COVID-19 Mixed Impact on Hospital Antimicrobial Stewardship Activities: A Qualitative Study in UK-Based Hospitals

Antimicrobial resistance (AMR) is a well-known global threat due to the subsequent increase in antimicrobial usage. Several antimicrobial stewardship (AMS) strategies have been implemented to curb irrational prescribing and reduce the AMR burden. However, since the beginning of the COVID-19 pandemic, it has enormously impacted the healthcare system and jeopardized public health, causing millions of deaths globally. Our semi-structured qualitative study aimed to explore the impact of COVID-19 on AMS activities in the UK hospitals. Seventeen interviews were conducted with health care professionals who were part of AMS teams (consultant medical microbiologists, infectious disease consultants, antimicrobial pharmacists). Interviews were audio-recorded and transcribed. An inductive thematic framework was adopted to analyse and create the themes. After agreement of the hierarchical framework definition, all transcripts were coded accordingly. Four main themes and 15 sub-themes were identified. These main themes were: (1) AMS activities or strategies before and during the pandemic; (2) challenges to implementing AMS activities before and during the pandemic; (3) information from public authorities on AMS during the pandemic; and (4) new AMS activities/strategies adopted during the pandemic. Staff vacancies, redeploying of AMS staff to other duties and meeting the burden related to the COVID-19 and lack of resources were the most frequently identified contributing factors to withheld AMS activities during the pandemic. However, modifications to the hybrid working environment, i.e., remote or flexible working, allowed for resumption of AMS activities including virtual ward rounds, virtual meetings and other activities. Further research needs to assess the impact of the hybrid delivery system on AMS activities

Additional file 1: of Spatial patterns and secular trends in human leishmaniasis incidence in Morocco between 2003 and 2013

Multilingual abstracts in the six official working languages of the United Nations. (PDF 502 kb

Spatiotemporal distribution and predictors of tuberculosis incidence in Morocco

Abstract Background Tuberculosis (TB) is a major health problem in Morocco. This study aims at examining trends in TB in Morocco and identifying TB spatial clusters and TB-associated predictors. Method Country-level surveillance data was exploited. Kendall’s correlation test was used to examine trends and an exploratory spatial data analysis was conducted to assess the global and local patterns of spatial autocorrelation in TB rates (Moran’s I and local indicator of spatial association [LISA]) at the prefecture/province level. Covariates including living in a prefecture versus living in a province, annual rainfall, annual mean temperature, population density, and AIDS incidence were controlled. An ordinary least squares regression was thus performed and both spatial dependence and heteroscedasticity were assessed. Results A decrease in TB incidence rate was seen between 1995 and 2014 (Kendall’s tau b = − 0.72; P <  0.0001). However, while the period between 2005 and 2014 (10 last years) was considered, TB rate remained stable and as high as 84 per 100 000 population per year (95% CI: 83.7–84.3). The highest incidence rates were seen in Tanger-Assilah, Fez, Tetouen-M’diq Fnidaq, Inezgane Ait Melleoul, and Casablanca. From 2005 to 2014, while TB incidence rate was stable in Fez (P = 0.500), Tetouen-M’diq Fnidaq (P = 0.300), Casablanca (P = 0.500), Mohammadia (P = 0.146), Al Hoceima (P = 0.364), and Guelmim (P = 0.242), an increase in TB incidence rate was seen in Tanger-Assilah (Kendall’s tau = 0.49; P = 0.023) and a decrease in Salé (Kendall’s tau b = − 0,54; P = 0.014) and Inezgane-Ait Melloul (Kendall’s tau b = − 0,67; P = 0.0023). TB is strongly clustered in space (P-values of Moran’s I <  0.01). Two distinct spatial regimes that affect TB spatial clustering were identified (east and west). In the east, both annual rainfall (P = 0.003) and AIDS (P = 0.0002) exert a statistically significant effect on TB rate. In the west, only the living area (prefecture versus province) was associated with TB rate (P = 0.048). Conclusions New information on TB incidence and TB-related predictors was provided to decision-making and to further pertinent research. Association between annual rainfall and TB may be of interest to be explored elsewhere

Additional file 1: of Secular trends in consultations for asthma in early childhood, the 16 administrative regions of Morocco, 2004–2012

Direct method for age-adjusted prevalence rate of consultations for asthma in under-5 children, urban areas, Morocco: 9-year trends (2004-2012). (PDF 45 kb

Additional file 2: of Secular trends in consultations for asthma in early childhood, the 16 administrative regions of Morocco, 2004–2012

Direct method for age-adjusted prevalence rate of consultations for asthma in under-5 children, rural areas, Morocco: 9-year trends (2004-2012). (PDF 44 kb

Assessment of the HBV vaccine response in a group of HIV-infected children in Morocco

