESBL-E. None had CPO or Corynebacterium diphtheriae and none reported any gastro-intestinal symptoms. Discussion Even with the most conservative estimates, the prevalence of Giardia intestinalis, Blastocystis sp. and MRSA was high in this asymptomatic refugee population. Conclusions We highlight the importance of raised awareness of antimicrobial-resistant bacteria when attending to newly arrived Syrian refugees. Meanwhile, our data suggest that routine screening for intestinal parasites in this population is of limited clinical relevance.
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Affiliation(s)
- Andreas Halgreen Eiset
- Center for Global Health (GloHAU), Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - Christen Rune Stensvold
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark
| | - Kurt Fuursted
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark
| | - Henrik Vedel Nielsen
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark
| | - Christian Wejse
- Center for Global Health (GloHAU), Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
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4
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Mobasherizadeh S, Shojaei H, Azadi D, Havaei SA, Ataei B, Khorvash F. Molecular Typing of Community-acquired Methicillin-Resistant Staphylococcus aureus Isolated from 2- to 6-year old Children by Staphylococcal Protein A and Agr Typing in Isfahan, Iran. Adv Biomed Res 2021; 10:3. [PMID: 33959560 PMCID: PMC8095255 DOI: 10.4103/abr.abr_139_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/20/2020] [Accepted: 09/28/2020] [Indexed: 11/08/2022] Open
Abstract
Background: Methicillin-resistant Staphylococcus aureus (MRSA) has become a considerable public health concern in the entire world due to the rapid spread of this bacterium in human community; also the epidemiology of MRSA has changed, as the isolation of MRSA strains from healthy and non-healthy patients. Therefore, the objective of this study is to determine the genetic diversity and antibiotic resistance profile of community-acquired (CA)-MRSA nasal carriage in the Iranian samples. Materials and Methods: A total of 25 CA-MRSA were isolated from the anterior nares of 410 healthy preschool children. All MRSA isolates were characterized by the detection of the toxic shock syndrome toxin-1 (TSST-1) and typed by γ-hemolysin genes, agr groups, and staphylococcal protein A (spa) typing. Kirby-Buyer antibiotic susceptibility testing was performed and interpreted as per the standard guidelines. Results: A total of 25 (6.1%) MRSA isolates were recovered from the anterior nares of 410 preschool children. Sixteen isolates (64%) were positive for the TSST-1 gene. Three agr specificity groups were determined, as follows: eight (32%) isolates belonged to agr Group I, five (20%) isolates belonged to agr Group II, and 12 (48%) isolates belonged to agr Group III. The repeated profiles of these spa types of 25 isolates were organized into eight different lineages groups. Five of lineages contained a single strain, three of lineages contained two strains, and three of lineages consisted of more than three strains. Conclusions: The results of our study show that the rate of MRSA in our region is significantly high. Additionally, spa type t037 was the predominant type among CA S. aureus.
