Refugees and asylum seekers might have an increased risk of antimicrobial resistance (AMR) carriage or infection due to several factors, with conflict and war known to accelerate the spread of AMR. However, data are scarce on prevalence and risk factors for AMR among refugees and asylum seekers and how they are affected globally; in addition, how their risk compares to that of the host-country population is unclear. We aimed to explore and assess global AMR data among refugees and asylum seekers. Ovid (MEDLINE and Embase) and PubMed were searched for peer-reviewed primary research articles from Jan 1, 2015, to Oct 23, 2023, and articles were included if they reported carriage or infection with laboratory-confirmed drug-resistant organisms in refugees or asylum seekers from any country. Of 884 articles identified, 41 reported prevalence of AMR among 16 970 refugees and asylum seekers and were included in the study. The most common phenotypes reported were multidrug-resistant Gram-negative bacteria (n=26; prevalence ranged from 4·2% to 60·8%), methicillin-resistant Staphylococcus aureus (n=24; 0·92% to 73%), and extended-spectrum β-lactamase-producing Gram-negative bacteria (n=20; 1·6% to 61·1%). Refugees and asylum seekers had a higher likelihood of carriage or infection with any AMR than the host-country population (n=7849 vs n=81 283, respectively; odds ratio 2·88, 95% CI 2·61–3·18; I²=94%). Refugees and asylum seekers are at an increased risk of AMR carriage and infection, with our data suggesting that refugees and asylum seekers might be exposed to conditions that support the emergence of drug resistance (including living in overcrowded camps and facing barriers to health and vaccine systems). Hence, more global and regional data on AMR are needed through strengthened surveillance programmes and health-care facilities, especially in low-income and middle-income countries. Increased efforts are needed to drive improvements in infection prevention and control (including vaccination), antimicrobial stewardship, treatment strategies tailored to groups at high risk, accessiblity to quality health care in these populations at risk globally, and address risk factors such as poor living and transit conditions.

中文翻译：

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难民和寻求庇护者中的抗微生物药物耐药性：全球系统评价和荟萃分析


由于多种因素，难民和寻求庇护者携带或感染抗菌素耐药性 （AMR） 的风险可能会增加，众所周知，冲突和战争会加速 AMR 的传播。然而，关于难民和寻求庇护者中 AMR 的流行率和风险因素以及他们在全球范围内如何受到影响的数据很少;此外，他们与东道国人口的风险相比如何尚不清楚。我们旨在探索和评估难民和寻求庇护者的全球 AMR 数据。检索了 2015 年 1 月 1 日至 2023 年 10 月 23 日期间的同行评审原始研究文章 Ovid（MEDLINE 和 Embase）和 PubMed，如果它们报告了来自任何国家的难民或寻求庇护者携带或感染了实验室确认的耐药微生物，则纳入其中。在确定的 884 篇文章中，有 41 篇报告了 16970 名难民和寻求庇护者中 AMR 的患病率，并被纳入研究。报告的最常见表型是多重耐药革兰氏阴性菌（n=26;患病率从 4·2% 到 60·8%）、耐甲氧西林金黄色葡萄球菌（n=24;0·92% 到 73%）和广谱产 β-内酰胺酶革兰氏阴性菌（n=20;1·6% 至 61·1%）。难民和寻求庇护者携带或感染任何 AMR 的可能性高于东道国人口（分别为 n=7849 和 n=81 283;比值比 2·88,95% CI 2·61-3·18;I²=94%）。难民和寻求庇护者携带和感染 AMR 的风险增加，我们的数据表明，难民和寻求庇护者可能暴露在支持出现耐药性的条件中（包括生活在过度拥挤的营地中，以及面临健康和疫苗系统的障碍）。 因此，需要通过加强监测规划和卫生保健机构，特别是在低收入和中等收入国家，获得更多关于抗微生物药物耐药性的全球和区域数据。需要加大努力来推动感染预防和控制（包括疫苗接种）、抗菌药物管理、为高危人群量身定制的治疗策略、全球高危人群获得优质医疗保健的机会，并解决生活和交通条件不佳等风险因素。