High prevalence of MRSA and ESBL among asylum seekers in the Netherlands

Abstract

Migration is one of the risk factors for the spread of multidrug-resistant organisms (MDRO). The increasing influx of migrants challenges local health care systems. To provide evidence for both hospital hygiene measure and empirical antibiotic therapy, we analysed all cultures performed in asylum seekers between January 1st 2014 and December 31st 2015 for methicillin resistant Staphylococcus aureus (MRSA) and for multidrug-resistant Enterobacteriaceae (MDRE). We compared these with cultures from the Dutch patient population with risk factors for carriage of MDRO. A total of 7181 patients were screened for MRSA. 7357 S. aureus were isolated in clinical cultures. Of 898 screened asylum seekers, almost 10% were MRSA positive. Of 118 asylum seekers with S. aureus in clinical cultures almost 19% were MRSA positive. The general patient population had a 1.3% rate of MRSA in S. aureus isolates. A higher rate of Panton-Valentine leukocidin (PVL) positive strains (RR: 2.4; 95% CI: 1.6–3.4) was found in asylum seekers compared to the general patient population. In 33475 patients one or more Enterobacteriaceae were obtained. More than 21% of the asylum seekers were carrier of MDRE, most of them producing extended spectrum beta-lactamases (20.3%). 5.1% of the general patient population was MDRE carrier. It can be concluded that asylum seekers present with higher rate of MDRO compared to the general patient population. These results justify continued screening of asylum seekers to anticipate multidrug-resistant organisms during hospital care of patients.

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).…”

“…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). In contrast, MRSA prevalence rates among refugees in the current study were lower than the rates of up to 37-56% found in Greece, Portugal (Ravensbergen et al, 2017), and Romania (Abbara et al, 2018;Ravensbergen et al, 2017). These figures raise serious concerns that movement of refugees to lowprevalence countries might result in the spread of MRSA in the new communities.…”

Migrant and refugee populations: a public health and policy perspective on a continuing global crisis

“…In developing countries facing high rates of internal displacements, there is an urgent need to unify screenings and treatments, and to fight the as yet largely unaddressed problem of counterfeit medicines. In the more developed destination countries, screening of migrant populations seeking healthcare may also help to understand and control the inter-country spread of antibiotic resistance [ 61 ]. Health assessment on arrival is a useful way of gaining an initial understanding of the health of incident migrant populations.…”

“…Antimicrobial resistance may be considered an emerging infectious disease, and is clearly linked to human mobility [ 84 , 85 ]. Prevalence of carriage of methicillin-resistant Staphylococcus aureus and multi-drug resistant Enterobacteriaceae in migrant populations may be as high as 27% [ 61 , 85 – 87 ]. Migrants are also overrepresented in terms of multi-drug resistant tuberculosis compared to host populations [ 88 ].…”

“…This may have implications for infection control policies if migrants are hospitalised in low-endemicity settings, as is the case for returned travellers and repatriated patients. Epidemiological screening may be a legitimate tool to better study the profile of migrant populations and understand their needs, and may also help understand and control the spread of antibiotic resistance [ 61 ]. It should not, however, be used as a political tool.…”