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Affiliation(s)
- Sina Mobasherizadeh
- Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hasan Shojaei
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Davood Azadi
- Department of Laboratory Sciences, Khomein University of Medical Sciences, Khomein, Iran
| | - Seyed Asghar Havaei
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behrooz Ataei
- Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farzin Khorvash
- Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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5
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Ehlkes L, Pfeifer Y, Werner G, Ignatius R, Vogt M, Eckmanns T, Zanger P, Walter J. No evidence of carbapenemase-producing Enterobacteriaceae in stool samples of 1,544 asylum seekers arriving in Rhineland-Palatinate, Germany, April 2016 to March, 2017. ACTA ACUST UNITED AC 2020; 24. [PMID: 30808444 PMCID: PMC6446954 DOI: 10.2807/1560-7917.es.2019.24.8.1800030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction: Since 2015, increased migration from Asia and Africa to Europe has raised public health concerns about potential importation of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE), specifically those producing carbapenemases (C-PE), into European hospitals. Aims: To inform infection control practices about ESBL-PE prevalence in asylum seekers and to investigate whether C-PE prevalence exceeds that in the German population. Methods: Cross-sectional study from April 2016–March 2017. Routinely collected stool samples from asylum seekers were tested for antibiotic resistant Enterobacteriaceae. Country/region of origin and demographic characteristics were explored as risk factors for faecal colonisation. Results: Of 1,544 individuals, 294 tested positive for ESBL-PE colonisation (19.0%; 95% confidence intervals (CI): 17.0–21.0). Asylum seekers originating from Afghanistan/Pakistan/Iran had a prevalence of 29.3% (95% CI: 25.6–33.2), from Syria 20.4% (95% CI: 16.1–25.2) and from Eritrea/Somalia 11.9% (95% CI: 8.7–15.7). CTX-M-15 (79%) and CTX-M-27 (10%) were the most common ESBL determinants. Highest ESBL-PE prevalences were observed in boys under 10 years and women aged 20–39 years (interaction: p = 0.03). No individuals tested positive for C-PE. Faecal C-PE colonisation prevalence in asylum seekers was not statistically significantly different from prevalence reported in German communities. Conclusion: In absence of other risk factors, being a newly arrived asylum seeker from a region with increased faecal ESBL-PE colonisation prevalence is not an indicator for C-PE colonisation and thus not a reason for pre-emptive screening and isolation upon hospital admission.
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Affiliation(s)
- Lutz Ehlkes
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.,Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany.,Federal State Agency for Consumer & Health Protection Rhineland-Palatinate, Koblenz, Germany
| | - Yvonne Pfeifer
- Robert Koch Institute, Nosocomial Pathogens and Antibiotic Resistance, Wernigerode, Germany
| | - Guido Werner
- Robert Koch Institute, Nosocomial Pathogens and Antibiotic Resistance, Wernigerode, Germany
| | - Ralf Ignatius
- Institute of Microbiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.,MVZ Labor 28, Berlin, Germany
| | - Manfred Vogt
- Federal State Agency for Consumer & Health Protection Rhineland-Palatinate, Koblenz, Germany
| | - Tim Eckmanns
- Robert Koch Institute, Nosocomial Infections and Surveillance of Antibiotic Resistance, Berlin, Germany
| | - Philipp Zanger
- These two authors have contributed equally to this manuscript and share last authorship.,Department of Infectious Diseases, Medical Microbiology and Hygiene, University Hospitals, Heidelberg, Germany.,Heidelberg Institute of Global Health, Unit of Epidemiology and Biostatistics, University Hospitals, Heidelberg, Germany.,Federal State Agency for Consumer & Health Protection Rhineland-Palatinate, Koblenz, Germany
| | - Jan Walter
- These two authors have contributed equally to this manuscript and share last authorship.,Robert Koch Institute, Nosocomial Infections and Surveillance of Antibiotic Resistance, Berlin, Germany
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6
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Hofmann F, Heudorf U, Steul K, Wichelhaus TA, Besier S, Hogardt M, Hack D, Steinmann E, Kempf VAJ, Reinheimer C. Anamnestic risk factor evaluation of patients carrying carbapenem-resistant Enterobacterales and/or Acinetobacter baumannii - impact on infection control management at a German University Hospital. GMS HYGIENE AND INFECTION CONTROL 2020; 15:Doc05. [PMID: 32547905 PMCID: PMC7273331 DOI: 10.3205/dgkh000340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background: Carbapenem-resistant Enterobacterales and Acinetobacterbaumannii are of major concern in terms of infection prevention and control. This study evaluated factors that may increase the frequency of Enterobacterales and A. baumannii with carbapenem resistance (CR) in patients admitted to a German University Hospital for implementation of optimized infection control management. Methods: A five-year-retrospective epidemiological cohort analysis was conducted on anamnestic risk factors for carrying Enterobacterales and/or A. baumannii with CR in patients who were first tested positive for these species at University Hospital Frankfurt (UHF) between January 2013 and June 2018. Results: 364 patients were tested positive for Enterobacterales and/or A. baumannii with CR, resulting in n=400 bacterial isolates in total, with Klebsiella pneumoniae being the most frequently detected species (n=146/400; 36.5%; 95% confidence interval: 31.8–41.4). In patients who were tested positive for Enterobacterales and/or A. baumannii with CR, any hospital stay within the previous 12 months was the most frequently reported common factor (n=275/364; 75.5%; 70.8–79.9). Conclusion: A hospital stay within the previous 12 months, including hospitals in Germany and abroad, is a frequent characteristic of patients who tested positive for Enterobacterales and/or A. baumannii with CR. Upon admission, any previous hospital stay of the given patient within the previous 12 months should be determined. Infection control strategies such as screening measures need to be adapted to these patient groups in hospital settings. In order to reflect the varying determinants in “nosocomial” cases in greater detail, the existing criteria used to characterize “nosocomial detection” of gram-negative bacteria with CR should be reviewed.
