权威报道：发展中国家的医院感染负担

鬼才

医院感染的经济负担在发展中国家系统评价和meta分析.pdf (472.51 KB, 下载次数: 115)

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Summary
Background Health-care-associated infection is the most frequent result of unsafe patient care worldwide, but few
data are available from the developing world. We aimed to assess the epidemiology of endemic health-care-associated
infection in developing countries.
Methods We searched electronic databases and reference lists of relevant papers for articles published 1995–2008.
Studies containing full or partial data from developing countries related to infection prevalence or
incidence—including overall health-care-associated infection and major infection sites, and their microbiological
cause—were selected. We classifi ed studies as low-quality or high-quality according to predefi ned criteria. Data
were pooled for analysis.
Findings Of 271 selected articles, 220 were included in the fi nal analysis. Limited data were retrieved from some
regions and many countries were not represented. 118 (54%) studies were low quality. In general, infection frequencies
reported in high-quality studies were greater than those from low-quality studies. Prevalence of health-care-associated
infection (pooled prevalence in high-quality studies, 15·5 per 100 patients [95% CI 12·6–18·9]) was much higher than
proportions reported from Europe and the USA. Pooled overall health-care-associated infection density in adult
intensive-care units was 47·9 per 1000 patient-days (95% CI 36·7–59·1), at least three times as high as densities
reported from the USA. Surgical-site infection was the leading infection in hospitals (pooled cumulative incidence
5·6 per 100 surgical procedures), strikingly higher than proportions recorded in developed countries. Gram-negative
bacilli represented the most common nosocomial isolates. Apart from meticillin resistance, noted in 158 of 290 (54%)
Staphylococcus aureus isolates (in eight studies), very few articles reported antimicrobial resistance.
Interpretation The burden of health-care-associated infection in developing countries is high. Our fi ndings indicate a
need to improve surveillance and infection-control practices.
Funding World Health Organization.

蓝鱼o_0

本文是关于发展中国家医疗保健相关感染最权威的综述，定量的显示了HAI在发展中国家的疾病负荷

文献出处：

Lancet. 2011 Jan 15;377(9761):228-41. Epub 2010 Dec 9.

（全文见鬼才斑竹附件）
Background Health-care-associated infection is the most frequent result of unsafe patient care worldwide, but few data are available from the developing world. We aimed to assess the epidemiology of endemic health-care-associated infection in developing countries.

研究背景 就全球而言，卫生保健相关感染是不安全病患护理中最常见的结果。然而在发展中国家相关研究数据较少。本研究拟评估发展中国家地方性卫生保健相关感染流行概况。
Methods We searched electronic databases and reference lists of relevant papers for articles published 1995–2008. Studies containing full or partial data from developing countries related to infection prevalence or incidence—including overall health-care-associated infection and major infection sites, and their microbiological cause—were selected. We classified studies as low-quality or high-quality according to predefined criteria. Data were pooled for analysis.

方法 通过检索电子资料库和文章的参考文献，查阅1995年-2008年发表相关论文。研究包含带有医院感染患病率和发病率的全部或者部分数据资料，包括整体卫生保健相关感染和主要感染地点，其微生物因果被选定。我们根据预定义的标准将研究分为低质量或高质量。汇总数据进行分析。

Findings Of 271 selected articles, 220 were included in the final analysis. Limited data were retrieved from some regions and many countries were not represented. 118 (54%) studies were low quality. In general, infection frequencies reported in high-quality studies were greater than those from low-quality studies. Prevalence of health-care-associated infection (pooled prevalence in high-quality studies, 15•5 per 100 patients [95% CI 12•6–18•9]) was much higher than proportions reported from Europe and the USA. Pooled overall health-care-associated infection density in adult intensive-care units was 47•9 per 1000 patient-days (95% CI 36•7–59•1), at least three times as high as densities reported from the USA. Surgical-site infection was the leading infection in hospitals (pooled cumulative incidence 5•6 per 100 surgical procedures), strikingly higher than proportions recorded in developed countries. Gram-negative bacilli represented the most common nosocomial isolates. Apart from meticillin resistance, noted in 158 of 290 (54%) Staphylococcus aureus isolates (in eight studies), very few articles reported antimicrobial resistance.

结果 在入选的271篇研究中，220篇进入了最后的分析。有限的数据是提取自一些地区和许多国家没有代表数据。 118（54％）的研究为低质量。一般来说，感染的频率在高质量的研究报告均优于低质量研究的更大。卫生保健相关感染患病率（集在高质量研究中分析，15.5每100例[95％CI为12.6~18.9]）显著高于欧洲和美国。成人重症监护病房种总体的卫生保健相关感染密度为47.9每1000个病人日（95％CI为36.7~59.1），这个数据至少有美国的三倍。在医疗保健相关感染种，手术部位切口感染是首要的疾病，（累计发病密度为： 5.6每100外科手术），显着高于发达国家的数据。革兰氏阴性杆菌最常见的院内获得性菌株。除了甲氧西林耐药，注意到54％（158/290）的金黄色葡萄球菌菌株（8个研究），很少有文献报道其他耐药情况。

Interpretation The burden of health-care-associated infection in developing countries is high. Our findings indicate a need to improve surveillance and infection-control practices.
启示 卫生保健相关感染疾病负担在发展中国家非常之高。我们的研究结果表明亟待改善监测和感染控制措施。

文章概括了目前发展中国家对于HAIs研究的几个问题:
1.超过半数的研究质量不高（54%）；
2.保守估计发展中国家的HAIS要显著高于发达国家，约三倍；
3.目前医院感染菌主要为革兰氏阴性菌；
4.主要的研究结果都是报道的MRSA，对其他耐药菌报道不足。

