School of Medical Laboratory Science, Jimma University, Ethiopia.
School of Medical Laboratory Science, Jimma University, Ethiopia.
J Hosp Infect. 2024 Feb;144:1-13. doi: 10.1016/j.jhin.2023.11.012. Epub 2023 Dec 10.
Due to abundant pathogen diversity and mounting antimicrobial resistance, sepsis is more common in sub-Saharan Africa (sSA). However, there is a lack of consistent reports regarding the prevalence of adult sepsis in the region. Therefore, this study aimed to determine pooled estimates of sepsis prevalence and associated mortality among adults admitted to hospitals in sSA. Medline (through PubMed), Scopus, Embase, and Web of Science were systematically searched for studies of sepsis in sSA published before 13th February 2023. A random-effects meta-analysis of hospital-wide and intensive care unit (ICU)-based sepsis prevalence was performed with a 95% confidence interval (CI). Subgroup analysis was conducted considering geographic region and sepsis diagnostic criteria. Funnel plots and Egger's test were used to assess publication bias. The protocol was submitted to the Prospective Register for Systematic Reviews (PROSPERO) with an identifier (CRD42023396719). Overall, 14 observational studies, published between 2009 and 2022, from eight different sSA countries comprising 31,653 adult patients (5723 with sepsis) were included in the review. Nine studies that were conducted in a hospital-wide setting showed a pooled prevalence and mortality of 17% (95% CI: 12-21%) and 15% (95% CI: 17-35%), respectively. Five studies in the ICUs presented a pooled prevalence and mortality of 31% (95% CI: 24-38%) and 46% (95% CI: 39-54%), respectively. Based on the sub-group analysis, the pooled hospital-wide prevalence of sepsis in East and Southern Africa was 18% (95% CI: 11-25%), and 20% (95% CI: 2-42%), respectively. The pooled prevalence in the ICU was 14% (95% CI: 4-23%) and 13% (95% CI: 5-20%) for East and Southern Africa, respectively. The hospital-wide and ICU-based sepsis prevalence and mortality are high in sSA. Addressing the burden of adult sepsis should be a priority for healthcare systems in sub-Saharan Africa.
由于病原体多样性丰富且抗菌药物耐药性不断增加，撒哈拉以南非洲（sSA）的脓毒症更为常见。然而，该地区成人脓毒症的流行率缺乏一致的报告。因此，本研究旨在确定 sSA 住院成人脓毒症的患病率和相关死亡率的汇总估计值。通过 Medline（通过 PubMed）、Scopus、Embase 和 Web of Science 系统地检索了 2023 年 2 月 13 日之前发表的关于 sSA 脓毒症的研究。采用 95%置信区间（CI）对医院和重症监护病房（ICU）的脓毒症患病率进行了随机效应荟萃分析。考虑到地理区域和脓毒症诊断标准，进行了亚组分析。使用漏斗图和 Egger 检验评估发表偏倚。该方案已提交给前瞻性系统评价注册库（PROSPERO），并附有标识符（CRD42023396719）。
总体而言，该综述纳入了来自 8 个不同 sSA 国家的 14 项观察性研究，共纳入 31653 名成年患者（5723 名患有脓毒症）。9 项在医院范围内进行的研究显示，患病率和死亡率的合并率分别为 17%（95%CI：12-21%）和 15%（95%CI：17-35%）。5 项 ICU 研究的合并患病率和死亡率分别为 31%（95%CI：24-38%）和 46%（95%CI：39-54%）。根据亚组分析，东非和南非的医院范围内脓毒症的合并患病率分别为 18%（95%CI：11-25%）和 20%（95%CI：2-42%）。东非和南非 ICU 的合并患病率分别为 14%（95%CI：4-23%）和 13%（95%CI：5-20%）。
sSA 的医院范围内和 ICU 基础上的脓毒症患病率和死亡率都很高。解决成人脓毒症的负担应该是撒哈拉以南非洲医疗保健系统的优先事项。
