Prevalence, risk factors, and antimicrobial resistance of endemic healthcare-associated infections in Africa: a systematic review and meta-analysis

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 associated with HCAI. This study was registered in PROSPERO (CRD42022374559) and followed PRISMA 2020 guidelines. Results Of 2541 records screened, 92 were included, comprising data from 81,968 patients. Prevalence of HCAI varied between 1.6 and 90.2% with a median of 15% across studies. Heterogeneity (I2) varied from 93 to 99%. Contaminated wound (OR: 1.75, 95% CI: 1.31–2.19), long hospital stay (OR: 1.39, 95% CI: 0.92–1.80), urinary catheter (OR: 1.57, 95% CI: 0.35–2.78), intubation and ventilation (OR: 1.53, 95% CI: 0.85–2.22), vascular catheters (OR: 1.49, 95% CI: 0.52–2.45) were among risk factors associated with HCAI. Bacteria reported from included studies comprised 6463 isolates, 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% (IQR: 58.8–80.3) of S. aureus were methicillin resistant and 55% (IQR: 27.3–81.3) Pseudomonas spp. were resistant to all agents tested. Conclusions 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.

Comparative Study of Antimicrobial Properties of Biomaterials and Dressings Based on Antiseptics Against Gram-Negative Bacteria as Pathogens of Wound Infections

“…Surgical site infections (SSIs), infectious complications of wounds and burns (including combat wounds) are mainly caused by microorganisms resistant to the most commonly used antimicrobial drugs and are characterized by multiple drug resistance. Carbapenemresistant K.pneumoniae (CRKP), P.aeruginosa (CRPA) and A.baumannii (CRAB) are among the dominant and threatening agents in the structure of pathogens [29][30][31][32][33][34][35][36].…”

Epidemiology and Risk Factors of Nosocomial Infection in Hospitalized Children and Adults: A Review

“…were resistant to all agents tested. It was concluded, that HCAI is a greater problem in Africa than other regions, however, there remains a paucity of data to guide local action [12] . Isigi et al demonstrated that patients with previous colonization and underlying conditions are at increased risk of nosocomial infections due to frailty, extended hospital stay, and suppressed immunity.…”