RBC Transfusion Strategy in Oncological Patients with Chronic RBC Transfusion Therapy.

BACKGROUND: Red blood cell (RBC) transfusion therapy has greatly reduced mortality and morbidity in multiply transfused patients with oncological malignancies. The aim of this study was to underline the necessity of introducing a policy for extended RBC phenotyping of these patients and for the issuing of antigen-matched blood (at least for E antigen). METHODS: Multivariate logistic regression analysis was used to evaluate the associations of age, gender, transfusion history, and various malignancies with the development of red cell alloimmunization. RESULTS: Given the results of antibody identification, we finally obtained 732 cases to be analyzed, designating them as the p group. The respiratory system (231/732; 31.6%), digestive system (273/732; 37.3%), and female reproductive system (127/732; 17.3%) had the three highest alloimmunization rates in the p group. We screened 81 cases from the p group for which antibody screening in our laboratory had historically yielded negative results. Among the 81 cases with antibody seroconversion, anti-E was the most frequently observed antibody (37%). CONCLUSIONS: The results related to multivariate logistic regression analysis of the Rh group indicate that, in contrast to the other variates, transfusion confers a strongly increased risk of Rh blood system-related red cell alloimmunization. To reduce alloimmunization in tumor patients, it will be essential to introduce a policy for extended RBC phenotyping of high-risk patients and for the issuing of antigen-matched blood (at least for E antigen).

Multiple configuration transitions of soft actuators under single external stimulus.

Soft actuators have a wide range of applications in medical instruments, soft robotics, 3D electronics, and deployable structures, where configuration transitions are crucial for their function realization. However, most soft actuators can only morph from the initial configuration directly to the final configuration under a single external stimulus. Herein, we report a novel soft actuator by 3D printing parallel strips with crescent cross-sections onto a thin PDMS film. Multiple configuration transitions are observed when the soft actuator swells in ethyl acetate. Four factors, i.e., the geometric asymmetry of the strips, the fabrication-induced heterogeneity of the film, the differential swelling ratios of the strips and the film, and the geometric parameters of the actuator, are demonstrated to synergistically regulate the multiple configuration transitions of the actuator. Particularly, the underlying mechanisms for the configuration transitions are systematically investigated through experiments and theoretical analysis, and verified via finite element simulation. Benefitting from the multiple configuration transitions, the grasp-release-re-grab function of the actuator is demonstrated under a single stimulus. This work contributes to fundamental understanding of the morphing behaviors and the novel design of soft actuators.

Physically Entangled Antiswelling Hydrogels with High Stiffness.

Physically cross-linked hydrogels have great potential for tissue engineering because of their excellent biocompatibility and easy fabrication. However, physical cross-linking points are typically weaker compared to chemical ones and therefore cannot form robust hydrogels with excellent water stability, which greatly hinder their further applications. In this work, a novel hydrogel with high stiffness and outstanding antiswelling performance cross-linked by hydrophobic polymer chains entanglements is reported. The hydrophobic polymer polyimide (PI) is mixed with the hydrophilic polymer poly-(vinyl pyrrolidone) (PVP) to form cross-linking points between the chains. At the equilibrium swelling state, tensile modulus of the hydrogel can be up to 22.57 MPa (higher than most existing hydrogels) and the equilibrium water swelling ratio (ESR) can be as low as 125.0%. By decreasing the PI mass ratio, tensile modulus and ESR of the hydrogel can be tuned in a wide range from 22.57 to 0.005 MPa and 125.0% to 765.6%, respectively. Using PVP/PI solutions as inks, uniform structures and multi-material structures are fabricated having mechanical properties close to cartilage through a direct ink writing 3D printing platform. This current work demonstrates that entangled PVP/PI hydrogels have excellent tailoring capabilities and are promising candidates for tissue engineering applications.

First annual report of Chinese haemovigilance network.

