title: 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: BACKGROUND
  The 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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  41/261(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.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Medical Clinic, Cantonal Hospital of Olten, Olten, Switzerland.
authors.forename: Rein Jan
authors.identifier: http://orcid.org/0000-0003-4326-819X
authors.initials: RJ
authors.lastname: Piso
authors.affiliation: Medical Clinic, Cantonal Hospital of Olten, Olten, Switzerland.
authors.forename: Roman
authors.initials: R
authors.lastname: Käch
authors.affiliation: Medical Clinic, Cantonal Hospital of Olten, Olten, Switzerland.
authors.forename: Roxana
authors.initials: R
authors.lastname: Pop
authors.affiliation: Medical Clinic, Cantonal Hospital of Olten, Olten, Switzerland.
authors.forename: Daniela
authors.initials: D
authors.lastname: Zillig
authors.affiliation: Bakt Institut Olten BIO AG, Olten, Switzerland.
authors.forename: Urs
authors.initials: U
authors.lastname: Schibli
authors.affiliation: Division of Internal Medicine, University Hospital Basel, Basel, Switzerland.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bassetti
authors.affiliation: Clinical Microbiology, University Hospital Basel, Basel, Switzerland.|Applied Microbiology Research, Department Biomedicine, University of Basel, Basel, Switzerland.
authors.forename: Dominik
authors.initials: D
authors.lastname: Meinel
authors.affiliation: Clinical Microbiology, University Hospital Basel, Basel, Switzerland.|Applied Microbiology Research, Department Biomedicine, University of Basel, Basel, Switzerland.
authors.forename: Adrian
authors.initials: A
authors.lastname: Egli
mesh_terms: D000346:Afghanistan; D001426:Bacterial Proteins / Q000378:metabolism; D002353:Carrier State / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004755:Enterobacteriaceae / Q000201:enzymology / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008877:Middle East; D015995:Prevalence; D012036:Refugees; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D013557:Switzerland; D013593:Syria; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase