Complications and mortality of typhoid fever: A global systematic review and meta-analysis.
Complications and mortality of typhoid fever: A global systematic review and meta-analysis.
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DOI：
10.1016/j.jinf.2020.10.030
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发表时间：
2020-12
期刊：
影响因子：
--
通讯作者：
Crump JA
中科院分区：
文献类型：
--
作者：
Marchello CS;Birkhold M;Crump JA
伤寒住院患者的并发症和死亡率相当高。与亚洲相比，非洲的伤寒病死率更高。在非洲的研究中，20%的伤寒肠穿孔患者死亡。在亚洲，延误治疗与伤寒病死率上升有关。需要对伤寒患者的并发症患病率和病死率(CFR)进行最新估计，以了解疾病负担。对1980年1月1日至2020年1月29日发表在PubMed和Web of Science上的文章进行系统综述，包括使用正常无菌部位培养的医院或社区非手术研究，以及手术中或术后发现提示伤寒的伤寒肠穿孔(TIP)的医院外科研究。使用随机效应荟萃分析计算了21个预先选定的伤寒并发症、粗CFR和中位数(四分位数范围)CFR以及合并CFR估计的患病率。在113个研究地点中，106个(93.8%)位于亚洲和非洲，84个(74.3%)为非手术地点。在非手术研究中，70项(83.3%)是基于医院的。在10355例确诊伤寒患者中，2719例(26.3%)有并发症。非手术患者的综合CFR估计在亚洲地区为0.9%，在非洲地区为5.4%。在亚洲，护理延迟与病死率增加显著相关(r = 0.84；p<；0.01)。在外科研究中，TIP的CFR中位数为15.5%(6.7-24.1%)。我们的发现确定了相当大的伤寒相关疾病和死亡，这些疾病和死亡可以通过预防措施来避免，包括引入伤寒结合疫苗。
Complications and death are considerable among hospitalized patients with typhoid fever. Case fatality ratio of typhoid fever was higher in Africa compared to Asia. Among studies in Africa, 20% of patients with typhoid intestinal perforation died. Delays in care were correlated with increased typhoid case fatality ratio in Asia. Updated estimates of the prevalence of complications and case fatality ratio (CFR) among typhoid fever patients are needed to understand disease burden. Articles published in PubMed and Web of Science from 1 January 1980 through 29 January 2020 were systematically reviewed for hospital or community-based non-surgical studies that used cultures of normally sterile sites, and hospital surgical studies of typhoid intestinal perforation (TIP) with intra- or post-operative findings suggestive of typhoid. Prevalence of 21 pre-selected recognized complications of typhoid fever, crude and median (interquartile range) CFR, and pooled CFR estimates using a random effects meta-analysis were calculated. Of 113 study sites, 106 (93.8%) were located in Asia and Africa, and 84 (74.3%) were non-surgical. Among non-surgical studies, 70 (83.3%) were hospital-based. Of 10,355 confirmed typhoid patients, 2,719 (26.3%) had complications. The pooled CFR estimate among non-surgical patients was 0.9% for the Asia region and 5.4% for the Africa region. Delay in care was significantly correlated with increased CFR in Asia (r = 0.84; p<0.01). Among surgical studies, the median CFR of TIP was 15.5% (6.7–24.1%) per study. Our findings identify considerable typhoid-associated illness and death that could be averted with prevention measures, including typhoid conjugate vaccine introduction.
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影响因子：
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作者：
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通讯作者：
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DOI：
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发表时间：
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