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Prevalence, Risk Factors, and Antimicrobial Resistance of Endemic Healthcare-Associated Infections in Africa: A Systematic Review and Meta-Analysis

38 Pages Posted: 7 Jul 2023

See all articles by Gabriel Kambale Bunduki

Gabriel Kambale Bunduki

University of Malawi - Malawi-Liverpool-Wellcome Trust Clinical Research Programme

Effita Masoamphambe

University of Malawi - Malawi-Liverpool-Wellcome Trust Clinical Research Programme

Tilly Fox

Liverpool School of Tropical Medicine - Department of Clinical Sciences

Janelisa Musaya

University of Malawi - Malawi-Liverpool-Wellcome Trust Clinical Research Programme

Patrick Musicha

University of Malawi - Malawi-Liverpool-Wellcome Trust Clinical Research Programme

Nicholas A. Feasey

Liverpool School of Tropical Medicine - Department of Clinical Sciences

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Abstract

Background: Healthcare-associated infections (HCAI) place a significant burden on healthcare systems globally. This systematic review and meta-analysis aimed to investigate the prevalence, risk factors, and aetiologic agents of endemic HCAI in Africa. 

Methods: MEDLINE/PubMed, CINAHL, and Global Health databases (EBSCOhost interface) were searched for studies published in English and French describing HCAI in Africa from 2010 to 2022. We extracted data on prevalence of HCAI, risk factors, aetiologic agents, and associated antimicrobial resistance patterns. We used random-effects models to estimate parameter values with 95% confidence intervals for risk factors with HCAI. This study was registered in PROSPERO (CRD42022374559) and followed PRISMA 2020 guidelines. 

Findings: Of 2541 records screened, 92 were included, comprising data from 81968 patients. Prevalence of HCAI varied between 1·6 and 90·2% with a median of 15% across studies. Heterogeneity (I2) varied from 93-99%. Contaminated wound (OR: 1.75, 95% CI: 1.31-2.19), long hospital stay (1.39, 0.92-1.80), urinary catheter (1.57, 0.35-2.78), intubation and ventilation (1.53, 0.85-2.22), vascular catheters (1.49, 0.52-2.45) were among risk factors associated with HCAI. 6463 bacterial isolates were reported from HCAI studies, with E. coli (18·3%, n=1182), S. aureus (17·3%, n=1118), Klebsiella spp. (17·2%, n=1115), Pseudomonas spp. (10·3%, n=671), and Acinetobacter spp. (6·8%, n=438) being most common. Resistance to multiple antibiotics was common; 70·3% (IQR: 50-100) of Enterobacterales were 3rd-generation cephalosporin resistant, 70·5% (58·8-80·3) of S. aureus were methicillin resistant and 55% (27·3-81·3) Pseudomonas spp. were resistant to all agents tested.

Interpretation: HCAI is a greater problem in Africa than other regions, however, there remains a paucity of data to guide local action. There is a clear need to develop and validate sustainable HCAI definitions in Africa to support the implementation of routine HCAI surveillance and inform implementation of context appropriate infection prevention and control strategies.

Funding: NF and GKB were funded by the NIHR Global Health Professorship (NIHR301627), and PM by a Wellcome International Training Fellowship (223012/Z/21/Z). GKB was also funded by the Else Kröner-Fresenius-Stiftung through the BEBUC Excellence Scholarship.

Declaration of Interest: The authors declare that they have no conflicts of interest.

Keywords: Healthcare-associated infection, Prevalence, Risk factors, Antimicrobial resistance, Surgical site infection, Bloodstream infection, Pneumonia, Urinary tract infection

Suggested Citation

Bunduki, Gabriel Kambale and Masoamphambe, Effita and Fox, Tilly and Musaya, Janelisa and Musicha, Patrick and Feasey, Nicholas A., Prevalence, Risk Factors, and Antimicrobial Resistance of Endemic Healthcare-Associated Infections in Africa: A Systematic Review and Meta-Analysis. Available at SSRN: https://ssrn.com/abstract=4499690 or http://dx.doi.org/10.2139/ssrn.4499690

Gabriel Kambale Bunduki (Contact Author)

University of Malawi - Malawi-Liverpool-Wellcome Trust Clinical Research Programme ( email )

United Kingdom

Effita Masoamphambe

University of Malawi - Malawi-Liverpool-Wellcome Trust Clinical Research Programme ( email )

United Kingdom

Tilly Fox

Liverpool School of Tropical Medicine - Department of Clinical Sciences ( email )

Janelisa Musaya

University of Malawi - Malawi-Liverpool-Wellcome Trust Clinical Research Programme ( email )

United Kingdom

Patrick Musicha

University of Malawi - Malawi-Liverpool-Wellcome Trust Clinical Research Programme ( email )

Nicholas A. Feasey

Liverpool School of Tropical Medicine - Department of Clinical Sciences ( email )

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