Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

Abstract

SummaryBackgroundRates 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.MethodsFor 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.FindingsWe 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.InterpretationMigrants 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...

Antibiotic-resistant pathogens in different patient settings and identification of surveillance gaps in Switzerland – a systematic review

“…Similar to our data, a recently published review on AMR among European migrants found a high prevalence of MRSA (8%) and resistant Gram-negative bacteria (27%), concluding that living conditions, access to healthcare and AMR detection should be improved in this high-risk population [75]. In line with our findings, data from Germany suggest that ESBL-colonisation seems to be common among refugees, whereas CPE are rarely detected [76].…”

A systematic review on the relationship between international migration and antimicrobial resistance

“…This systematic review shows that the majority of the included studies analysing the burden of AMR on migrants as compared to the local population of the host country, present a higher prevalence in the migrant population. These results con rm the emerge of the circulation of resistant strains among migrant groups being highlighted in previous research and reports of international health organisations like the WHO [15,16,[22][23][24].…”

“…The review found a high percentage of resistant strains have been circulating among refugees and asylum seekers. Focusing in Europe, Nellums et al [16] analysed 23 observational studies that reported on migration and AMR in 2319 migrants, including methicillin-resistant Staphylococcus aureus and antibiotic-resistant Gram-negative bacteria. The results showed a combined prevalence of any infection by resistant bacteria in migrants of 25.4% (I2 = 98%), with refugees and asylum seekers having a signi cantly higher risk than other groups of migrants and the general population (33% vs. 6%, I2 = 92% and 98%, respectively), with no evidence of AMR transmission from migrants to host populations.…”

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