BACKGROUND AND OBJECTIVES: Haemovigilance involves surveillance of the whole chain of blood transfusion with the aim of identifying adverse events and errors and improving outcomes for patients. The Chinese Haemovigilance Network, founded in August 2017, has witnessed a rapid development in the last three years. MATERIALS AND METHODS: Based on the 1,022 cases in 2019, we analysed the adverse reactions (ARs) by blood component, clinical outcome severity and demography of recipients in an effort to publish the first annual Chinese haemovigilance report. RESULTS: The AR rate associated with blood transfusion in 2019 was 0·2% in China. Allergic reactions and FNHTR were the two most common adverse symptoms, accounting for 97·7% of the reports. Two-thirds of the TAD, AHTR and TACO and all of the HTR and DHTR resulted in hospitalization or prolongation of hospitalization. Plasma and AP were usually associated with allergic reaction (81·1%), whereas red cells more commonly cause FNHTR (68·8%) and all the AHTR, HTR, DSTR and DHTR. 84·1% of patients were aged 16 years or over, and the majority of the TAD, AHTR, TACO and HTR involved patients aged 60 and above. The ratio of serious adverse reactions (SARs) was 8·2%. Allergic reaction and FNHTR were top two (85·7%) SARs. The first case related to anti-D immunoglobulin was detected in a DHTR report. CONCLUSION: This report provides the world's first overview of transfusion-related adverse reactions in China. This report is useful for better understanding transfusion risks in China.

Spatial Compartmentalization of Cobalt Phosphide in P-Doped Dual Carbon Shells for Efficient Alkaline Overall Water Splitting.

Highly durable and earth-abundant bifunctional catalysts with low cell voltage are desirable for alkaline overall water splitting in the industrial fields. Herein, a novel carbon-based CoP hybrid with spatial compartmentalization of CoP nanoparticles (NPs) in P-doped dual carbon shells is achieved via a cheap Co-glycerate-template strategy. Benefitted from the uniform atomic blending of Co2+ ions in the Co-glycerate precursors, CoP NPs in situ formed in the confined space with NaH2PO2 as phosphorus source during the annealing process; meanwhile, glycerate suffered carbonization and transformed into P-doped dual carbon shells during the annealing process, including interior thin carbon coating, closely encircled CoP NP, and peripheral hollow carbon sphere loading a lot of CoP NPs. Not only does spatial compartmentalization of CoP NPs avoid the aggregation and expose more active sites but also P-doped dual carbon shells improve the conductivity and durability of the catalyst. As expected, the optimized hybrid exhibits outstanding electrocatalytic activities in alkaline media, such as hydrogen evolution reaction (HER) overpotential of 101 mV, oxygen evolution reaction (OER) overpotential of 280 mV, and a low cell voltage of 1.66 V to deliver a current density of 10 mA cm-2. Moreover, durability and stability are greatly improved under harsh electrochemical conditions. The current strategy shades new insight into the development of carbon-based transition metal phosphides (TMP) catalysts for electrocatalysis applications.

An amidase is required for proper intercellular communication in the filamentous cyanobacterium Anabaena sp. PCC 7120.

Channels that cross cell walls and connect the cytoplasm of neighboring cells in multicellular cyanobacteria are pivotal for intercellular communication. We find that the product of the gene all1140 of the filamentous cyanobacterium Anabaena sp. PCC 7120 is required for proper channel formation. All1140 encodes an amidase that hydrolyses purified peptidoglycans. An All1140-GFP fusion protein is located at the Z-ring in the periplasmic space during most of the cell cycle. An all1140-null mutant (M40) was unable to grow diazotrophically, and no mature heterocysts were observed in the absence of combined nitrogen. Expression of two key genes, hetR and patS, was studied in M40 using GFP as a reporter. Upon nitrogen step-down, the patterned distribution of green fluorescent cells in filaments seen in the wild type were not observed in mutant M40. Intercellular communication in M40 was studied by measuring fluorescence recovery after photobleaching (FRAP). Movement of calcein (622 Da) was aborted in M40, suggesting that the channels connecting the cytoplasm of neighboring cells are impaired in the mutant. The channels were examined with electron tomography; their diameters were nearly identical, 12.7 nm for the wild type and 12.4 nm for M40, suggesting that AmiC3 is not required for channel formation. However, when the cell wall sacculi isolated by boiling were examined by EM, the average sizes of the channels of the wild type and M40 were 20 nm and 12 nm, respectively, suggesting that the channel walls of the wild type are expandable and that this expandability requires AmiC3.

Subjective Age and Memory Performance Among Older Chinese Adults : A Moderated Mediation Model.

This study aims to examine the mediating role of learning self-efficacy in the relationship between subjective age and memory performance as well as the moderating role of education in these indirect and direct relationships. A study was conducted with 200 older adults aged 60 to 81 years who completed measures of subjective age, learning self-efficacy, education, and memory performance. Analysis revealed that learning self-efficacy partially mediated the association between subjective age and memory performance. Further analysis found that the indirect associations between subjective age and memory through learning self-efficacy vary as a function of education. Implications and suggestions for future research are discussed.

