LAUSR

Thank you to Reinheimer& Kempf for their letter and comments on our manuscript “Refugees and antimicrobial resistance: a systematic review” [1]. We agree that the demographic data including the country of origin of the refugees, and more importantly the route of travel, are key elements for understanding the potential impact of refugees' displacement on the transmission of multidrug resistant (MDR) pathogens. The lack of any information on refugees' itineraries is a common limitation of many of the studies addressing this issue to date. We can confirm that the publication by Reinheimer et al (2016) [2] was included in the data synthesis as they note from its inclusion in Table 1. However, the data presented in their manuscript presents us with limitations when we try to interpret it. 143 refugees were screened but a maximum of 33% were from Syria and the rest from a number of other countries. Of particular note, despite this being a study focusing on refugees, the country of origin was not recorded for over 20%. 60.8% of the samples were positive for multidrug resistant Gram-negative bacteria (MDR GNB) but no information is given in their Table as to which refugee groups these belonged to. Therefore we have faithfully reproduced the MDR GNB identified in Table 1 but we cannot ascribe the countries that these bacteria originate from, as these data are lacking in the publication. We also note that while origin and destination countries are recorded for around 80% of the refugees, we have no idea from the publication about the route taken nor the length of time of residence of the refugees in Germany. Therefore we are at significant risk of misrepresenting the countries of origin if we try to ascribe drug-resistance rates to them and have therefore