A quarter of migrants to Europe infected with drug-resistant bacteria
Among refugees and asylum seekers, pooled prevalence of AMR infection or carriage was 33 percent, compared with 6 pwrcent in other migrants. In high-migrant community settings, the prevalence was 33.1 percent.
None of the articles showed evidence of high rates of onward transmission of AMR pathogens to host populations, a finding the authors say could be linked to high-migrant communities being segregated from local communities.
Poor living conditions
While many of the countries and regions that the migrants came from are known to have high rates of AMR, the authors say they found evidence in the included studies that suggests the antibiotic-resistant organisms were acquired either during migration or in the host countries, which included Spain, Italy, Greece, Germany, Austria, the Netherlands, Sweden, and Switzerland.
For example, three of the studies found that migrants with similar migration trajectories were colonized with the same microorganisms. A study that looked at MRSA infections in four Swiss refugee centers found six clusters with recent transmission events and no relatedness in isolates from patients who came from similar regions.
Three of the countries where the studies were conducted—Greece, Italy, and Spain—are the main points of entry for migrants to Europe. They have also been found to have a high prevalence of MRSA (39.2 percent, 34.1 percent, and 25.3 percent, respectively), which raises the possibility that migrants could have acquired the pathogen from people in those countries.
But it’s the poor conditions in the places where refugees are housed while they await resettlement that may be the most important factor in spreading AMR bacteria among migrants, the authors argue.
They suggest that interventions to improve living conditions should include a focus on better sanitation, less overcrowding, better infection prevention and control strategies, and increased access to health services. In addition, they call for more screening for colonization and improved antibiotic susceptibility testing in high-migrant community settings. While hospitals routinely target migrants and refugees from high-AMR-prevalence countries for this kind of testing, the migrants evaluated in the reviewed studies had infrequently been admitted to hospitals.
“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 in host countries,” the authors write. “These improvements will enable timely detection and treatment of infections when they do occur, thus reducing transmission and poorer and more costly health outcomes.”
— Read more in Laura B. Nellums et al., “Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis,” The Lancet (17 May 2018) (DOI: https://doi.org/10.1016/S1473-3099(18)30219-6)