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Affiliation(s)
- Franziska Hofmann
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt, Germany.,University Center of Competence for Infection Control, State of Hesse, Germany
| | - Ursel Heudorf
- Public Health Department of the City of Frankfurt/Main, Germany
| | - Katrin Steul
- Public Health Department of the City of Frankfurt/Main, Germany
| | - Thomas A Wichelhaus
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt, Germany.,University Center of Competence for Infection Control, State of Hesse, Germany
| | - Silke Besier
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt, Germany.,University Center of Competence for Infection Control, State of Hesse, Germany
| | - Michael Hogardt
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt, Germany.,University Center of Competence for Infection Control, State of Hesse, Germany
| | - Daniel Hack
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt, Germany.,University Center of Competence for Infection Control, State of Hesse, Germany
| | - Elvira Steinmann
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt, Germany.,University Center of Competence for Infection Control, State of Hesse, Germany
| | - Volkhard A J Kempf
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt, Germany.,University Center of Competence for Infection Control, State of Hesse, Germany
| | - Claudia Reinheimer
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Germany.,University Center for Infectious Diseases, University Hospital Frankfurt, Germany.,University Center of Competence for Infection Control, State of Hesse, Germany
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7
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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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8
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Reinheimer C, Abdollahi P, Zacharowski K, Meybohm P, Mutlak H, Klingebiel T, Wichelhaus TA, Kempf VAJ. Prevalence of multidrug-resistant organisms in refugee patients admitted to a German university hospital depending on duration of stay in Germany. GMS HYGIENE AND INFECTION CONTROL 2019; 14:Doc07. [PMID: 31293878 PMCID: PMC6606948 DOI: 10.3205/dgkh000323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Refugees have a significant risk of carrying multidrug-resistant organisms (MDRO), including multidrug-resistant gram-negative organisms (MDRGN) and methicillin-resistant Staphylococcus aureus (MRSA). Since the duration of MDRGN colonization has been shown to last for several months, we hypothesize that the prevalence of MDRO in refugees gradually declines during their stay in Germany to the level of MDRO prevalence in non-refugee patients. Knowledge about the dynamics of refugees' MDRO prevalence might provide the basis for appropriate infection control measures for refugees in hospitals as well as refugees' MDRO epidemiology in general. Material and methods: MDRO prevalence in 109 refugees admitted to the University Hospital Frankfurt, Germany, were compared to 819 adult controls and 224 pediatric patients admitted to the intensive care unit between June 2016 and May 2017. Results: 41.3% (95% confidence interval=31.9-51.1) of the refugees, 5.7% (4.2-7.6) of the adult controls and 8.9% (5.5-13.5) of the pediatric controls were positive for at least one MDRGN. The highest MDRGN prevalence was found in refugees who recently arrived (≤3 months) in Germany (72.4%; 52.8-87.3). Refugees' MDRGN prevalence declined continuously over time, reaching the adult and pediatric controls' MDRGN prevalence 18 months at the earliest after their arrival in Germany, i.e., 14.9% (1.8-42.8). Conclusion: This study demonstrates that refugees' MDRGN prevalence is declining over time since their arrival in Germany. 18 months after their arrival, refugees' and locals' MDRGN prevalence no longer differs significantly, although the refugees' MDRGN prevalence is still higher. A decline of MRSA prevalence was found 18 months after refugees' arrival. However, MRSA prevalence was still 14%, and thus 8 times higher than that of controls, indicating that precautionary measures continue to be necessary to prevent MRSA transmission.
