Bridget Chukwudile, Daniel Pan, Luisa Silva, Mayuri Gogoi, Amani Al-Oraibi, Paul Bird, Nisha George, Hayley A Thompson, Rebecca F Baggaley, Sally Hargreaves, Manish Pareek, Laura B Nellums
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The pooled prevalence for any detected AMR was 28.0% (95% CI 18.0%-41.0%, <i>I</i> <sup><i>2</i></sup> = 100%) compared to a 25.4% seen in the previous review; gram-negative bacteria 31.0% (95% CI 20.0%-44.0%, <i>I</i> <sup><i>2</i></sup> = 100%), and methicillin-resistant staphylococcus aureus 10.0% (95% CI 5.0%-16.0%, <i>I</i> <sup><i>2</i></sup> = 99%). Drug-resistant bacteria were more prevalent in community settings in large migrant populations (pooled prevalence: 41.0%, 95% CI 24.0%-60.0%, <i>I</i> <sup><i>2</i></sup> = 99%) than in hospitals (21.0%, 95% CI 12.0%-32.0%, <i>I</i> <sup><i>2</i></sup> = 99%). AMR estimates in 'other' migrants were 32.0%, (95% CI 12.0%-57.0%, <i>I</i> <sup><i>2</i></sup> = 100%) and 28.0% (95% CI 18.0%-38.0%, <i>I</i> <sup>2</sup> = 100%) in forced migrants. 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引用次数: 0
摘要
背景：抗菌素耐药性（AMR）是全球关注的一个重要健康问题。之前的一项系统性研究表明，欧洲移民感染 AMR 的风险增加。自 COVID-19 大流行以来，抗生素使用、AMR 和移民模式发生了迅速变化。我们旨在就目前欧洲移民中 AMR 的分布情况提供最新的证据综述：我们按照 PRISMA 指南（PROSPERO ID：CRD42022343263）进行了系统回顾和荟萃分析。我们检索了从 2017 年 1 月 18 日到 2023 年 1 月 18 日的数据库（MEDLINE、Embase、PubMed 和 Scopus），以确定报告欧洲经济区（EEA）和欧盟 15 国（EU-15）移民中任何经实验室证实的 AMR 的观察性研究的原始数据，其中使用了 7 个以上关于移民的关键检索词和 70 个以上关于 AMR 和欧洲各国的检索词。结果是感染或定植了 AMR 细菌。方法学质量采用乔安娜-布里格斯研究所的观察性研究批判性评估核对表进行评估。我们对AMR病菌感染和/或定植的总发生率进行了荟萃分析：在 630 篇文章中，有 21 项观察性研究符合纳入标准并被纳入本综述。任何检测到的AMR的总流行率为28.0%（95% CI为18.0%-41.0%，I 2 = 100%），而之前的综述中为25.4%；革兰氏阴性菌为31.0%（95% CI为20.0%-44.0%，I 2 = 100%），耐甲氧西林金黄色葡萄球菌为10.0%（95% CI为5.0%-16.0%，I 2 = 99%）。与医院（21.0%，95% CI 12.0%-32.0%，I 2 = 99%）相比，耐药细菌在大量流动人口的社区环境中更为普遍（总流行率：41.0%，95% CI 24.0%-60.0%，I 2 = 99%）。其他 "移民的 AMR 估计值为 32.0%（95% CI 12.0%-57.0%，I 2 = 100%），被迫移民的 AMR 估计值为 28.0%（95% CI 18.0%-38.0%，I 2 = 100%）。没有发现确凿证据表明AMR的获得与抵达时间或在东道国的停留时间有关：对移民中 AMR 的调查研究存在很大差异。然而，自 COVID-19 大流行以来，移民在欧洲难民营和拘留中心等社区环境中感染耐药细菌（尤其是革兰氏阴性菌）的风险可能更高。我们的研究强调了在这些环境中采取基础设施和卫生措施以减少耐药病原体传播的重要性。在可行的情况下，政策制定者应在移民离开原籍国之前和抵达新国家后对其进行AMR筛查，以确保最佳的健康检查、感染控制和有效治疗：本研究无资金来源。
Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis - update from 2017 to 2023.
Background: Antimicrobial resistance (AMR) is a critical global health concern. A previous systematic review showed that migrants in Europe are at increased risk of AMR. Since the COVID-19 pandemic there have been rapid changes in patterns of antibiotic use, AMR, and migration. We aimed to present an updated evidence synthesis on the current distribution of AMR among migrants in Europe.
Methods: We carried out a systematic review and meta-analysis in accordance with PRISMA guidelines (PROSPERO ID: CRD42022343263). We searched databases (MEDLINE, Embase, PubMed and Scopus) from 18 January 2017 until 18 January 2023 to identify primary data from observational studies reporting any laboratory-confirmed AMR among migrants in the European Economic Area (EEA) and European Union-15 (EU-15) countries using over 7 key search terms for migrants and over 70 terms for AMR and countries in Europe. Outcomes were infection with, or colonisation of AMR bacteria. Methodological quality was assessed using Joanna Briggs Institute Critical Appraisal Checklist for Observational Studies. We meta-analysed the pooled-prevalence of infection and/or colonisation of AMR organisms.
Findings: Among 630 articles, 21 observational studies met the inclusion criteria and were included in this review. The pooled prevalence for any detected AMR was 28.0% (95% CI 18.0%-41.0%, I2 = 100%) compared to a 25.4% seen in the previous review; gram-negative bacteria 31.0% (95% CI 20.0%-44.0%, I2 = 100%), and methicillin-resistant staphylococcus aureus 10.0% (95% CI 5.0%-16.0%, I2 = 99%). Drug-resistant bacteria were more prevalent in community settings in large migrant populations (pooled prevalence: 41.0%, 95% CI 24.0%-60.0%, I2 = 99%) than in hospitals (21.0%, 95% CI 12.0%-32.0%, I2 = 99%). AMR estimates in 'other' migrants were 32.0%, (95% CI 12.0%-57.0%, I2 = 100%) and 28.0% (95% CI 18.0%-38.0%, I2 = 100%) in forced migrants. No firm evidence of AMR acquisition with arrival time or length of stay in the host country was found.
Interpretation: Studies investigating AMR in migrants are highly heterogenous. However, since the COVID-19 pandemic, migrants may be at higher risk of acquiring resistant bacteria, particularly gram-negative bacteria, within community settings such as refugee camps and detention centres in Europe. Our study highlights the importance of infrastructure and hygiene measures within these settings, to mitigate transmission of resistant pathogens. Policy-makers should screen for AMR in migrants prior to departure from countries of origin, where feasible, and upon arrival to a new country to ensure optimal health screening, infection control and effective treatment.
Funding: There was no funding source for this study.
期刊介绍：
eClinicalMedicine is a gold open-access clinical journal designed to support frontline health professionals in addressing the complex and rapid health transitions affecting societies globally. The journal aims to assist practitioners in overcoming healthcare challenges across diverse communities, spanning diagnosis, treatment, prevention, and health promotion. Integrating disciplines from various specialties and life stages, it seeks to enhance health systems as fundamental institutions within societies. With a forward-thinking approach, eClinicalMedicine aims to redefine the future of healthcare.
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