Community-acquired bloodstream infections in Africa: a systematic review and meta-analysis

Abstract

Data on the prevalence and causes of community-acquired bloodstream infections in Africa are scarce. We searched three databases for studies that prospectively studied patients admitted to hospital with at least a blood culture, and found 22 eligible studies describing 58 296 patients, of whom 2051 (13.5%) of 15 166 adults and 3527 (8.2%) of 43 130 children had bloodstream infections. 1643 (29.1%) non-malaria bloodstream infections were due to Salmonella enterica (58.4% of these non-typhoidal Salmonella), the most prevalent isolate overall and in adults, and 1031 (18.3% overall) were due to Streptococcus pneumoniae, the most common isolate in children. Other common isolates included Staphylococcus aureus (531 infections; 9.5%) and Escherichia coli (412; 7.3%). Mycobacterium tuberculosis complex accounted for 166 (30.7%) of 539 isolates in seven studies that used mycobacterial culture techniques. HIV infection was associated with any bloodstream infection, particularly with S enterica and M tuberculosis complex bacteraemia. Where recorded, patients with bloodstream infections had an in-hospital case fatality of 18.1%. Our results show that bloodstream infections are common and associated with high mortality. Improved clinical microbiology services and reassessment of empirical treatment guidelines that account for the epidemiology of bloodstream infections might contribute to better outcomes.

Non-Typhoidal Salmonella Gastroenteritis at a Diarrheal Hospital in Dhaka, Bangladesh, 1996–2011

“…Although our data suggest that rainfall-associated contamination of water may be associated with disease transmission, it is likely that both environmental and host behavioral factors play a role in the seasonal variation of NTS, as they do for other enteric infections in Bangladesh. 16,17 Although S. Typhimurium and S. Enteritidis are the predominant serotypes known to cause gastroenteritis and bacteremia in sub-Saharan Africa, [18][19][20] limited data from studies in South and Southeast Asia show differences in serotype frequency, especially among stool isolates. 6,12 In this analysis, we show that approximately 60% of NTS serogroups identified from stool were from Groups B and C1, whereas Group D, to which S. Enteritidis belongs, only represented 5% of isolates.…”

Typhoid fever: misuse of Widal test in Libya

“…The TUBEX commercial kit which detected IgM antibodies appeared to provide the most accurate results but has some limitations [23]. These new commercially available typhoid rapid antibody tests have shown variable performance [24][25][26] and have not fully been evaluated in Africa [27][28][29] (Table 1).…”

Identifying an immune signature against invasive Salmonella

“…Underlying risk factors for NTS infections are very young age, malaria anemia, malnourishment, and HIV infection (12). Antimicrobial resistance among clinical invasive Salmonella isolates in Africa is increasingly common, making treatment of these infections even more difficult (13). The lack of vaccines against invasive NTS is concerning, and efforts toward their development should be a priority in the control of these infections in both developed and developing countries (13,14).…”

“…Antimicrobial resistance among clinical invasive Salmonella isolates in Africa is increasingly common, making treatment of these infections even more difficult (13). The lack of vaccines against invasive NTS is concerning, and efforts toward their development should be a priority in the control of these infections in both developed and developing countries (13,14). Although vaccines against typhoid Salmonella are available, their use and effectiveness is questionable, and this disease continues to be a burden in many developing countries (1).…”