Division of Infectious Diseases, Department of Medicine, Queen's University, Kingston, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Int J Infect Dis. 2022 Sep;122:405-411. doi: 10.1016/j.ijid.2022.06.026. Epub 2022 Jun 18.
Staphylococcus aureus bacteremia (SAB) is a common infection worldwide. We compared SAB mortality in low- and middle-income countries (LMIC) versus high-income countries (HIC) in a meta-analysis.
We searched MEDLINE, Embase, and Cochrane Database of Systematic Reviews from 1991-2021 and included observational, single-country studies on patients with positive blood cultures for S. aureus. The main outcome was the proportion of patients with SAB who died in the hospital. A generalized linear mixed random-effects model was used to pool estimates, and a meta-regression was used to adjust for study-level characteristics.
A total of 332 studies involving 517,671 patients in 39 countries were included. No study was conducted in a low-income country. Only 33 (10%) studies were performed in middle-income countries (MIC), which described 6,216 patients. The pooled in-hospital mortality was 32.4% (95% confidence interval [CI] 27.2%-38.2%, T = 0.3063) in MIC and 22.3% (95% CI 20.1%-24.6%, T = 0.3257) in HIC. In a meta-regression model, MIC had higher in-hospital mortality (adjusted odds ratio 1.37, 95% CI 1.11-1.71; P = 0.0042) than HIC.
In SAB studies, LMIC are poorly represented. In-hospital mortality was significantly higher in MIC than in HIC. Research should be conducted in LMIC to characterize differences in care processes driving the mortality gap.
金黄色葡萄球菌菌血症（SAB）是一种全球常见的感染。我们通过荟萃分析比较了低收入和中等收入国家（LMIC）与高收入国家（HIC）的 SAB 死亡率。
我们检索了 1991 年至 2021 年的 MEDLINE、Embase 和 Cochrane 系统评价数据库，并纳入了关于金黄色葡萄球菌阳性血培养患者的观察性、单国籍研究。主要结局是 SAB 患者在医院死亡的比例。使用广义线性混合随机效应模型汇总估计值，并使用元回归调整研究水平特征。
共纳入 39 个国家的 332 项研究，涉及 517671 名患者。没有在低收入国家进行的研究。只有 33 项（10%）研究在中等收入国家（MIC）进行，描述了 6216 名患者。MIC 的住院死亡率为 32.4%（95%置信区间 [CI] 27.2%-38.2%，T=0.3063），HIC 为 22.3%（95% CI 20.1%-24.6%，T=0.3257）。在元回归模型中，MIC 的住院死亡率更高（调整后的优势比 1.37，95% CI 1.11-1.71；P=0.0042）。
在 SAB 研究中，LMIC 的代表性较差。MIC 的住院死亡率明显高于 HIC。应在 LMIC 开展研究，以描述导致死亡率差距的护理过程差异。