Abstract Background Since its development in the early 1980s, Hepatitis B virus (HBV) vaccine has been proven to be highly protective. However, its immunogenicity may be ineffective among HIV-infected children. In Morocco, HBV vaccine was introduced in 1999, and since then all infants, including vertically HIV-infected infants, have been following the vaccination schedule, implemented by the Moroccan ministry of health. An assessment of the immunization of these children is important to optimize efforts aimed at tackling Hepatitis B coinfection, within the country. Methods Forty-nine HIV-infected children (HIV group) and 112 HIV uninfected children (control group) were enrolled in this study. Samples were tested by Elisa (Monolisa Anti-HBs, Biorad) to quantify the anti-HBs antibodies. The % of lymphocyte subsets i.e. CD4+ T cells, CD8+ T cells, B cells, and NK, was determined by flow cytometry, using CellQuest Pro software (Becton-Dickinson), and for HIV group, HIV viral load was measured by real time PCR assay (Abbott). All variables were statistically compared in the two groups. Results The median age was 51 ± 35 months for the HIV group and 50 ± 36 months (p > 0.05) for the control group. Female represented 63% and 41% (p = 0.01), among the HIV group and the control group, respectively. Among HIV-infected children, 71.4% (35/49) were under HAART therapy at the enrollment in the study. Seroprotection titer i.e. anti-HBs ≥10mUI/ml among control group was 76% (85/112), and only 29% (14/49) among the perinatally HIV-infected children (p < 0.0001). Lower % of CD4 + T cells was observed in HIV-infected children with a poor anti-HBs response. Conclusion In this studied group, we have shown that despite the vaccination of HIV-children with HBV vaccine, 71% did not show any seroprotective response. These findings support the need for monitoring HBV vaccine response among HIV-infected children in Morocco, in order to revaccinate non-immunized children

Seroprevalence of measles vaccine antibody response in vertically HIV-infected children, in Morocco

Abstract Background The widespread use of an effective and safe vaccine to measles has substantially decreased morbidity and mortality from this epidemic. Nevertheless, HIV-infected children vaccinated against measles may develop an impaired vaccine response and remain susceptible to this disease. In Morocco, infants are routinely vaccinated against measles, regardless of their HIV serostatus. An evaluation of the immunization of these children may be of paramount importance to implement timely measures aimed at preventing measles transmission. Methods In this study, we have enrolled 114 children vaccinated against measles, 50 children prenatally infected with HIV and 64 HIV-uninfected children. For all children, blood samples were taken to measure anti-measles IgG by EIA and CD4 count by flow cytometry. Additionally, HIV viral load was determined by automated real time PCR, for HIV-infected children. Results The seroprotective rate of IgG anti-measles antibodies was significantly lower among HIV-infected children (26%) compared with HIV-uninfected children (73%) (p  0.999 and p = 0.730, respectively. However, CD4 count was lower among children with negative serostatus to measles (23% versus 32%, p < 0.001). Furthermore, viral load was higher, with 2.91 log10 ± 2.24 versus 1.7 log10 ± 1.5 (p = 0.042). Finally, 62% of children with a negative vaccine response to measles were under HAART therapy, versus 92% (p = 0.008). Conclusion The majority of HIV-infected children vaccinated against measles develop a suboptimal seroprotective titer, and therefore remain at risk for this highly infectious disease. These data in combination with international recommendations, including recent WHO guidance on vaccination of HIV-infected children, suggest there is a need for national measures to prevent these children from measles

Nonselective Beta-Blockers Do Not Affect Survival in Cirrhotic Patients with Ascites

The role of nonselective beta-blockers in cirrhotic patients with ascites has been recently questioned; however, definitive evidence in this regard is still lacking. To analyze published data on the influence of nonselective beta-blockers as compared to control group on survival of cirrhotic patients with ascites. Computerized bibliographic search on the main databases was performed. Hazard ratios from Kaplan-Meier curves were extracted in order to perform an unbiased comparison of survival estimates. Secondary outcomes were mortality in patients with refractory ascites, pooled rate of nonselective beta-blockers interruption, spontaneous bacterial peritonitis and hepato-renal syndrome incidence. Three randomized controlled trials and 13 observational studies with 8279 patients were included. Overall survival was comparable between the two groups (hazard ratio = 0.86, 0.71-1.03, p = 0.11). Study design resulted as the main source of heterogeneity in sensitivity analysis and meta-regression. Mortality in refractory ascites patients was similar in the two groups (odds ratio = 0.90, 0.45-1.79; p = 0.76). No difference in spontaneous bacterial peritonitis (odds ratio = 0.78, 0.47-1.29, p = 0.33) and hepato-renal syndrome incidence (odds ratio = 1.22, 0.48-3.09; p = 0.67) was observed. Pooled rate of nonselective beta-blockers interruption was 18.6% (5.2-32.1%). Based on our findings, nonselective beta-blockers should not be routinely withheld in patients with cirrhosis and ascites, even if refractory