Preparation of a Phenolic-Resin-Based Polymer Sponge Composed of Intertwined Nanofibers with Tunable Wettability for High-Efficiency Separation of Oil-Water Emulsions.

Nowadays, as the combination of water pollution and water shortage causes severe environmental and social issues, the special wettable materials, which can be selectively wetted by either water or oil, attract tremendous attention for high-efficiency separation of oil-water mixtures. Herein, we prepare a phenolic-resin-based sponge composed of intertwined nanofibers via a simple hydrothermal method. The wettability of the as-prepared polymer is tuned readily by controlling only the hydrothermal temperature. In the case of the hydrothermal temperature below 210 °C, the polymer sponge demonstrates superhydrophilic and underwater superoleophobic properties, affording the separation of oil-in-water emulsions. However, as the hydrothermal temperature increases above 220 °C, the resulting bulk phenolic-resin-based material becomes superhydrophobic and underoil superhydrophobic, realizing a high filtration flux of 6147 L m-2 h-1 for the separation of water-in-oil emulsions driven by an external pressure of 40 kPa. This provides a feasible platform for future practical applications. The wettability transition depending on the hydrothermal temperature is discussed in terms of the reaction mechanism. In addition, the stability and breakthrough pressure are also addressed from the viewpoints of thermodynamic and fluid mechanics, respectively.

Effect of Thermal Conductivity on Enhanced Evaporation of Water Droplets from Heated Graphene-PDMS Composite Surfaces.

The dynamics of evaporating water droplets on heated graphene-poly(dimethylsiloxane) (PDMS) composites is investigated experimentally and theoretically. By inserting graphene nucleates in PDMS, we report the effect of change in thermal resistance on the evaporation process of water droplets on the heated graphene-PDMS composite surface. By dispersing graphene within the PDMS matrix, the evaporation of water droplets is enhanced. The graphene nucleate density over the surface was controlled by varying graphene wt % from 0 to 2%, which in turn controls the thermal resistance and hence the evaporation rate. Experimentally, the maximum evaporation rate of 0.0044 µL/s was observed for the sample of 2 wt % graphene-PDMS composite. The evaporation rate on a 2 wt % graphene-PDMS composite surface is about 1.5 times higher compared to that of plain PDMS without graphene. A theoretical model confirms that the initial contact angle and the presence of thermal coupling between liquid droplets and the substrate play an important role in evaporation dynamics. Thermal conductance increases 3 times with the increase in graphene wt % from 0.1 to 2.0 wt % in PDMS. The heat-storing capacity of graphene is responsible for the enhanced evaporation. The experimental findings are in good agreement with theoretical results. These samples were found insensitive to degradation and may find potential applications where high efficiency and high heat flux are needed.

ProLo: Localization via Projection for Three-Dimensional Mobile Underwater Sensor Networks.

We study the problem of three-dimensional localization of the underwater mobile sensor networks using only range measurements without GPS devices. This problem is challenging because sensor nodes often drift with unknown water currents. Consequently, the moving direction and speed of a sensor node cannot be predicted. Moreover, the motion devices of the sensor nodes are not accurate in underwater environments. Therefore, we propose an adaptive localization scheme, ProLo, taking these uncertainties into consideration. This scheme applies the rigidity theory and maintains a virtual rigid structure through projection. We have proved the correctness of this three-dimensional localization scheme and also validated it using simulation. The results demonstrate that ProLo is promising for real mobile underwater sensor networks with various noises and errors.

The impact of effort-reward imbalance on loneliness of the elderly: the multiple mediation effect of social support and control belief in social domain.

Objective: The empirical studies of loneliness have experienced unprecedented growth in the past decades. As such, there is now a growing body of research showing that loneliness is negatively related to physical and mental health. More recently, one of the most widely tested models of effort-reward imbalance (ERI) posits that the imbalance between high effort and low reward elicits strong negative emotions and sustained stress responses. Despite these developments, the mechanism between ERI and loneliness of the elderly remains unclear. In the current study, we explored how ERI influences loneliness via social support and control belief in social domain. Method: We selected a convenience sample aged 53-84 years old (N = 231) to complete a series of standard psychological assessments. Results: Multiple mediation analysis showed that (1) the positive effect of ERI on loneliness was partially mediated by social support (95% IC = -.001 to .078) and control belief in social domain (95% IC = .028 to .154), and (2) the chain mediating effect of both mediators was also significant (95% IC = .037 to .112). Discussion: The study suggests that ERI can influence loneliness through decreasing social support and subsequently reducing control belief in social domain.

