Community-acquired bloodstream infections in Africa: a systematic review and meta-analysis.
Community-acquired bloodstream infections in Africa: a systematic review and meta-analysis.
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DOI：
10.1016/s1473-3099(10)70072-4
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发表时间：
2010-06
影响因子：
56.3
通讯作者：
Crump, John A.
中科院分区：
文献类型：
--
作者：
Reddy, Elizabeth A.;Shaw, Andrea V.;Crump, John A.
关于非洲社区获得性血流感染的流行率和原因的数据很少。我们检索了三个数据库，以寻找前瞻性研究至少接受血培养的住院患者的研究，发现22项符合条件的研究描述了58296例患者，其中15166例成人中的2051例（13.5%）和43130例儿童中的3527例（8.2%）患有血流感染。1643例（29.1%）非疟疾血流感染是由于肠道沙门氏菌（占这些非伤寒沙门氏菌的58.4%），总体和成人中最流行的分离株，1031例（总体18.3%）是由于肺炎链球菌，儿童中最常见的分离株。其他常见的分离株包括金黄色葡萄球菌（531例感染; 9.5%）和大肠杆菌（412例; 7.3%）。结核分枝杆菌复合体占166（30.7%）的539个分离株在7项研究中，使用分枝杆菌培养技术。HIV感染与任何血液感染有关，尤其是与肠道沙门氏菌和结核分枝杆菌复合菌血症有关。在有记录的地方，血液感染患者的院内病死率为18.1%。我们的研究结果表明，血流感染是常见的，并与高死亡率相关。改善临床微生物学服务和重新评估经验性治疗指南，说明血流感染的流行病学可能有助于更好的结果。
Data on the prevalence and causes of community-acquired bloodstream infections in Africa are scarce. We searched three databases for studies that prospectively studied patients admitted to hospital with at least a blood culture, and found 22 eligible studies describing 58 296 patients, of whom 2051 (13.5%) of 15 166 adults and 3527 (8.2%) of 43 130 children had bloodstream infections. 1643 (29.1%) non-malaria bloodstream infections were due to Salmonella enterica (58.4% of these non-typhoidal Salmonella), the most prevalent isolate overall and in adults, and 1031 (18.3% overall) were due to Streptococcus pneumoniae, the most common isolate in children. Other common isolates included Staphylococcus aureus (531 infections; 9.5%) and Escherichia coli (412; 7.3%). Mycobacterium tuberculosis complex accounted for 166 (30.7%) of 539 isolates in seven studies that used mycobacterial culture techniques. HIV infection was associated with any bloodstream infection, particularly with S enterica and M tuberculosis complex bacteraemia. Where recorded, patients with bloodstream infections had an in-hospital case fatality of 18.1%. Our results show that bloodstream infections are common and associated with high mortality. Improved clinical microbiology services and reassessment of empirical treatment guidelines that account for the epidemiology of bloodstream infections might contribute to better outcomes.