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Affiliation(s)
- Claudia Reinheimer
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Germany
- University Center of Infectious Diseases, University Hospital Frankfurt, Germany
- University Center of Competence for Infection Control of the State of Hesse, Frankfurt Main, Germany
| | - Parisa Abdollahi
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Germany
- University Center of Infectious Diseases, University Hospital Frankfurt, Germany
| | - Kai Zacharowski
- University Center of Infectious Diseases, University Hospital Frankfurt, Germany
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Germany
| | - Patrick Meybohm
- University Center of Infectious Diseases, University Hospital Frankfurt, Germany
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Germany
| | - Haitham Mutlak
- University Center of Infectious Diseases, University Hospital Frankfurt, Germany
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Germany
| | - Thomas Klingebiel
- University Center of Infectious Diseases, University Hospital Frankfurt, Germany
- Department of Pediatric and Adolescent Medicine, University Hospital Frankfurt, Germany
| | - Thomas A. Wichelhaus
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Germany
- University Center of Infectious Diseases, University Hospital Frankfurt, Germany
- University Center of Competence for Infection Control of the State of Hesse, Frankfurt Main, Germany
| | - Volkhard A. J. Kempf
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, Germany
- University Center of Infectious Diseases, University Hospital Frankfurt, Germany
- University Center of Competence for Infection Control of the State of Hesse, Frankfurt Main, Germany
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9
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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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10
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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: 76] [Impact Index Per Article: 12.7] [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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11
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Kossow A, Stühmer B, Schaumburg F, Becker K, Glatz B, Möllers M, Kampmeier S, Mellmann A. High prevalence of MRSA and multi-resistant gram-negative bacteria in refugees admitted to the hospital-But no hint of transmission. PLoS One 2018; 13:e0198103. [PMID: 29851962 PMCID: PMC5978789 DOI: 10.1371/journal.pone.0198103] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 05/09/2018] [Indexed: 12/19/2022] Open
Abstract
With high numbers of refugees arriving in Europe uncertainty exists as to whether multidrug-resistant organisms are imported into the healthcare system. In our study, we identified 383 refugee-inpatients admitted to the University Hospital Münster, Germany between September 2015 and September 2016. For this patient cohort screening for Methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant Gram-negative bacteria (MDR-GNB) and Vancomycin-resistant enterococci (VRE) was recommended in our institution. Until May 2016 pre-emptive isolation was applied to all refugee-inpatients until the exclusion of these multidrug-resistant organisms. MRSA were found in 34 refugee-patients (9.8%), MDR-GNB in 25 refugee-patients (12.9%) and VRE in none of the refugee patients. We did not find any strains carrying carbapenemases. Whole genome sequencing (WGS) data demonstrated that the respective isolates were genetically heterogeneous and revealed no transmission of refugee-patient isolates to other patients. We therefore omitted pre-emptive isolation as an infection control measure for this group of patients. Furthermore, molecular typing did not show evidence for nosocomial transmission from refugee-patients to other patients. Standard hygiene measures successfully prevented the transmission of refugee-patient isolates to other patients and as a result introduction into the healthcare system. This underlines that any multidrug-resistant organisms present within this cohort are not of any extraordinary concern for health systems.
