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Bacterial pathogens and resistance causing community acquired paediatric bloodstream infections in low- and middle-income countries: a systematic review and meta-analysis.
Antimicrobial Resistance & Infection Control ( IF 5.5 ) Pub Date : 2019-12-30 , DOI: 10.1186/s13756-019-0673-5
Nina Droz 1 , Yingfen Hsia 2 , Sally Ellis 3 , Angela Dramowski 4 , Mike Sharland 2 , Romain Basmaci 1, 5
Affiliation  

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, Salmonella typhi (26.2%) was the most commonly isolated pathogen, followed by Staphylococcus aureus (7.7%) whereas in Africa, S. aureus (17.8%) and Streptococcus pneumoniae (16.8%) were predominant followed by Escherichia coli (10.7%). S. aureus was more likely resistant to methicillin in Africa (29.5% vs. 7.9%), whereas E. coli was more frequently resistant to third-generation cephalosporins (31.2% vs. 21.2%), amikacin (29.6% vs. 0%) and ciprofloxacin (36.7% vs. 0%) in Asia. The overall estimate for case-fatality rate among 8 studies was 12.7% [6.6-20.2%]. Underlying conditions, such as malnutrition or HIV infection were assessed as a factor associated with bacteraemia in 4 studies each. 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.

中文翻译:

中低收入国家的细菌性病原体和耐药性导致社区获得性小儿血流感染:系统评价和荟萃分析。

背景技术尽管儿童期死亡率很高,但关于中低收入国家(LMIC)儿科血流感染的原因和结果的证据有限。我们进行了系统的综述和荟萃分析,以鉴定LMIC中小儿血流感染的细菌病因及其耐药性。方法我们在1990年1月1日至2019年10月30日之间搜索Pubmed和Embase数据库,将MeSH和自由文本术语结合在一起,用于儿童的“败血症”和“中低收入国家”。两名评论者筛选了文章并进行了数据提取,以识别研究至少有一种血液培养的儿童(1个月至18岁)的研究。感兴趣的主要结果是血液培养阳性率,细菌性病原体的分布,抵抗模式和病死率。使用Freeman-Tukey双反正弦变换合并从每个研究中获得的比例,并使用随机效应荟萃分析模型。结果我们鉴定了2403份合格研究,最终纳入17篇研究,包括52,915名儿童(非洲11名,亚洲6名)。血液培养阳性的总百分比为19.1%[95%CI:12.0-27.5%];非洲为15.5%[8.4-24.4%],亚洲为28.0%[13.2-45.8%]。总共4836细菌分离株被包括在研究中。革兰氏阴性为2974(63.9%[52.2-74.9]),革兰氏阳性为1858(35.8%[24.9-47.5])。在亚洲,伤寒沙门氏菌(26.2%)是最常见的病原体,其次是金黄色葡萄球菌(7.7%),而在非洲,金黄色葡萄球菌(17.8%)和肺炎链球菌(16。8%)居首位,其次是大肠杆菌(10.7%)。在非洲,金黄色葡萄球菌对甲氧西林的耐药性更高(29.5%对7.9%),而大肠杆菌对第三代头孢菌素(31.2%对21.2%),丁胺卡那霉素(29.6%对0%)的抗药性更高。 )和环丙沙星(36.7%vs. 0%)在亚洲。在8项研究中,病死率的总体估计为12.7%[6.6-20.2%]。每项4项研究均将营养不良或HIV感染等潜在疾病作为与菌血症相关的因素进行了评估。结论我们观察到亚洲和非洲之间病原体分布及其抗药性差异显着。关于菌血症的潜在危险因素,多药耐药感染的治疗方式以及不良结局的预测因素的数据非常有限。在非洲,金黄色葡萄球菌对甲氧西林的耐药性更高(29.5%对7.9%),而大肠杆菌对第三代头孢菌素的耐药率更高(31.2%对21.2%),丁胺卡那霉素(29.6%对0%)和亚洲的环丙沙星(36.7%vs. 0%)。在8项研究中,病死率的总体估计为12.7%[6.6-20.2%]。每项4项研究均将营养不良或HIV感染等潜在疾病作为与菌血症相关的因素进行了评估。结论我们观察到亚洲和非洲之间病原体分布及其抗药性差异显着。关于菌血症的潜在危险因素,多药耐药感染的治疗方式以及不良结局的预测因素的数据非常有限。在非洲,金黄色葡萄球菌对甲氧西林的耐药性更高(29.5%对7.9%),而大肠杆菌对第三代头孢菌素的耐药率更高(31.2%对21.2%),丁胺卡那霉素(29.6%对0%)和亚洲的环丙沙星(36.7%vs. 0%)。在8项研究中,病死率的总体估计为12.7%[6.6-20.2%]。每项4项研究均将营养不良或HIV感染等潜在疾病作为与菌血症相关的因素进行了评估。结论我们观察到亚洲和非洲之间病原体分布及其抗药性差异显着。关于菌血症的潜在危险因素,多药耐药感染的治疗方式以及不良结局的预测因素的数据非常有限。在亚洲,大肠埃希菌对第三代头孢菌素(31.2%比21.2%),丁胺卡那霉素(29.6%比0%)和环丙沙星(36.7%比0%)的耐药性更高。在8项研究中,病死率的总体估计为12.7%[6.6-20.2%]。每项4项研究均将营养不良或HIV感染等潜在疾病作为与菌血症相关的因素进行了评估。结论我们观察到亚洲和非洲之间病原体分布及其抗药性差异显着。关于菌血症的潜在危险因素,多药耐药感染的治疗方式以及不良结局的预测因素的数据非常有限。在亚洲,大肠埃希菌对第三代头孢菌素(31.2%比21.2%),丁胺卡那霉素(29.6%比0%)和环丙沙星(36.7%比0%)的耐药性更高。在8项研究中,病死率的总体估计为12.7%[6.6-20.2%]。每项4项研究均将营养不良或HIV感染等潜在疾病作为与菌血症相关的因素进行了评估。结论我们观察到亚洲和非洲之间病原体分布及其抗药性差异显着。关于菌血症的潜在危险因素,多药耐药感染的治疗方式以及不良结局的预测因素的数据非常有限。6-20.2%]。每项4项研究均将营养不良或HIV感染等潜在疾病作为与菌血症相关的因素进行了评估。结论我们观察到亚洲和非洲之间病原体分布及其抗药性差异显着。关于菌血症的潜在危险因素,多药耐药感染的治疗方式以及不良结局的预测因素的数据非常有限。6-20.2%]。每项4项研究均将营养不良或HIV感染等潜在疾病作为与菌血症相关的因素进行了评估。结论我们观察到亚洲和非洲之间病原体分布及其抗药性差异显着。关于菌血症的潜在危险因素,多药耐药感染的治疗方式以及不良结局的预测因素的数据非常有限。
更新日期:2019-12-31
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