Antimicrobial resistance among migrants in Europe
Citation: Nellums LB, Thompson H, Holmes A, et al. Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis. The Lancet Infectious Diseases. 2018;18(7):796-811.
Language: Abstract and full text available in EN.
Free to view: Yes.
Funding sources: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimicrobial Resistance at Imperial College London.
What is this? The prevalence of antimicrobial resistance (AMR) is increasing globally. AMR reduces the effectiveness of antibiotics in treating bacterial infections leading to increased morbidity and mortality. It is not clear whether the high levels of migration contribute to AMR in Europe.
In this systematic review, the authors searched for peer-reviewed articles reporting information related to antimicrobial resistant infection in migrants coming to 21 European Union-15, European Economic Area countries, and Switzerland. They restricted their searches to observational studies published from January 1, 2000, to January 18, 2017. They did not restrict their searches by language. Studies focused on tuberculosis antimicrobial resistance (AMR) only were excluded. The authors included 23 articles from Austria (1), Germany (7), Greece (1), Italy (2), The Netherlands (2), Spain (6), Sweden (2), and Switzerland (2). A total of 15 articles were included in the meta-analysis. This systematic review was registered with PROSPERO, number CRD42016043681.
What was found: The prevalence of AMR was found to be slightly higher in high-migrant community settings (e.g., refugee camps, reception centres, transit centres, or detention centres) than in hospital settings. The prevalence of AMR was also reported to be higher in refugees and asylum seekers compared with other migrants. Conditions such as poor sanitation, overcrowding, and restricted access to health services might be some of the reasons for the higher prevalence of antibiotic resistant infections amongst migrants in these settings.
Based on the included studies, antibiotic-resistant organisms appeared to be acquired during or following migration. No evidence of transmission between migrants and host populations was reported. There was little evidence to suggest that migrants contribute to the AMR burden in Europe.
Implications: The authors of the review stated that targeted strategies are needed to improve the detection, treatment, and prevention of AMR in high-migrant community settings.
Other considerations: The authors of the review discussed their findings in the context of place of residence and ethnicity.
This summary was prepared by Joly Ghanawi, checked by Sneha Bhadti and Grace Meng, and finalized by Helen Worthington.