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Affiliation(s)
- Annelene Kossow
- Institute of Hygiene, University Hospital Münster, Münster, Germany
- * E-mail:
| | - Bianca Stühmer
- International Patient Management, University Hospital Münster, Münster, Germany
| | - Frieder Schaumburg
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Karsten Becker
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Birgit Glatz
- Clinic for Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
| | - Mareike Möllers
- Clinic for Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
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12
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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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13
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Ravensbergen SJ, Louka C, Lokate M, Bathoorn E, Pournaras S, van der Werf TS, de Lange WCM, Stienstra Y, Akkerman OW. Case Report: Carbapenemase-Producing Enterobacteriaceae in an Asylum Seeker with Multidrug-Resistant Tuberculosis. Am J Trop Med Hyg 2018; 98:376-378. [PMID: 29280429 PMCID: PMC5929199 DOI: 10.4269/ajtmh.17-0544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 11/10/2017] [Indexed: 03/27/2024] Open
Abstract
A Syrian asylum seeker with multidrug-resistant tuberculosis (TB) developed a bronchopleural fistula after pneumonectomy. Although screening tests were negative on admission, carbapenemase-producing Enterobacteriaceae were cultured after a few months of TB treatment. Prevalence of multidrug-resistant organisms is reported to be increased in asylum seekers compared with the general Dutch population. Arduous conditions during transit and interrupted health care delivery in our patient led to multiple-resistant microorganisms that complicated treatment.
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Affiliation(s)
- Sofanne J. Ravensbergen
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, The Netherlands
| | - Christina Louka
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, The Netherlands
- Department of Medical Microbiology, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Mariëtte Lokate
- Department of Medical Microbiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Erik Bathoorn
- Department of Medical Microbiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Spyros Pournaras
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Tjip S. van der Werf
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, The Netherlands
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wiel C. M. de Lange
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Tuberculosis Center Beatrixoord, University of Groningen, University Medical Center Groningen, Haren, The Netherlands
| | - Ymkje Stienstra
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, The Netherlands
| | - Onno W. Akkerman
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Tuberculosis Center Beatrixoord, University of Groningen, University Medical Center Groningen, Haren, The Netherlands
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14
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Kahl F, Kühlein T. Differences between the antibiotic prescribing pattern of newly arrived refugees in Germany and the German population. Confl Health 2018; 12:3. [PMID: 29422945 PMCID: PMC5787911 DOI: 10.1186/s13031-018-0139-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 01/12/2018] [Indexed: 11/12/2022] Open
Abstract
The number of refugees arriving in Europe increased dramatically in 2015, challenging the German health system. Amongst others, the treatment of infectious diseases is an important topic in refugee healthcare. A high prevalence of multi-drug-resistant organisms has been identified among the refugee population. Still, little is known about the prescription of antibiotic medication for refugees. We conducted a descriptive analysis of all antibiotics prescribed to newly arrived refugees who were treated as outpatients between 10/01/2014 and 09/30/2015 in Erlangen, an average sized German town. The City’s invoicing documents were used to collect data on prescriptions written for refugees. Basic penicillins, aminopenicillins with beta-lactamase inhibitor and cephalosporins constituted the largest proportion of antibiotics prescribed in the adult refugee group. Of these, both aminopenicillins with beta-lactamase-inhibitor as well as basic penicillins were prescribed significantly more often compared to non-refugees. We conclude that the high percentage of prescriptions of aminopenicillins with beta-lactamase inhibitor is striking and should be further investigated.
