撒哈拉以南非洲地区细菌性产妇感染的病因和抗菌药物耐药性：系统评价和荟萃分析。
The aetiology and antimicrobial resistance of bacterial maternal infections in Sub-Saharan Africa-a systematic review and meta-analysis.
机构信息
Department of Children's and Women's Health, University of Liverpool, Liverpool, UK.
Malawi-Liverpool- Research-Programme, Blantyre, Malawi.
出版信息
BMC Infect Dis. 2024 Sep 14;24(1):978. doi: 10.1186/s12879-024-09855-3.
BACKGROUND
Understanding the aetiological organisms causing maternal infections is crucial to inform antibiotic treatment guidelines, but such data are scarce from Sub-Saharan Africa (SSA). We performed this systematic review and meta-analysis to address this gap.
METHODS
Microbiologically confirmed maternal infection data were collected from PubMed, Embase, and African Journals online databases. The search strategy combined terms related to bacterial infection, pregnancy, postnatal period, observational studies, SSA. Exclusion criteria included colonization, asymptomatic infection, and screening studies. Pooled proportions for bacterial isolates and antimicrobial resistance (AMR) were calculated. Quality and completeness of reporting were assessed using the Newcastle-Ottawa and STROBE checklists.
FINDINGS
We included 14 papers comprising data from 2,575 women from four sources (blood, urine, surgical wound and endocervical). Mixed-growth was commonly reported at 17% (95% CI: 12%-23%), E. coli from 11%(CI:10%-12%), S. aureus from 5%(CI: 5%-6%), Klebsiella spp. at 5%(CI: 4%- 5%) and Streptococcus spp. at 2%(CI: 1%-2%). We observed intra-sample and inter-sample heterogeneity between 88-92% in all meta-analyses. AMR rates were between 19% -77%, the highest with first-line beta-lactam antibiotics. Convenience sampling, and limited reporting of laboratory techniques were areas of concern.
INTERPRETATION
We provide a comprehensive summary of microbial aetiology of maternal infections in SSA and demonstrate the paucity of data available for this region. We flag the need to review the current local and international empirical treatment guidelines for maternal bacterial infections in SSA because there is high prevalence of AMR among common causative bacteria.
FUNDING
This research was supported by the NIHR-Professorship/NIHR300808 and the Wellcome-Strategic-award /206545/Z/17/Z.
TRIAL REGISTRATION
Prospero ID CRD42021238515.
背景
了解导致产妇感染的病因生物体对于制定抗生素治疗指南至关重要，但撒哈拉以南非洲（SSA）缺乏此类数据。我们进行了这项系统评价和荟萃分析，以填补这一空白。
方法
从 PubMed、Embase 和 African Journals online 数据库中收集微生物学确认的产妇感染数据。搜索策略结合了与细菌感染、妊娠、产后时期、观察性研究相关的术语和 SSA。排除标准包括定植、无症状感染和筛查研究。计算细菌分离株和抗生素耐药性（AMR）的合并比例。使用纽卡斯尔-渥太华和 STROBE 清单评估报告的质量和完整性。
结果
我们纳入了 14 篇论文，这些论文的数据来自来自四个来源（血液、尿液、手术伤口和宫颈）的 2575 名妇女。混合生长通常占 17%（95%CI：12%-23%），大肠杆菌占 11%（CI：10%-12%），金黄色葡萄球菌占 5%（CI：5%-6%），克雷伯氏菌属占 5%（CI：4%-5%），链球菌属占 2%（CI：1%-2%）。我们观察到所有荟萃分析中存在 88-92%的样本内和样本间异质性。AMR 率在 19%-77%之间，一线β-内酰胺类抗生素的 AMR 率最高。便利抽样和实验室技术的有限报告是令人关注的领域。
解释
我们提供了撒哈拉以南非洲产妇感染微生物病因的综合总结，并表明该地区缺乏可用数据。我们强调需要审查当前撒哈拉以南非洲地区针对产妇细菌感染的本地和国际经验性治疗指南，因为常见病原体的 AMR 患病率很高。
资金
这项研究得到了 NIHR 教授/ NIHR300808 和 Wellcome-Strategic-award /206545/Z/17/Z 的支持。
试验注册
Prospero ID CRD42021238515。
Zotero 插件