资金资助：WHO

蓝鱼o_0

回复 1# 鬼才


翻译的题目建议修改下：

医院感染在发展中国家的疾病负担：系统评价和荟萃分析
（文章主要从疾病负担的角度来讲的。）

帖子题目改成：
[权威报道：医院感染在发展中国家的疾病负担]您觉得如何？

婉若秋水

发在《中国感染控制杂志》2011第1期上的论文是这一篇吗？

蓝鱼o_0

回复 4# 婉若秋水


此文章是否为翻译稿？将别人的文章翻译一下就能发表嘛？毕竟这不是我们的劳动成果，还是不提倡这种行为。
可以再新闻作为report ，但是科研论著，应该尊重知识产权。

鬼才

回复 5# 蓝鱼o_0
付陈超老师只是翻译了一个论文摘要，没有全文翻译。我看了他的译文。我认领该篇的全部翻译。

鬼才

Introduction

Health-care-associated infections are deemed the most frequent adverse event threatening patients’ safety worldwide. However, reliable estimates of the globalburden are hampered by a paucity of data adequately describing endemic infections at national and regional levels, particularly in resource-limited settings. In countries where less than 5% of the gross national product is spent on health care, and workforce density is less than five per 1000 population, other emerging health problems and diseases take priority.The epidemiological gap leading to the absence of reliable estimates of the global burden is mainly because surveillance of health-care-associated infection expends time and resources and needs expertise in study design, data collection, analysis, and interpretation. Very few countries of low and middle income have national surveillance systems for health-care-associated infections. Data from the International Nosocomial Infection Control Consortium, and fi ndings of two systematic reviews on hospital-acquired neonatal infections and ventilator-associated pneumonia, suggested not only that risks of health-care-associated infection are signifi cantly higher in developing countries but also that the eff ect on patients and health-care systems is severe and greatly under estimated.

引言

医院感染被认为是世界上造成患者安全隐患最常见的因素。然而，在不同国家和地区之间对于地方性传染病数据的缺乏，妨碍了对全球经济负担的可靠性评估，尤其是在（欠发达地区）资源有限的国家。在这些国家对卫生保健的投入少于国民收入的5%，卫技人员少于总人口的5‰，暴露出十分严重的疾病的卫生保健问题。导致全球性负担可靠性评估出现流行病学差别主要是缺乏监测，医院感染所需的时间、资源和必要的研究人员、数据收集、分析及解释。只有极少数低收入和中等收入国家卫生保健相关感染的国家监测系统。来自国际医院感染控制联盟及两份新生儿医院获得性感染和呼吸机相关性肺炎的综述数据表明在发展中国家不仅医院感染的风险率较高，而且其对病人和医务人员的影响估计不足。

The aim of this systematic review and meta-analysis is to assess the burden of endemic health-care-associated infection in developing countries by collation of  available data from published studies on epidemiology. We also aim to investigate  onstraints linked to surveillance of health-care-associated infection in resource-limited settings and identify perspectives
for improvement.

该系统综述和meta分析的目的在于通过收集到的流行病学研究出版物上的数据去评估发展中国家医院感染的负担。同时也通过持续调查欠发达地区的医院感染状况，以确定有效的改善方法。

(本译文由sunlight版主审校，蓝鱼o_O会员友情复审。特此致谢)

蓝鱼o_0

婉若秋水 发表于 2011-4-20 18:18

                               
登录/注册后可看大图

发在《中国感染控制杂志》2011第1期上的论文是这一篇吗？

这个只是摘要，我把全文上传。

但是里面有很多有价值的东西，还需要看全文才能够完全体会。

鬼才

今天再读这篇文章，觉得有全文翻译的必要，先在此作个标记。陆续翻译后，上传。
因本栏目贴子太多，不好找，故先回复一下，便于下次好找。

鬼才

Methods

Searchstrategy and selection criteria

We undertook a literaturesearch and review process according to a protocol designed before data collection. We aimed to identify studies on theepidemiology of health-care-associatedinfection in developing countries, with a particular focus on the most frequent bacterial infections—urinary-tract infection,surgical-site infection, bloodstream infection, hospital-acquired pneumonia, and ventilator-associated pneumonia. We searchedMedline for reports published betweenJanuary, 1995, and December,2008, with no language restriction. We used a comprehensive list of terms (panel 1),including MeSH terms “crossinfection”, “infection control”, and “developingcountries”, together with individual names of countries of low and middle income, according to the 2008 World Bank classification. We applied the same search strategy to the Cochrane database to identify anypublished reviews, and we searched WHO regional medical databases (panel 1). Furthermore, we consulted Embase but our search did not yield additional publications.

方法

检索策略和选择标准

根据收集资料之前制定的设计方案，我们着手进行了文献检索和审核。我们旨在对发展中国家医院感染的流行病学进行研究，特别关注最常见的细菌感染、泌尿道感染、手术部位感染、血液感染、医院获得性肺炎和机械通气相关肺炎。我们对1995年1月至2008年12月发表的医院感染相关报道通过Medline进行了检索，没有语言限制。我们使用一个全面的术语列表 (表1),包括MeSH 中的“交叉感染”,“感染控制”和“发展中国家”术语及根据2008年世界银行对国家经济收入分类中的中低收入国家的名称。我们对Cochrane数据库实施了同样的检索策略来鉴别任何已经发表的评论，我们也检索了WHO区域医疗数据库(表1)。此外,我们还咨询了Embase，但我们没检索其他的出版物。

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