Why are older adults victims of fraud? Current knowledge and prospects regarding older adults' vulnerability to fraud.

Older adults are disproportionately targeted by various kinds of fraud, which result in irreversible economic losses and great psychological distress. Over the past years, researchers have conducted systematic research on the prevalence, under-reporting, and research methods of fraud victimization in older adults. Research paradigms regarding fraud victimization among older adults have mainly included cognitive, emotion regulation and motivation, and comprehensive paradigms. Factors shown to influence fraud victimization among older adults include cognitive decline, emotional regulation and motivational changes, their overly trusting nature, psychological vulnerability, social isolation, risk-taking, and a lack of knowledge and information regarding fraud prevention. Based on a review of the literature, future research can benefit from constructing a comprehensive fraud victimization theory, improving research methods, extending existing research, exploring physiological mechanisms of elderly fraud, and strengthening prevention and intervention efforts.

Credulity rather than general trust may increase vulnerability to fraud in older adults: a moderated mediation model.

The present study aimed to clarify whether it is credulity or general trust that specifically affects vulnerability to fraud, as well as investigating the mediating role of susceptibility to persuasion and the moderating role of greed in this relationship. 254 Chinese older adults completed measures of credulity, general trust, susceptibility to persuasion, greed, and vulnerability to fraud. The results showed that credulity, but not general trust, was positively correlated with vulnerability to fraud, after controlling for demographic covariates. Susceptibility to persuasion partially mediated the effect of credulity on vulnerability to fraud. In addition, this mediating effect of susceptibility to persuasion was only significant in older adults with higher levels of greed. Our findings suggest that credulity, rather than general trust, is a risk factor in vulnerability to fraud among older adults, and may inform the development of supportive interventions to reduce this population's risk of falling victim to fraud.

The temporal dynamics of detached versus positive reappraisal: An ERP study.

Detached reappraisal and positive reappraisal are regarded as two distinct types of cognitive reappraisal strategy, and the former is considered more disengaging than the latter. The conceptual framework of emotion regulation choice posits that strategies involving disengagement operate earlier and more efficiently than engagement strategies. Here, we compare for the first time the temporal dynamics of detached and positive reappraisal during the regulation and re-exposure phases thereof by measuring event-related potentials. During the regulation phase, pictures were viewed or regulated using detached or positive reappraisal. During the re-exposure phase, the same pictures were viewed again. Results showed that during regulation, central-parietal late positive potentials (LPPs) were greatly attenuated under both strategy types, with the regulation effect of detached reappraisal occurring earlier than that of positive reappraisal and resulting in a stronger attenuation of LPP amplitudes. Upon re-exposure, detached reappraisal exerted enduring effects on self-reported arousal and the central-parietal LPP, whereas positive reappraisal had an enduring effect only on pleasantness. These findings demonstrate the differential effects of detached and positive reappraisal on valence, arousal, and neural responses, and underline the striking differences in the temporal dynamics of these reappraisal strategies.

Is matching or discrepancy between filial piety expectation and filial support better? The role of filial support of children and social support.

Filial piety in traditional Chinese culture is an essential variable in explaining intergenerational interaction. However, previous studies have not clarified whether older adults' filial responsibility expectations matched children's filial support and the effects of the filial discrepancy on their life satisfaction and loneliness. The latent profile analysis showed that older adults were divided into two groups: (1) high expectations and support, and (2) low expectations and support. The results showed that compared with older adults with low expectations and low support, those with high expectations and high support reported higher life satisfaction and lower loneliness. Additionally, social support played a moderating role in the effect of the groups of older adults on life satisfaction and loneliness. Our conclusion shows that filial support is an essential factor influencing older adult life satisfaction and loneliness, and social support is an effective supplement to filial support.

A novel cholesterol metabolism-related ferroptosis pathway in hepatocellular carcinoma.