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Affiliation(s)
- Fabian Kahl
- 1Institut für Geschichte und Ethik der Medizin, Friedrich-Alexander Universität Erlangen-Nürnberg, Glückstraße 10, 91054 Erlangen, Germany
| | - Thomas Kühlein
- 2Allgemeinmedizinisches Institut, Friedrich-Alexander Universität Erlangen-Nürnberg, Universitätsstraße 29, 91054 Erlangen, Germany
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15
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Münch J, Hagen RM, Müller M, Kellert V, Wiemer DF, Hinz R, Schwarz NG, Frickmann H. Colonization with Multidrug-Resistant Bacteria - On the Efficiency of Local Decolonization Procedures. Eur J Microbiol Immunol (Bp) 2017; 7:99-111. [PMID: 28690877 PMCID: PMC5495082 DOI: 10.1556/1886.2017.00008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 04/27/2017] [Indexed: 01/16/2023] Open
Abstract
The effectiveness of a disinfectant-based decolonization strategy for multidrug-resistant bacteria like extended spectrum β-lactamase (ESBL)-positive Gram-negative bacteria with or without additional fluoroquinolon and carbapenem resistance as well as vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus was assessed. Between 2011 and 2015, 25 patients from Libya, Syria, and the Ukraine with war traumata were treated at the Bundeswehr hospital Hamburg. The patients were heavily colonized and infected with multidrug-resistant bacteria, altogether comprising 371 distinct combinations of pathogens and isolation sites. Local disinfection was assessed for effectiveness regarding successful decolonization of multidrug-resistant bacteria. Altogether, 170 cases of successful decolonization were observed, comprising 95 (55.8%) such events at sampling sites that were accessible to disinfecting procedures. The remaining 75 (44.2%) decolonization events had to be considered as spontaneous. In contrast, 95 out of 172 (55.2%) colonized isolation sites that were accessible to disinfection procedures were successfully decolonized. Patient compliance with the enforced hygiene procedures was associated with decolonization success. Systemic antibiotic therapy did not relevantly affect isolation time. Disinfecting washing moderately supports local decolonization of multidrug-resistant pathogens in comparison with spontaneous decolonization rates if the patients’ compliance with the applied hygiene procedures is ensured.
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Affiliation(s)
- Julia Münch
- Department of Internal Medicine, Bundeswehr Hospital Hamburg, Hamburg, Germany
| | - Ralf Matthias Hagen
- Department of Preventive Medicine, Bundeswehr Medical Academy, Munich, Germany
| | - Martin Müller
- Central Institute of the Bundeswehr Medical Service Kiel, Department Berlin, Berlin, Germany
| | - Viktor Kellert
- Department of Hygiene, Bundeswehr Hospital Hamburg, Hamburg, Germany
| | - Dorothea Franziska Wiemer
- Department of Tropical Medicine at the Bernhard Nocht Institute, Bundeswehr Hospital Hamburg, Hamburg, Germany
| | - Rebecca Hinz
- Institute for Medical Microbiology, Virology and Hygiene, Bundeswehr Hospital Hamburg, Hamburg, Germany
| | - Norbert Georg Schwarz
- Infectious Disease Epidemology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Hamburg, Germany
| | - Hagen Frickmann
- Department of Tropical Medicine at the Bernhard Nocht Institute, Bundeswehr Hospital Hamburg, Hamburg, Germany.,Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
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16
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Angeletti S, Cella E, Lai A, Lo Presti A, Antonelli F, Conti A, Lopalco M, Spoto S, Zehender G, Ciccozzi M. Whole-genome sequencing of Klebsiella pneumoniae MDR strain isolated in a Syrian refugee. Pathog Glob Health 2017; 111:212-215. [PMID: 28403683 DOI: 10.1080/20477724.2017.1316918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Silvia Angeletti
- a Clinical Pathology and Microbiology Unit , University Campus Bio-Medico of Rome , Rome , Italy
| | - Eleonora Cella
- b Department of Infectious, Parasitic, and Immune-Mediated Diseases, Epidemiology Unit , Reference Centre on Phylogeny, Molecular Epidemiology, and Microbial Evolution (FEMEM), National Institute of Health , Rome , Italy.,c Public Health and Infectious Diseases , Sapienza University , Rome , Italy
