[ 柳叶刀]Community-acquired bloodstream infections in Africa: a SR and meta

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Community-acquired bloodstream infections in Africa: a systematic review and meta-analysis
Elizabeth A Reddy, Andrea V Shaw, John A Crump
Lancet Infect Dis 2010;10: 417–32
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.