BACKGROUND: Emerging studies have reported the contribution of cholesterol to hepatocellular carcinoma (HCC) progression. However, the specific role and mechanism of cholesterol metabolism on spontaneous and progressive HCC development from the point of view of ferroptosis are still worth exploring. The present study aimed to reveal a novel mechanism of cholesterol metabolism-related ferroptosis in hepatocellular carcinoma cells. METHODS: Two microarray datasets (GSE25097, GSE22058) related to HCC were downloaded from Gene Expression Omnibus (GEO) datasets. Metabolomics analysis was performed by ultra performance liquid chromatography - tandem mass spectrometer (UPLC-MS/MS). The cholesterol-related proteins were downloaded from HMBD. Ferroptosis-related genes were extracted from FerrDb database. Data sets were separated into two groups. GSE25097 was used to identify ferroptosis-related genes, and GSE22058 was used to verify results. During these processes, chemical-protein interaction (CPI), protein-protein interaction (PPI), the Gene Ontology (GO), and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were conducted. Multivariate logistic regression analysis was used to test the associated pathway. RESULTS: We identified 8 differentially expressed ferroptosis-related genes (HAMP, PTGS2, IL1B, ALOX15B, CDKN2A, RRM2, NQO1 and KIF20A) and 4 differentially expressed cholesterol-related genes (LCAT, CH25H, CEL and CYP7A1). Furthermore, based on the predicted results with STITCH, we identified indomethacin and IL1B as the essential node for cholesterol-mediated ferroptosis in hepatocellular carcinoma cell. Multivariate logistic regression analysis showed the activities of plasma IL1B in liver cancer patients enrolled have been significantly affected by the level of plasma cholesterol (P < 0.001) and the test result of IL1B is a predictor variable causing the changes of serum Fe levels (P < 0.001). CONCLUSIONS: Our findings shed new light on the association between cholesterol metabolism and ferroptosis in HCC, and suggest that IL1B is the necessary node for cholesterol to lead to ferroptosis process in HCC. Also, we identified the potential role of indomethacin in adjuvant therapy of HCC with complications of abnormal cholesterol metabolism.

Effect and safety of electroacupuncture on weight loss in obese patients with pre-diabetes: study protocol of a randomised controlled trial.

INTRODUCTION: Obesity has been identified as a significant risk factor for several chronic conditions, including diabetes, tumours and cardiovascular disease, and has been associated with increased mortality rates. Despite the well-established clinical practice of electroacupuncture (EA) as a potential treatment option for obesity, its efficacy remains questionable, primarily due to the paucity of empirical evidence supporting its therapeutic benefits. METHODS AND ANALYSIS: The present study aims to investigate the efficacy and safety of EA for weight loss in obese individuals with pre-diabetes, using a randomised, placebo-controlled clinical trial design. A total of 256 eligible patients will be randomly assigned to one of two groups: EA (comprising EA treatment with health education) or superficial acupuncture (SA) (comprising SA treatment with health education). The intervention will be administered three times per week for the initial 12 weeks, two times per week for the subsequent 8 weeks and one time per week for the final 4 weeks, with a 24-week follow-up period. The primary outcome measure will be the percentage of patients who achieve a reduction of 10% or more in their body weight at week 24. Secondary outcome measures will include changes in body weight and body mass index, blood test results, data collected by the body composition analyser, size of adipose tissue scanned by MRI of the abdomen and the Impact of Weight on Quality of Life, the 21-item Three-Factor Eating Questionnaire-Revised and the Food Craving Questionnaire-Trait. The Treatment Emergent Symptom Scale will be employed to monitor every adverse reaction from baseline to follow-up. ETHICS AND DISSEMINATION: This trial has received ethical clearance from the Ethics Committee of Shanghai Municipal Hospital of Traditional Chinese Medicine under the registration number 2021SHL-KY-74. All participants will provide their written informed consent prior to their enrolment. The findings of this investigation will be disseminated through peer-reviewed publications and scholarly conferences. TRIAL REGISTRATION NUMBER: NCT05237089.

Impacts of pharmacist-led multifaceted antimicrobial stewardship on antibiotic use and clinical outcomes in urology department of a tertiary hospital in Guangzhou, China: an interrupted time series study.

