The burden of healthcare-associated infection in Moroccan hospitals: systematic review and meta-analysis

Abstract

Background: Healthcare-associated infections (HAI) continue to be a major public health concern throughout the world because of the associated mortality and socioeconomic costs. The significant financial burden of healthcare-associated infections is especially relevant for developing countries. Meta-analysis can be a major tool that can aid in decision making in the realm of public health, owing to theirevidence level, especially in countries with limited resources, such as Morocco. In Morocco, recently, the Ministry of Health creates the national coordination unit and the technical committee for the surveillance of antimicrobial resistance but still does not have a national HAI surveillance system making it very difficult to systematically assess and report on the burden of hospital-acquired infections HAIs. The main objective of this systematic review and meta-analysis is to estimate the overall prevalence of infections acquired in hospitals in Morocco using data from prevalence studies. We also studied the variability in the evolution of these infections over time.Methods: A multisource search strategy was used to retrieve all published and unpublished data.The search terms were used in databases, conference abstracts, national research banks, the World Health Organization database, Google scholar and were also applied in a manual search. Two reviewers independently extracted and evaluated the data and the concordance between the two examiners was calculated by Kappa (κ) statistical coefficient. The meta-analysis was performed using the R and Stata software with a random effects model.Results: Fourteen studies with 6,532 patients were included. The pooled prevalence of HAI was 10% (CI 95%: 8 - 12, I2= 87%). Of the 14 studies, ten were conducted in tertiary hospitals with pooled prevalence of 10.84% (CI 95%: 8.9 - 13.714 I2=86%), compared with 6.34% (CI 95% 4.43 – 8.99, I2=63%) in non-tertiary hospitals. When subgrouping analysis by infection type, the most common HAI were nosocomialurinary tract infections with a proportion of 24.52% (CI 95 %:14.09 - 39.15, I2=87%). This proportion was followed closely by surgical wound infections at 24.42% (CI 95%: 20.15 – 29.26, I2=51%). Respiratory infections accounted for 16.82% (CI 95%: 12.51 - 22.24, I2=57%) of the HAI. The change in number of HAI over time has increased between 2004 and 2014 (beta =0.05, 95% CI -0.07 to 0.16 and p = 0.9). There were no publication biases, as evaluated by Funnel Plot and Begg and Egger tests (p> 0.05).Conclusion: The pooled prevalence of HAI across 6,632 patients in Morocco was 10%. The most common HAI were nosocomial urinary tract infections (rate of 24.52%), followed by surgical wound infections (rate of 24.42%), and respiratory infections (rate of 16.82%).