[EQ] Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis

Burden of endemic health-care-associated infection in developing countries:
systematic review and meta-analysis

Benedetta Allegranzi a, Sepideh Bagheri Nejad a, Christophe Combescure b, Wilco Graafmans a, Homa Attar a, Liam Donaldson a d, Prof Didier Pittet a c
a  First Global Patient Safety Challenge, WHO Patient Safety, Geneva, Switzerland

b  Division of Clinical Epidemiology, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland

c  Infection Control Programme, and WHO Collaborating Centre on Patient Safety (Infection Control and Improving Practices), University of Geneva Hospitals & Faculty of Medicine Switzerland

d National Patient Safety Agency, London, UK

The Lancet, Early Online Publication, 10 December 2010doi:10.1016/S0140-6736(10)61458-4

Website: http://bit.ly/ggXdOJ

 

Health-care-associated infection is the most frequent result of unsafe patient care worldwide, but few data are available from the developing world. We aimed to assess the epidemiology of endemic health-care-associated infection in developing countries.

Methods

We searched electronic databases and reference lists of relevant papers for articles published 1995—2008. Studies containing full or partial data from developing countries related to infection prevalence or incidence—including overall health-care-associated infection and major infection sites, and their microbiological
cause—were selected. We classified studies as low-quality or high-quality according to predefined criteria. Data were pooled for analysis.

Findings

Of 271 selected articles, 220 were included in the final analysis. Limited data were retrieved from some regions and many countries were not represented. 118 (54%) studies were low quality. In general, infection frequencies reported in high-quality studies were greater than those from low-quality studies. Prevalence of health-care-associated infection (pooled prevalence in high-quality studies, 15·5 per 100 patients [95% CI 12·6—18·9]) was much higher than proportions reported from Europe and the USA. Pooled overall health-care-associated infection density in adult intensive-care units was 47·9 per 1000 patient-days (95% CI 36·7—59·1), at least three times as high as densities reported from the USA. Surgical-site infection was the leading infection in hospitals (pooled cumulative incidence 5·6 per 100 surgical procedures), strikingly higher than proportions recorded in developed countries. Gram-negative bacilli represented the most common nosocomial isolates. Apart from meticillin resistance, noted in 158 of 290 (54%) Staphylococcus aureus isolates (in eight studies), very few articles reported antimicrobial resistance.

Interpretation

The burden of health-care-associated infection in developing countries is high. Our findings indicate a need to improve surveillance and infection-control practices

 

 *      *     *
This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]
Washington DC USA

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
------------------------------------------------------------------------------------
PAHO/WHO Website
Equity List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html
Twitter http://twitter.com/eqpaho

IMPORTANT: This transmission is for use by the intended
recipient and it may contain privileged, proprietary or
confidential information. If you are not the intended
recipient or a person responsible for delivering this
transmission to the intended recipient, you may not
disclose, copy or distribute this transmission or take
any action in reliance on it. If you received this transmission
in error, please dispose of and delete this transmission. 

Thank you.