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.
Highlights
As poverty, violent conflicts, or persecution of minorities remain important problems throughout the world, migration to countries with stable political situation or higher income will hardly diminish
The colonisation rate of the refugees was about 10 times higher for methicillin-resistant Staphylococcus aureus (MRSA) and 2–5 times higher for extendedspectrum beta-lactamase (ESBL) compared to the Swiss population
The travel conditions promote the possibility of transmission from one person to another e.g. by overloaded boats without sanitary facilities, crowded refugee camps with poor hygiene conditions, and passage through countries with high rates of multidrug resistant bacteria (MDR) bacteria such as Greece and Italy [3,4,5]
Summary
Violent conflicts, or persecution of minorities remain important problems throughout the world, migration to countries with stable political situation or higher income will hardly diminish. The data on prevalence of highly resistant bacteria in the origin countries of the refugees is not known, a worldwide increase of antibiotic resistance is documented [2]. Important gaps in surveillance exist and the colonization status with multi-drug resistant (MDR) bacteria of asylum seekers coming to developed countries remains largely unknown. The travel conditions promote the possibility of transmission from one person to another e.g. by overloaded boats without sanitary facilities, crowded refugee camps with poor hygiene conditions, and passage through countries with high rates of MDR bacteria such as Greece and Italy [3,4,5]. Data about multidrug resistant bacteria (MDR) prevalence are not present for these countries. When entering the European heath care systems, data about colonisation rates regarding highly resistant bacterial pathogens are important
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