Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2019 Dec 20;64(1):e01974-19.
doi: 10.1128/AAC.01974-19. Print 2019 Dec 20.

A Systematic Review and Meta-analysis of the Prevalence of Community-Onset Bloodstream Infections among Hospitalized Patients in Africa and Asia

Christian S Marchello  1 , Ariella P Dale  2 , Sruti Pisharody  3 , Matthew P Rubach  4 , John A Crump  5
Affiliations
Meta-Analysis

A Systematic Review and Meta-analysis of the Prevalence of Community-Onset Bloodstream Infections among Hospitalized Patients in Africa and Asia

Christian S Marchello et al. Antimicrob Agents Chemother. .

Abstract

Community-onset bloodstream infections (CO-BSI) are major causes of severe febrile illness and death worldwide. In light of new data and the growing problem of antimicrobial resistance (AMR) among pathogens causing BSI, we undertook a systematic review of hospital-based studies of CO-BSI among patients hospitalized with fever. Without restriction to language or country, we searched PubMed, Web of Science, and Scopus for prospective hospital-based studies of culture-confirmed CO-BSI among febrile inpatients. We determined by study the prevalence of BSI among participants, the pathogens responsible for BSI, and the antimicrobial susceptibility patterns of pathogens causing BSI, according to place and time. Thirty-four (77.3%) of 44 eligible studies recruited 29,022 participants in Africa and Asia combined. Among participants in these two regions, the median prevalence of BSI was 12.5% (range, 2.0 to 48.4%); of 3,220 pathogens isolated, 1,119 (34.8%) were Salmonella enterica, 425 (13.2%) Streptococcus pneumoniae, and 282 (8.8%) Escherichia coli Antimicrobial susceptibility testing was reported in 16 (36.4%) studies. When isolates collected prior to 2008 were compared to those collected in the period of 2008 through 2018, the proportions of typhoidal Salmonella and Staphylococcus aureus isolates resistant to several clinically relevant antimicrobials increased over time, while S. pneumoniae susceptibility was stable. CO-BSI remain a major cause of severe febrile illness among hospitalized patients in Africa and Asia, with S. enterica, S. pneumoniae, and E. coli predominating. There is a concerning increase in AMR among serious infections caused by community-onset pathogens. Ongoing surveillance is needed to inform empirical management and strategies to control AMR.

Keywords: antimicrobial resistance; bacteremia; bloodstream infections; community-onset infections.

PubMed Disclaimer

Figures

FIG 1
FIG 1
Flow diagram of search strategy and selection of articles reporting the prevalence of CO-BSI among febrile hospitalized patients in 1946 through 2018.
FIG 2
FIG 2
World map of hospital-based study locations and summary findings on prevalent pathogens causing CO-BSI among febrile hospitalized patients in 1946 through 2018 (created using MapChart).
See this image and copyright information in PMC

References

    1. Petit PL, van Ginneken JK. 1995. Analysis of hospital records in four African countries, 1975–1990, with emphasis on infectious diseases. J Trop Med Hyg 98:217–227. - PubMed
    1. Feikin DR, Olack B, Bigogo GM, Audi A, Cosmas L, Aura B, Burke H, Njenga MK, Williamson J, Breiman RF. 2011. The burden of common infectious disease syndromes at the clinic and household level from population-based surveillance in rural and urban Kenya. PLoS One 6:e16085. doi:10.1371/journal.pone.0016085. - DOI - PMC - PubMed
    1. Campbell JD, Sow SO, Levine MM, Kotloff KL. 2004. The causes of hospital admission and death among children in Bamako, Mali. J Trop Pediatr 50:158–163. doi:10.1093/tropej/50.3.158. - DOI - PubMed
    1. Centers for Disease Control and Prevention. 2019. National Hospital Ambulatory Medical Care Survey: 2015 emergency department summary tables. https://www.cdc.gov/nchs/data/nhamcs/web_tables/2015_ed_web_tables.pdf.
    1. Keitel K, Kagoro F, Samaka J, Masimba J, Said Z, Temba H, Mlaganile T, Sangu W, Rambaud-Althaus C, Gervaix A, Genton B, D'Acremont V. 2017. A novel electronic algorithm using host biomarker point-of-care tests for the management of febrile illnesses in Tanzanian children (e-POCT): a randomized, controlled non-inferiority trial. PLoS Med 14:e1002411. doi:10.1371/journal.pmed.1002411. - DOI - PMC - PubMed

Publication types

Substances