Malawi-Liverpool-Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi.
Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
BMC Infect Dis. 2024 Feb 2;24(1):158. doi: 10.1186/s12879-024-09038-0.
Healthcare-associated infections (HCAI) place a significant burden on healthcare systems globally. This systematic review and meta-analysis aimed to investigate the prevalence, risk factors, and aetiologic agents of endemic HCAI in Africa.
MEDLINE/PubMed, CINAHL, and Global Health databases (EBSCOhost interface) were searched for studies published in English and French describing HCAI in Africa from 2010 to 2022. We extracted data on prevalence of HCAI, risk factors, aetiologic agents, and associated antimicrobial resistance patterns. We used random-effects models to estimate parameter values with 95% confidence intervals for risk factors associated with HCAI. This study was registered in PROSPERO (CRD42022374559) and followed PRISMA 2020 guidelines.
Of 2541 records screened, 92 were included, comprising data from 81,968 patients. Prevalence of HCAI varied between 1.6 and 90.2% with a median of 15% across studies. Heterogeneity (I) varied from 93 to 99%. Contaminated wound (OR: 1.75, 95% CI: 1.31-2.19), long hospital stay (OR: 1.39, 95% CI: 0.92-1.80), urinary catheter (OR: 1.57, 95% CI: 0.35-2.78), intubation and ventilation (OR: 1.53, 95% CI: 0.85-2.22), vascular catheters (OR: 1.49, 95% CI: 0.52-2.45) were among risk factors associated with HCAI. Bacteria reported from included studies comprised 6463 isolates, with E. coli (18.3%, n = 1182), S. aureus (17.3%, n = 1118), Klebsiella spp. (17.2%, n = 1115), Pseudomonas spp. (10.3%, n = 671), and Acinetobacter spp. (6.8%, n = 438) being most common. Resistance to multiple antibiotics was common; 70.3% (IQR: 50-100) of Enterobacterales were 3rd -generation cephalosporin resistant, 70.5% (IQR: 58.8-80.3) of S. aureus were methicillin resistant and 55% (IQR: 27.3-81.3) Pseudomonas spp. were resistant to all agents tested.
HCAI is a greater problem in Africa than other regions, however, there remains a paucity of data to guide local action. There is a clear need to develop and validate sustainable HCAI definitions in Africa to support the implementation of routine HCAI surveillance and inform implementation of context appropriate infection prevention and control strategies.
医疗保健相关感染（HCAI）在全球范围内给医疗系统带来了巨大负担。本系统评价和荟萃分析旨在调查非洲地方性 HCAI 的流行率、风险因素和病原体。
检索 2010 年至 2022 年期间在英文和法文发表的描述非洲 HCAI 的 MEDLINE/PubMed、CINAHL 和全球健康数据库（EBSCOhost 界面）的研究。我们提取了 HCAI 流行率、风险因素、病原体和相关抗生素耐药模式的数据。我们使用随机效应模型，使用 95%置信区间估计与 HCAI 相关的风险因素的参数值。本研究在 PROSPERO（CRD42022374559）中注册，并遵循 PRISMA 2020 指南。
在筛选出的 2541 条记录中，有 92 条被纳入，其中包括 81968 名患者的数据。HCAI 的流行率在 1.6%至 90.2%之间，各研究的中位数为 15%。异质性（I）从 93%到 99%不等。污染伤口（OR：1.75，95%CI：1.31-2.19）、住院时间长（OR：1.39，95%CI：0.92-1.80）、导尿管（OR：1.57，95%CI：0.35-2.78）、插管和通气（OR：1.53，95%CI：0.85-2.22）、血管导管（OR：1.49，95%CI：0.52-2.45）是与 HCAI 相关的风险因素。纳入研究报告的细菌包括 6463 株分离株，其中大肠杆菌（18.3%，n=1182）、金黄色葡萄球菌（17.3%，n=1118）、克雷伯菌属（17.2%，n=1115）、铜绿假单胞菌（10.3%，n=671）和不动杆菌属（6.8%，n=438）最为常见。对多种抗生素的耐药性很常见；肠杆菌科中 70.3%（IQR：50-100）对第三代头孢菌素耐药，金黄色葡萄球菌中 70.5%（IQR：58.8-80.3）对甲氧西林耐药，55%（IQR：27.3-81.3）铜绿假单胞菌对所有测试药物均耐药。
HCAI 在非洲是一个比其他地区更严重的问题，但仍缺乏数据来指导当地的行动。显然需要在非洲制定和验证可持续的 HCAI 定义，以支持常规 HCAI 监测的实施，并为实施适合当地情况的感染预防和控制策略提供信息。
