RESUMO
BACKGROUND: Streptococcus pneumoniae, a major contributor to global morbidity and mortality, disproportionately affects children, the elderly, and immunocompromised individuals. Despite vaccination efforts, the challenge of serotype replacement highlights the ongoing struggle against invasive pneumococcal diseases (IPD) in Morocco, emphasizing the need for updated public health strategies and vaccine efficacy assessments. METHODS: This study was conducted at the Ibn Rochd University Hospital Center and the Mohammed VI University Hospital Center from 2019 to 2022, focusing on hospitalized children. It involved the analysis of 74 strains of IPD, assessing the distribution of pneumococcal serotypes and their antibiotic sensitivity in the post-vaccination era. RESULTS: The prevalence of meningitis or meningo-encephalitis was found to be 66% among the study subjects, with the most frequent serotypes being 3, 19A, 6B, 14, and 11. These serotypes varied significantly by age and location. Coverage rates for the pneumococcal conjugate vaccines, PCV-10 and PCV-13, were 20.27% and 56.75%, respectively. Notably, 43% of the strains were non-vaccine serotypes, with serotypes 3 and 19 accounting for 36% of the infections in children, indicating a lack of vaccine efficacy against these types. Additionally, 31.3% of the strains were Penicillin non-susceptible Streptococcus pneumoniae (PNSP), with 81.25% associated with non-vaccine serotypes. CONCLUSIONS: This study highlights the persistence of IPD in Moroccan children, revealing significant challenges despite vaccination efforts. With the reintroduction of PCV-13, concerns about the efficacy against non-vaccine serotypes, particularly 3 and 19A, remain. Continuous surveillance and adaptable vaccination strategies are essential to combat these serotype replacements and ensure the effectiveness of future preventive measures.
Assuntos
Infecções Pneumocócicas , Vacinas Pneumocócicas , Sorogrupo , Streptococcus pneumoniae , Humanos , Marrocos/epidemiologia , Vacinas Pneumocócicas/administração & dosagem , Vacinas Pneumocócicas/imunologia , Infecções Pneumocócicas/prevenção & controle , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/microbiologia , Pré-Escolar , Streptococcus pneumoniae/imunologia , Streptococcus pneumoniae/classificação , Streptococcus pneumoniae/isolamento & purificação , Lactente , Criança , Masculino , Feminino , Vacinação/estatística & dados numéricos , Adolescente , Antibacterianos/uso terapêutico , PrevalênciaAssuntos
Unidades de Terapia Intensiva Pediátrica , Sepse , Criança , Humanos , Lactente , Estudos Retrospectivos , Sepse/diagnóstico , Sepse/terapiaRESUMO
Acute kidney injury (AKI) is very common in intensive care units (ICUs). Its complications are often fatal, life-threatening, and may lead to kidney impairment. This is a multicentric, prospective, and descriptive study, spread over a period of six months, from January 1, 2017 to June 30, 2017, including incident cases of AKI defined according to the AKI Network criteria seen in the ICUs of Ibn Rochd University Hospital of Casablanca. Their evolution was studied during the hospital stay at three, six, 12, and 24 months. A total of 102 patients were included, 52% of whom were female. The median age was 45.2 ±0 22.93 years (10 days-87 years). Clinically, 28.4% were oligo-anuric and 54.8% had a multivisceral failure, mainly neurological and respiratory. The median creatinine level was 37.6 mg/L ± 19.82 (8-230). AKI was mainly organic and functional in 43.1% and 40.2% of cases, respectively, and the main etiologies were dehydration, sepsis, and tumor obstruction. Dialysis was required in 25.5% of cases. When discharged from the hospital, mortality occurs in 35% of cases, total recovery of renal function was observed in 22%, progression to chronicity in 38%, and end-stage renal disease (ESRD) in 5% of cases. The progression to chronicity and ESRD increased in the 1st and 2nd year of followup after the first episode of AKI. The risk factors for progression to chronicity were as follows: age, hypertension, the presence of comorbidities, the presence of multivisceral failure and the severity of AKI. AKI is now considered a risk factor for chronic kidney disease and longterm mortality, hence the interest and importance of nephrological monitoring.