BACKGROUND: Limited research has explored the effectiveness of pharmacist-led antimicrobial stewardship programs (ASPs) in the urology department. OBJECTIVE: To evaluate the impact of pharmacist-led multifaceted ASPs on antibiotic use and clinical outcomes. METHODS: We conducted a prescription review of inpatients receiving one or more antibiotics in the urology department of a large teaching hospital in Guangzhou, China, from April 2019 to March 2023. The pharmacist-led multifaceted ASPs intervention included guidelines development, training, medication consultation, review of medical orders, indicator monitoring, and consultation. Our primary outcome was antibiotic consumption. The data was analysed using interrupted time series (ITS) analysis. RESULTS: Following the implementation of ASPs, we observed an immediate decrease in total antibiotic consumption (ß = -32.42 DDDs/100PD and -36.24 DOT/100PD, P < 0.001), Antibiotic use rate (ß = -7.87 %, P = 0.002), Second-generation cephalosporins (ß = -12.43 DDDs/100PD and -15.18 DOT/100PD, P < 0.001), Third-generation cephalosporins (ß = -5.13 DDDs/100PD, P = 0.001 and -6.16 DOT/100PD, P = 0.002), Fluoroquinolones (ß = -12.26 DDDs/100PD and -12.70 DOT/100PD, P < 0.001), and WHO Watch category antibiotics (ß = -32.07 DDDs/100PD and -34.96 DOT/100PD, P < 0.001). There were no differences observed in mortality rate before and after the intervention, and no significant short-term or long-term effects were found on length of hospital stay (LOS) using ITS. However, there was a significant short-term effect on average antibiotic cost (ß = -446.83 RMB, P = 0.004). CONCLUSION: The implementation of pharmacist-led multifaceted ASPs had positive impacts on reducing antimicrobial consumption without increasing LOS, antibiotic cost, or mortality rate.

Global antimicrobial resistance and antibiotic use in COVID-19 patients within health facilities: A systematic review and meta-analysis of aggregated participant data.

OBJECTIVES: The COVID-19 pandemic has posed a significant threat to the global healthcare system, presenting a major challenge to antimicrobial stewardship worldwide. This study aimed to provide a comprehensive and up-to-date picture of global antimicrobial resistance (AMR) and antibiotic use in COVID-19 patients. METHODS: We conducted a systematic review to determine the prevalence of AMR and antibiotic usage among COVID-19 patients receiving treatment in healthcare facilities. Our search encompassed the PubMed, Web of Science, Embase, and Scopus databases, spanning studies published from December 2019 to May 2023. We utilized random-effects meta-analysis to assess the prevalence of multidrug-resistant organisms (MDROs) and antibiotic use in COVID-19 patients, aligning with both the WHO's priority list of MDROs and the AWaRe list of antibiotic products. Estimates were stratified by region, country, and country income. Meta-regression models were established to identify predictors of MDRO prevalence and antibiotic use in COVID-19 patients. The study protocol was registered with PROSPERO (CRD 42023449396). RESULTS: Among the 11,050 studies screened, 173 were included in the review, encompassing a total of 892,312 COVID-19 patients. MDROs were observed in 42.9% (95% CI 31.1-54.5%, I2 = 99.90%) of COVID-19 patients: 41.0% (95% CI 35.5-46.6%) for carbapenem-resistant organisms (CRO), 19.9% (95% CI 13.4-27.2%) for methicillin-resistant Staphylococcus aureus (MRSA), 24.9% (95% CI 16.7-34.1%) for extended-spectrum beta-lactamase-producing organisms (ESBL), and 22.9% (95% CI 13.0-34.5%) for vancomycin-resistant Enterococcus species (VRE), respectively. Overall, 76.2% (95% CI 69.5-82.9%, I2 = 99.99%) of COVID-19 patients were treated with antibiotics: 29.6% (95% CI 26.0-33.4%) with "Watch" antibiotics, 22.4% (95% CI 18.0-26.7%) with "Reserve" antibiotics, and 16.5% (95% CI 13.3-19.7%) with "Access" antibiotics. The MDRO prevalence and antibiotic use were significantly higher in low- and middle-income countries than in high-income countries, with the lowest proportion of antibiotic use (60.1% (95% CI 52.1-68.0%)) and MDRO prevalence (29.1% (95% CI 21.8-36.4%)) in North America, the highest MDRO prevalence in the Middle East and North Africa (63.9% (95% CI 46.6-81.2%)), and the highest proportion of antibiotic use in South Asia (92.7% (95% CI 90.4-95.0%)). The meta-regression identified antibiotic use and ICU admission as a significant predictor of higher prevalence of MDROs in COVID-19 patients. CONCLUSIONS: This systematic review offers a comprehensive and current assessment of MDRO prevalence and antibiotic use among COVID-19 patients in healthcare facilities. It underscores the formidable challenge facing global efforts to prevent and control AMR amidst the backdrop of the COVID-19 pandemic. These findings serve as a crucial warning to policymakers, highlighting the urgent need to enhance antimicrobial stewardship strategies to mitigate the risks associated with future pandemics.