| | - Alessia Lai
- d Department of Biomedical and Clinical Sciences "L. Sacco", Infectious Diseases and Tropical Medicine Chair , University of Milan , Milan , Italy
| | - Alessandra Lo Presti
- b Department of Infectious, Parasitic, and Immune-Mediated Diseases, Epidemiology Unit , Reference Centre on Phylogeny, Molecular Epidemiology, and Microbial Evolution (FEMEM), National Institute of Health , Rome , Italy
| | - Francesca Antonelli
- a Clinical Pathology and Microbiology Unit , University Campus Bio-Medico of Rome , Rome , Italy
| | - Alessia Conti
- a Clinical Pathology and Microbiology Unit , University Campus Bio-Medico of Rome , Rome , Italy
| | - Maurizio Lopalco
- e Sanitary Bureau of Asylum Seekers Center of Castelnuovo di Porto , Rome , Italy.,f Auxilium Società Cooperativa Sociale , Senise , Italy
| | - Silvia Spoto
- g Internal Medicine Department , University Hospital Campus Bio-Medico , Rome , Italy
| | - Gianguglielmo Zehender
- d Department of Biomedical and Clinical Sciences "L. Sacco", Infectious Diseases and Tropical Medicine Chair , University of Milan , Milan , Italy
| | - Massimo Ciccozzi
- a Clinical Pathology and Microbiology Unit , University Campus Bio-Medico of Rome , Rome , Italy.,b Department of Infectious, Parasitic, and Immune-Mediated Diseases, Epidemiology Unit , Reference Centre on Phylogeny, Molecular Epidemiology, and Microbial Evolution (FEMEM), National Institute of Health , Rome , Italy
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17
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Exner M, Bhattacharya S, Christiansen B, Gebel J, Goroncy-Bermes P, Hartemann P, Heeg P, Ilschner C, Kramer A, Larson E, Merkens W, Mielke M, Oltmanns P, Ross B, Rotter M, Schmithausen RM, Sonntag HG, Trautmann M. Antibiotic resistance: What is so special about multidrug-resistant Gram-negative bacteria? GMS HYGIENE AND INFECTION CONTROL 2017; 12:Doc05. [PMID: 28451516 PMCID: PMC5388835 DOI: 10.3205/dgkh000290] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In the past years infections caused by multidrug-resistant Gram-negative bacteria have dramatically increased in all parts of the world. This consensus paper is based on presentations, subsequent discussions and an appraisal of current literature by a panel of international experts invited by the Rudolf Schülke Stiftung, Hamburg. It deals with the epidemiology and the inherent properties of Gram-negative bacteria, elucidating the patterns of the spread of antibiotic resistance, highlighting reservoirs as well as transmission pathways and risk factors for infection, mortality, treatment and prevention options as well as the consequences of their prevalence in livestock. Following a global, One Health approach and based on the evaluation of the existing knowledge about these pathogens, this paper gives recommendations for prevention and infection control measures as well as proposals for various target groups to tackle the threats posed by Gram-negative bacteria and prevent the spread and emergence of new antibiotic resistances.
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Affiliation(s)
- Martin Exner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | | | - Bärbel Christiansen
- Department of Internal Hygiene, Schleswig-Holstein University Hospital, Kiel, Germany
| | - Jürgen Gebel
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | | | - Philippe Hartemann
- Departement Environnement et Santé Publique S.E.R.E.S., Faculté de Médecine, Nancy, France
| | - Peter Heeg
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Germany
| | - Carola Ilschner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany
| | - Elaine Larson
- School of Nursing, Columbia University, New York, USA.,Mailman School of Public Health, Columbia University, New York, USA
| | | | | | | | - Birgit Ross
- Hospital Hygiene, Essen University Hospital, Essen, Germany
| | | | | | - Hans-Günther Sonntag
- Institute of Hygiene and Medical Microbiology, University of Heidelberg, Germany
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