Bacterial pathogens and resistance causing community acquired paediatric bloodstream infections in low- and middle-income countries: a systematic review and meta-analysis.
Adolescent
Africa
/ epidemiology
Anti-Bacterial Agents
/ pharmacology
Asia
/ epidemiology
Bacteremia
/ epidemiology
Bacteria
/ drug effects
Child
Child Health
/ statistics & numerical data
Child, Preschool
Community-Acquired Infections
/ epidemiology
Developing Countries
Drug Resistance, Bacterial
Humans
Infant
Microbial Sensitivity Tests
Observational Studies as Topic
Poverty
Sepsis
/ epidemiology
Antimicrobial resistance
Bacteraemia
Bloodstream infection
Children
Epidemiology
Resource-limited settings
Sepsis
Journal
Antimicrobial resistance and infection control
ISSN: 2047-2994
Titre abrégé: Antimicrob Resist Infect Control
Pays: England
ID NLM: 101585411
Informations de publication
Date de publication:
2019
2019
Historique:
received:
14
06
2019
accepted:
23
12
2019
entrez:
2
1
2020
pubmed:
2
1
2020
medline:
18
7
2020
Statut:
epublish
Résumé
Despite a high mortality rate in childhood, there is limited evidence on the causes and outcomes of paediatric bloodstream infections from low- and middle-income countries (LMICs). We conducted a systematic review and meta-analysis to characterize the bacterial causes of paediatric bloodstream infections in LMICs and their resistance profile. We searched Pubmed and Embase databases between January 1st 1990 and October 30th 2019, combining MeSH and free-text terms for "sepsis" and "low-middle-income countries" in children. Two reviewers screened articles and performed data extraction to identify studies investigating children (1 month-18 years), with at least one blood culture. The main outcomes of interests were the rate of positive blood cultures, the distribution of bacterial pathogens, the resistance patterns and the case-fatality rate. The proportions obtained from each study were pooled using the Freeman-Tukey double arcsine transformation, and a random-effect meta-analysis model was used. We identified 2403 eligible studies, 17 were included in the final review including 52,915 children (11 in Africa and 6 in Asia). The overall percentage of positive blood culture was 19.1% [95% CI: 12.0-27.5%]; 15.5% [8.4-24.4%] in Africa and 28.0% [13.2-45.8%] in Asia. A total of 4836 bacterial isolates were included in the studies; 2974 were Gram-negative (63.9% [52.2-74.9]) and 1858 were Gram-positive (35.8% [24.9-47.5]). In Asia, We observed a marked variation in pathogen distribution and their resistance profiles between Asia and Africa. Very limited data is available on underlying risk factors for bacteraemia, patterns of treatment of multidrug-resistant infections and predictors of adverse outcomes.
Sections du résumé
Background
Despite a high mortality rate in childhood, there is limited evidence on the causes and outcomes of paediatric bloodstream infections from low- and middle-income countries (LMICs). We conducted a systematic review and meta-analysis to characterize the bacterial causes of paediatric bloodstream infections in LMICs and their resistance profile.
Methods
We searched Pubmed and Embase databases between January 1st 1990 and October 30th 2019, combining MeSH and free-text terms for "sepsis" and "low-middle-income countries" in children. Two reviewers screened articles and performed data extraction to identify studies investigating children (1 month-18 years), with at least one blood culture. The main outcomes of interests were the rate of positive blood cultures, the distribution of bacterial pathogens, the resistance patterns and the case-fatality rate. The proportions obtained from each study were pooled using the Freeman-Tukey double arcsine transformation, and a random-effect meta-analysis model was used.
Results
We identified 2403 eligible studies, 17 were included in the final review including 52,915 children (11 in Africa and 6 in Asia). The overall percentage of positive blood culture was 19.1% [95% CI: 12.0-27.5%]; 15.5% [8.4-24.4%] in Africa and 28.0% [13.2-45.8%] in Asia. A total of 4836 bacterial isolates were included in the studies; 2974 were Gram-negative (63.9% [52.2-74.9]) and 1858 were Gram-positive (35.8% [24.9-47.5]). In Asia,
Conclusions
We observed a marked variation in pathogen distribution and their resistance profiles between Asia and Africa. Very limited data is available on underlying risk factors for bacteraemia, patterns of treatment of multidrug-resistant infections and predictors of adverse outcomes.
Identifiants
pubmed: 31893041
doi: 10.1186/s13756-019-0673-5
pii: 673
pmc: PMC6937962
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
207Informations de copyright
© The Author(s). 2019.
Déclaration de conflit d'intérêts
Competing interestsThe authors declare that they have no competing interests.
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