Elizabeth D Hermsen, James Amos, Andy Townsend, Thomas Becker, Sally Hargreaves
{"title":"Antimicrobial resistance among refugees and asylum seekers: a global systematic review and meta-analysis","authors":"Elizabeth D Hermsen, James Amos, Andy Townsend, Thomas Becker, Sally Hargreaves","doi":"10.1016/s1473-3099(24)00578-4","DOIUrl":null,"url":null,"abstract":"Refugees and asylum seekers might have an increased risk of antimicrobial resistance (AMR) carriage or infection due to several factors, with conflict and war known to accelerate the spread of AMR. However, data are scarce on prevalence and risk factors for AMR among refugees and asylum seekers and how they are affected globally; in addition, how their risk compares to that of the host-country population is unclear. We aimed to explore and assess global AMR data among refugees and asylum seekers. Ovid (MEDLINE and Embase) and PubMed were searched for peer-reviewed primary research articles from Jan 1, 2015, to Oct 23, 2023, and articles were included if they reported carriage or infection with laboratory-confirmed drug-resistant organisms in refugees or asylum seekers from any country. Of 884 articles identified, 41 reported prevalence of AMR among 16 970 refugees and asylum seekers and were included in the study. The most common phenotypes reported were multidrug-resistant Gram-negative bacteria (n=26; prevalence ranged from 4·2% to 60·8%), methicillin-resistant <em>Staphylococcus aureus</em> (n=24; 0·92% to 73%), and extended-spectrum β-lactamase-producing Gram-negative bacteria (n=20; 1·6% to 61·1%). Refugees and asylum seekers had a higher likelihood of carriage or infection with any AMR than the host-country population (n=7849 <em>vs</em> n=81 283, respectively; odds ratio 2·88, 95% CI 2·61–3·18; <em>I</em><sup>2</sup>=94%). Refugees and asylum seekers are at an increased risk of AMR carriage and infection, with our data suggesting that refugees and asylum seekers might be exposed to conditions that support the emergence of drug resistance (including living in overcrowded camps and facing barriers to health and vaccine systems). Hence, more global and regional data on AMR are needed through strengthened surveillance programmes and health-care facilities, especially in low-income and middle-income countries. Increased efforts are needed to drive improvements in infection prevention and control (including vaccination), antimicrobial stewardship, treatment strategies tailored to groups at high risk, accessiblity to quality health care in these populations at risk globally, and address risk factors such as poor living and transit conditions.","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":"1 1","pages":""},"PeriodicalIF":36.4000,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Lancet Infectious Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/s1473-3099(24)00578-4","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
引用次数: 0
Abstract
Refugees and asylum seekers might have an increased risk of antimicrobial resistance (AMR) carriage or infection due to several factors, with conflict and war known to accelerate the spread of AMR. However, data are scarce on prevalence and risk factors for AMR among refugees and asylum seekers and how they are affected globally; in addition, how their risk compares to that of the host-country population is unclear. We aimed to explore and assess global AMR data among refugees and asylum seekers. Ovid (MEDLINE and Embase) and PubMed were searched for peer-reviewed primary research articles from Jan 1, 2015, to Oct 23, 2023, and articles were included if they reported carriage or infection with laboratory-confirmed drug-resistant organisms in refugees or asylum seekers from any country. Of 884 articles identified, 41 reported prevalence of AMR among 16 970 refugees and asylum seekers and were included in the study. The most common phenotypes reported were multidrug-resistant Gram-negative bacteria (n=26; prevalence ranged from 4·2% to 60·8%), methicillin-resistant Staphylococcus aureus (n=24; 0·92% to 73%), and extended-spectrum β-lactamase-producing Gram-negative bacteria (n=20; 1·6% to 61·1%). Refugees and asylum seekers had a higher likelihood of carriage or infection with any AMR than the host-country population (n=7849 vs n=81 283, respectively; odds ratio 2·88, 95% CI 2·61–3·18; I2=94%). Refugees and asylum seekers are at an increased risk of AMR carriage and infection, with our data suggesting that refugees and asylum seekers might be exposed to conditions that support the emergence of drug resistance (including living in overcrowded camps and facing barriers to health and vaccine systems). Hence, more global and regional data on AMR are needed through strengthened surveillance programmes and health-care facilities, especially in low-income and middle-income countries. Increased efforts are needed to drive improvements in infection prevention and control (including vaccination), antimicrobial stewardship, treatment strategies tailored to groups at high risk, accessiblity to quality health care in these populations at risk globally, and address risk factors such as poor living and transit conditions.
由于多种因素,难民和寻求庇护者携带或感染抗菌素耐药性(AMR)的风险可能会增加,众所周知,冲突和战争会加速 AMR 的传播。然而,有关难民和寻求庇护者中AMR的流行情况和风险因素以及他们在全球范围内受到何种影响的数据却很少;此外,他们的风险与东道国人口的风险相比如何也不清楚。我们旨在探索和评估全球难民和寻求庇护者中的AMR数据。我们检索了Ovid(MEDLINE和Embase)和PubMed上从2015年1月1日至2023年10月23日经同行评议的主要研究文章,如果这些文章报道了来自任何国家的难民或寻求庇护者携带或感染实验室确认的耐药菌,则将其纳入研究范围。在确定的884篇文章中,有41篇报道了16 970名难民和寻求庇护者中AMR的流行情况,并被纳入研究。报告中最常见的表型是耐多药革兰氏阴性菌(26人;流行率从4-2%到60-8%不等)、耐甲氧西林金黄色葡萄球菌(24人;0-92%到73%)和产扩展谱β-内酰胺酶革兰氏阴性菌(20人;1-6%到61-1%)。与东道国人口相比,难民和寻求庇护者携带或感染任何AMR的可能性更高(分别为7849人和81 283人;几率比2-88,95% CI 2-61-3-18;I2=94%)。难民和寻求庇护者携带和感染AMR的风险增加,我们的数据表明,难民和寻求庇护者可能会暴露在支持耐药性出现的条件下(包括生活在过度拥挤的难民营,面临卫生和疫苗系统的障碍)。因此,需要通过加强监测计划和医疗保健设施,特别是在低收入和中等收入国家,获得更多有关 AMR 的全球和区域数据。需要加大力度,推动改善感染预防和控制(包括疫苗接种)、抗菌药物管理、针对高危人群的治疗策略、这些全球高危人群获得优质医疗服务的机会,并解决生活和过境条件恶劣等风险因素。
期刊介绍:
The Lancet Infectious Diseases was launched in August, 2001, and is a lively monthly journal of original research, review, opinion, and news covering international issues relevant to clinical infectious diseases specialists worldwide.The infectious diseases journal aims to be a world-leading publication, featuring original research that advocates change or sheds light on clinical practices related to infectious diseases. The journal prioritizes articles with the potential to impact clinical practice or influence perspectives. Content covers a wide range of topics, including anti-infective therapy and immunization, bacterial, viral, fungal, and parasitic infections, emerging infectious diseases, HIV/AIDS, malaria, tuberculosis, mycobacterial infections, infection control, infectious diseases epidemiology, neglected tropical diseases, and travel medicine. Informative reviews on any subject linked to infectious diseases and human health are also welcomed.