A Systematic Review and Meta-analysis of the Prevalence of Community-Onset Bloodstream Infections among Hospitalized Patients in Africa and Asia

Abstract

Community-onset bloodstream infections (CO-BSI) are major causes of severe febrile illness and death worldwide. In light of new data and the growing problem of antimicrobial resistance (AMR) among pathogens causing BSI, we undertook a systematic review of hospital-based studies of CO-BSI among patients hospitalized with fever. Without restriction to language or country, we searched PubMed, Web of Science, and Scopus for prospective hospital-based studies of culture-confirmed CO-BSI among febrile inpatients. We determined by study the prevalence of BSI among participants, the pathogens responsible for BSI, and the antimicrobial susceptibility patterns of pathogens causing BSI, according to place and time. Thirty-four (77.3%) of 44 eligible studies recruited 29,022 participants in Africa and Asia combined. Among participants in these two regions, the median prevalence of BSI was 12.5% (range, 2.0 to 48.4%); of 3,220 pathogens isolated, 1,119 (34.8%) were Salmonella enterica, 425 (13.2%) Streptococcus pneumoniae, and 282 (8.8%) Escherichia coli. Antimicrobial susceptibility testing was reported in 16 (36.4%) studies. When isolates collected prior to 2008 were compared to those collected in the period of 2008 through 2018, the proportions of typhoidal Salmonella and Staphylococcus aureus isolates resistant to several clinically relevant antimicrobials increased over time, while S. pneumoniae susceptibility was stable. CO-BSI remain a major cause of severe febrile illness among hospitalized patients in Africa and Asia, with S. enterica, S. pneumoniae, and E. coli predominating. There is a concerning increase in AMR among serious infections caused by community-onset pathogens. Ongoing surveillance is needed to inform empirical management and strategies to control AMR.

A prospective study of bloodstream infections among febrile adolescents and adults attending Yangon General Hospital, Yangon, Myanmar

“…The finding of S. enterica Typhi and Paratyphi A as the leading cause of BSI in Yangon is consistent with similar studies from other parts of South and South-East Asia [5,[36][37][38]. In a study of patients suspected to have enteric fever in Mandalay in central Myanmar during 2012-2013, S. enterica Typhi was isolated from 4.5% of blood cultures [35].…”

Prevalence and speciation of brucellosis in febrile patients from a pastoralist community of Tanzania

“…Several more commonly reported bloodstream infections, including non-typhoidal serovars of Salmonella enterica, Staphylococcus aureus, Streptococcus pneumoniae, and Escherichia coli were also identified in this study population, but at lower relative frequency as compared to Brucella spp. 25,26 . Malaria was less prevalent than brucellosis in our study participants, as has been reported previously for northern Tanzania 46 .…”

Estimation of Incidence of Typhoid and Paratyphoid Fever in Vientiane, Lao People’s Democratic Republic

“…2 In Southeast Asia in 2017, enteric fever incidence was estimated to be 219.8 per 100,000 populations and associated with 877,200 disability-adjusted life-year lost. 3 As with other countries in Southeast Asia, 4 Salmonella Typhi has been identified as a leading cause of community-onset bloodstream infection in the Lao People's Democratic Republic (Lao PDR), not only in the capital of Vientiane 5 but also in Luang Namtha in the northwest and Salavan in the south. 6 Furthermore, multiple-drug resistance has been identified among Salmonella Typhi isolates in Lao PDR.…”