Chukwudile Bridget, Pan Daniel, Silva Luisa, Gogoi Mayuri, Al-Oraibi Amani, Bird Paul, George Nisha, Thompson Hayley A, Baggaley Rebecca F, Hargreaves Sally, Pareek Manish, Nellums Laura B
Nottingham Centre for Public Health and Epidemiology, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom.
Development Centre for Population Health, University of Leicester, Leicester, United Kingdom.
EClinicalMedicine. 2024 Sep 5;75:102801. doi: 10.1016/j.eclinm.2024.102801. eCollection 2024 Sep.
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.
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.
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%, = 100%) compared to a 25.4% seen in the previous review; gram-negative bacteria 31.0% (95% CI 20.0%-44.0%, = 100%), and methicillin-resistant staphylococcus aureus 10.0% (95% CI 5.0%-16.0%, = 99%). Drug-resistant bacteria were more prevalent in community settings in large migrant populations (pooled prevalence: 41.0%, 95% CI 24.0%-60.0%, = 99%) than in hospitals (21.0%, 95% CI 12.0%-32.0%, = 99%). AMR estimates in 'other' migrants were 32.0%, (95% CI 12.0%-57.0%, = 100%) and 28.0% (95% CI 18.0%-38.0%, = 100%) in forced migrants. No firm evidence of AMR acquisition with arrival time or length of stay in the host country was found.
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.
There was no funding source for this study.
抗菌药物耐药性（AMR）是一个关键的全球卫生问题。先前的一项系统评价表明，欧洲的移民面临更高的AMR风险。自新冠疫情以来，抗生素使用模式、AMR和移民情况发生了迅速变化。我们旨在提供一份关于欧洲移民中AMR当前分布情况的最新证据综述。
我们按照PRISMA指南（PROSPERO编号：CRD42022343263）进行了系统评价和荟萃分析。我们检索了18项数据库（MEDLINE、Embase、PubMed和Scopus），时间跨度从2017年1月18日至2023年1月18日，以识别观察性研究中的原始数据，这些研究报告了欧洲经济区（EEA）和欧盟15国（EU - 15）国家中移民的任何经实验室确认的AMR情况，使用了超过7个关于移民的关键检索词以及超过70个关于AMR和欧洲国家的检索词。结局指标为AMR细菌感染或定植。使用乔安娜·布里格斯研究所观察性研究批判性评价清单评估方法学质量。我们对AMR生物体感染和/或定植的合并患病率进行了荟萃分析。
在630篇文章中，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的合并患病率为28.0%（95%置信区间18.0% - 41.0%，I² = 100%），而先前综述中的患病率为25.4%；革兰氏阴性菌为31.0%（95%置信区间20.0% - 44.0%，I² = 100%），耐甲氧西林金黄色葡萄球菌为10.0%（95%置信区间5.0% - 十六进制0%，I² = 99%）。在大型移民群体的社区环境中，耐药菌比在医院中更为普遍（合并患病率：41.0%，95%置信区间24.0% - 60.0%，I² = 99%）（医院中为21.0%，95%置信区间12.0% - 32.0%，I² = 99%）。“其他”移民中的AMR估计值为32.0%（95%置信区间12.0% - 57. /十六进制0%，I² = 100%），强迫移民中的估计值为28.0%（95%置信区间18.0% - 38.0%，I² = 100%）。未发现AMR与抵达东道国的时间或停留时间之间有确凿证据。
调查移民中AMR的研究具有高度异质性。然而，自新冠疫情以来，移民在欧洲的难民营和拘留中心等社区环境中感染耐药菌，尤其是革兰氏阴性菌的风险可能更高。我们的研究强调了这些环境中基础设施和卫生措施对于减轻耐药病原体传播的重要性。政策制定者应在可行的情况下，在移民离开原籍国之前以及抵达新国家时对其进行AMR筛查，以确保进行最佳的健康筛查、感染控制和有效治疗。
本研究无资金来源。
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