背景:医疗保健相关感染(HCAI)给全球医疗保健系统带来了巨大的负担。这项系统评价和荟萃分析旨在调查患病率,危险因素,和非洲地方性HCAI的病因。
方法:MEDLINE/PubMed,CINAHL,搜索了全球卫生数据库(EBSCOhost界面),以英语和法语发表的描述2010年至2022年非洲HCAI的研究。我们提取了HCAI患病率的数据,危险因素,病原体,以及相关的抗菌素耐药模式。我们使用随机效应模型以95%置信区间估计与HCAI相关的危险因素的参数值。本研究在PROSPERO(CRD42022374559)注册,并遵循PRISMA2020指南。
结果:在筛选的2541条记录中,92人包括在内,包括来自81,968名患者的数据。HCAI的患病率在1.6%至90.2%之间变化,所有研究的中位数为15%。异质性(I2)从93%到99%不等。污染伤口(OR:1.75,95%CI:1.31-2.19),长期住院(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相关的危险因素.纳入研究报告的细菌包括6463个分离株,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),假单胞菌属。(10.3%,n=671),和不动杆菌属。(6.8%,n=438)是最常见的。对多种抗生素耐药是常见的;70.3%(IQR:50-100)的肠杆菌对第三代头孢菌素耐药,70.5%(IQR:58.8-80.3)的金黄色葡萄球菌对甲氧西林耐药,55%(IQR:27.3-81.3)的假单胞菌属耐药。对所有测试的试剂都有抗性。
结论:HCAI在非洲的问题比其他地区更大,然而,仍然缺乏指导当地行动的数据。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,并为实施适当的感染预防和控制策略提供信息。
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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 (I2) 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.
CONCLUSIONS: 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.