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
复制标题
DOI：
10.1016/s0140-6736(10)61458-4
复制
发表时间：
2011-01-15
期刊：
影响因子：
168.9
通讯作者：
Pittet, Didier
中科院分区：
文献类型：
--
作者：
Allegranzi, Benedetta;Nejad, Sepideh Bagheri;Pittet, Didier
背景：卫生保健相关感染是世界范围内不安全患者护理最常见的结果，但发展中国家的数据很少。我们的目的是评估流行病学的地方性卫生保健相关的感染在developingcountries. Methods我们搜索电子数据库和参考文献列表中发表的文章1995 - 2008年的相关文件。选择了包含来自发展中国家的与感染流行率或发生率相关的全部或部分数据的研究，包括总体卫生保健相关感染和主要感染部位及其微生物学原因。我们根据预定义的标准将研究分为低质量或高质量。结果：在271篇文献中，有220篇纳入最终分析。从一些区域检索到的数据有限，许多国家没有列入。118项（54%）研究质量较低。一般来说，高质量研究中报告的感染频率高于低质量研究中报告的感染频率。医疗保健相关感染的患病率（高质量研究的汇总患病率，15.5/100例患者[95% CI 12.6 - 18.9]）远高于欧洲和美国报告的比例。成人重症监护病房的汇总总体医疗保健相关感染密度为47.9/1000患者-天（95% CI 36.7 - 59.1），至少是美国报告密度的3倍。手术部位感染是医院中的主要感染（每100例手术的合并累积发生率为5.6），明显高于发达国家记录的比例。革兰阴性杆菌是最常见的医院分离株。除了甲氧西林耐药性，注意到在158 290（54%）金黄色葡萄球菌分离株（在8项研究），很少有文章报道antimicrobial resistance.Interpretation卫生保健相关的感染在发展中国家的负担很高。我们的研究结果表明，需要改善监测和感染控制措施。
Background 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 induded 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.