Cited by 2,514Infection Control in HealthcareNosocomial Infections in ICUAntibiotic Use and Resistance

Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis

Open access
Allegranzi, Benedetta, Nejad, Sepideh Bagheri, Combescure, Christophe, Graafmans, Wilco, Attar, Homa, Donaldson, Liam, Pittet, Didier·2011·The Lancet

Abstract

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 classified studies as low-quality or high-quality according to predefined criteria. Data were pooled for analysis. 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…

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Crossref · 10.1016/s0140-6736(10)61458-4

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192 of 192 references verified0 citation errors · 0 not checkable

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  • The most common postpartum infections include endometritis (puerperal sepsis), urinary tract infections, bloodstream infections, and cesarean surgical site infections.

    “The most common postpartum infections include endometritis (puerperal sepsis), urinary tract infections (UTIs), bloodstream infections, and cesarean surgical site infections.[3, 5, 7]”
  • In low-resource settings, differences in antibiotic prophylaxis and treatment, cesarean delivery practices, HIV prevalence, access to microbiology testing, antimicrobial stewardship and infection control practices may lead to differences in infection incidence, microbiology, and antimicrobial resistance.

    “In low-resource settings, differences in antibiotic prophylaxis and treatment, cesarean delivery practices, human immunodeficiency virus (HIV) prevalence, access to microbiology testing, antimicrobial stewardship and infection control practices may lead to differences in infection incidence, microbiology, and antimicrobial resistance.[4, 5, 9, 10]”
  • Prospective studies on the incidence, microbiology and antimicrobial resistance of postpartum infections are lacking.

    “prospective studies on incidence, microbiology and antimicrobial resistance are lacking.”
  • Nosocomial UTIs are understudied and likely underestimated in resource-limited settings.

    “which are understudied and likely underestimated in resource-limited settings.[5, 22]”
  • UTI microbiology and antimicrobial resistance in sub-Saharan Africa is not well described.

    “Though UTI microbiology and antimicrobial resistance in sub-Saharan Africa is not well described,[4, 5, 25]”

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Authors
Allegranzi, B., Nejad, S. B., Combescure, C., Graafmans, W., Attar, H., Donaldson, L., & Pittet, D.
Affiliations
  • World Health Organization (CH)
  • University of Geneva (CH)
Corresponding author
Pittet, Didier
Venue
The Lancet
Publisher
Elsevier BV
Published
2011-01
Volume
377
Issue
9761
Pages
228-241
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
OpenAlex
W2113701842
Cited by
2,514
References
202
Citations by year
2026: 173 · 2025: 191 · 2024: 205 · 2023: 200 · 2022: 207 · 2021: 258 · 2020: 260 · 2019: 202 · 2018: 207 · 2017: 160 · 2016: 114 · 2015: 96 · 2014: 93 · 2013: 66 · 2012: 53
FWCI
5.42
Type
journal article
Language
en
Open access
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
  • Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by)
Funders
World Health Organization
Topics
  • Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
  • Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
Keywords
nosocomial infections, developing countries, infection prevalence, intensive care unit, surgical site infection, Gram-negative bacilli, Staphylococcus aureus, methicillin resistance, antimicrobial resistance, infection control, infection surveillance
MeSH terms
Cross Infection, Developing Countries, Humans, Cost of Illness, Endemic Diseases

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