A Cross-Sectional Study of Colonization Rates with Methicillin-Resistant Staphylococcus aureus (MRSA) and Extended-Spectrum Beta-Lactamase (ESBL) and Carbapenemase-Producing Enterobacteriaceae in Four Swiss Refugee Centres

Abstract

BackgroundThe recent crisis of refugees seeking asylum in European countries challenges public health on many levels. Most refugees currently arrive from Syria, Afghanistan, or Eritrea. Data about multidrug resistant bacteria (MDR) prevalence are not present for these countries. However, when entering the European heath care systems, data about colonisation rates regarding highly resistant bacterial pathogens are important.MethodsWe performed a cross-sectional screening in four Swiss refugee centres to determine the colonization rates for MRSA and ESBL- and carbapenemase-producing Enterobacteriaceae. We used pharyngeal, nasal, and inguinal swabs for MRSA and rectal swabs and urine for ESBL and carbapenemase screening using standard microbiological procedures. Whole genome sequencing (WGS) was used to determine the relatedness of MRSA isolates with high resolution due to a suspected outbreak.Results41/261(15.7%) refugees were colonized with MRSA. No differences regarding the country of origin were observed. However, in a single centre significantly more were colonized, which was confirmed to be a recent local outbreak. 57/241 (23.7%) refugees were colonized with ESBL with significantly higher colonisation in persons originating from the Middle East (35.1%, p<0.001). No carbapenemase producers were detected.ConclusionThe colonisation rate of the refugees was about 10 times higher for MRSA and 2–5 times higher for ESBL compared to the Swiss population. Contact precaution is warranted for these persons if they enter medical care. In cases of infections, MRSA and ESBL-producing Enterobacteriaceae should be considered regarding antibiotic treatment choices.

Methicillin-resistant Staphylococcus aureus carriage rate and molecular characterization of the staphylococcal cassette chromosome mec among Syrian refugees in Iraq

“…The MRSA carriage rate among newcomers in this study was 16.9%, which was higher than that found in refugees who were already in camps, as well as that in the host community, although the difference was not statistically significant. These results are in agreement with MRSA prevalence rates in refugees residing in asylum centers or camps in Switzerland (15.7%) (Piso et al, 2017), Italy (12.5%) (Angeletti et al, 2016), and the Netherlands (approximately 10%) (Ravensbergen et al, 2017). However, the prevalence rates of MRSA in both the host community and refugees in the present study were much higher than those in the population of the Netherlands as a whole (1%), as well as those of Germany (10%), Belgium (0%), and Iceland (0%) (Abbara et al, 2018).…”

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

“…After removal of duplicates, 2274 articles were screened for eligibility, of which 376 were included in the full-text screening ( figure 1 ). 23 articles 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 reporting on antibiotic resistance in 2319 migrants met the inclusion criteria and were included in the systematic review; 15 articles reporting prevalence data on AMR in migrants were included in the main meta-analysis ( table 1 ).

Figure 1 Study selection

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“…Seven studies 43 , 48 , 49 , 50 , 57 , 58 , 60 were done in Germany, six in Spain, 40 , 41 , 42 , 44 , 52 , 61 one in Greece, 45 two in the Netherlands, 47 , 56 one in Austria, 51 two in Sweden, 46 , 59 two in Switzerland, 53 , 55 and two in Italy. 39 , 54 Four articles were published in Spanish and translated before full-text screening.…”

“…Of the 2319 migrants included across the studies, 1795 (77%) were asylum seekers or refugees (defined as those who have applied for or been granted asylum). 48 , 49 , 50 , 51 , 55 , 56 , 57 , 58 , 60 Other migrants across the studies were non-refugee or asylum-seeking foreign-born individuals (eg, those migrating for economic or family reasons), 40 , 41 , 42 , 52 , 54 , 59 , 61 including child migrants or adopted children. 44 , 46 , 47 However, reason for migration was often not reported for individuals classified as other migrants, for whom only data on foreign-born status were available.…”

Profiling infectious diseases in Turkey after the influx of 3.5 million Syrian refugees

“…The first two isolates of New Delhi Metallo-Beta-Laktamaz-1 (NDM-1) were reported from a hospital, one isolate was from a Syrian refugee and the second was from a patient who had never travelled outside Turkey [39]. In a study performed in Switzerland, the colonization rate of the refugees was about ten times higher for methicillinresistant Staphylococcus aureus and two to five times higher for extended-spectrum beta-lactamase than the Swiss population [40]; a striking difference in risk was not reported from Turkey.…”