Department of Internal Medicine, Clinicum, Medical Faculty, University of Helsinki, Helsinki, Finland.
Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Euro Surveill. 2018 Nov;23(45). doi: 10.2807/1560-7917.ES.2018.23.45.1700797.
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 (MRSA), 0.7% carbapenemase-producing Enterobacteriaceae (CPE), 0.4% multiresistant (MRPA), 0.4% multiresistant (MRAB); no vancomycin-resistant (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.
简介
在卫生水平低、抗菌药物使用管理不善的国家，抗菌药物耐药性正迅速增加。耐药菌的传播对全球的医疗保健构成威胁。来自高流行国家的难民和移民可能会增加低流行国家多药耐药（MDR）细菌的数量。然而，相关数据仍然有限。
方法
我们回顾性地收集了 2010 年 1 月至 2017 年 8 月期间在赫尔辛基大学医院接受治疗的寻求庇护者和难民的微生物学和临床数据。
结果
在 447 名寻求庇护者和难民中（伊拉克：46.5%；阿富汗：10.3%；叙利亚：9.6%；索马里：6.9%），45.0%的人被 MDR 细菌定植：32.9%产生超广谱β-内酰胺酶的肠杆菌科（ESBL-PE），21.3%耐甲氧西林金黄色葡萄球菌（MRSA），0.7%碳青霉烯酶产生肠杆菌科（CPE），0.4%多药耐药（MRPA），0.4%多药耐药（MRAB）；未发现万古霉素耐药（VRE）。12.5%的患者记录了两种或两种以上 MDR 细菌株。多变量分析显示，地理区域和北欧国家以外的既往手术是 MRSA 定植的危险因素。年龄较小（<6 岁）、从到达到第一次采样的时间较短以及北欧国家以外的既往住院是 ESBL-PE 定植的危险因素。
结论
我们发现，来自当前冲突地区的寻求庇护者和难民中 MDR 细菌定植很常见。特别是，我们发现 MRSA 的患病率很高。因此，难民和移民应被纳入需要进行 MDR 筛查和医院感染控制措施的高危人群。
