Bacterial pathogens and resistance causing community acquired paediatric bloodstream infections in low- and middle-income countries : a systematic review and meta-analysis
Date
2019-12-30
Journal Title
Journal ISSN
Volume Title
Publisher
BMC (part of Springer Nature)
Abstract
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 multidrugresistant
infections and predictors of adverse outcomes.
Description
CITATION: Droz, N., et al. 2020. Bacterial pathogens and resistance causing community acquired paediatric bloodstream infections in low- and middle-income countries : a systematic review and meta-analysis. Antimicrobial Resistance and Infection Control, 8:207, doi:10.1186/s13756-019-0673-5.
The original publication is available at https://aricjournal.biomedcentral.com
The original publication is available at https://aricjournal.biomedcentral.com
Keywords
Septicemia in children -- Developing countries, Meta-analysis, Systematic reviews (Medical research)
Citation
Droz, N., et al. 2020. Bacterial pathogens and resistance causing community acquired paediatric bloodstream infections in low- and middle-income countries : a systematic review and meta-analysis. Antimicrobial Resistance and Infection Control, 8:207, doi:10.1186/s13756-019-0673-5