Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis
Open accessAbstract
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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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]”
From Antimicrobial-resistant infections among postpartum women at a Ugandan referral hospital (2017) · cites this paper as [5]
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]”
From Antimicrobial-resistant infections among postpartum women at a Ugandan referral hospital (2017) · cites this paper as [5]
Prospective studies on the incidence, microbiology and antimicrobial resistance of postpartum infections are lacking.
“prospective studies on incidence, microbiology and antimicrobial resistance are lacking.”
From Antimicrobial-resistant infections among postpartum women at a Ugandan referral hospital (2017) · cites this paper as [5]
Nosocomial UTIs are understudied and likely underestimated in resource-limited settings.
“which are understudied and likely underestimated in resource-limited settings.[5, 22]”
From Antimicrobial-resistant infections among postpartum women at a Ugandan referral hospital (2017) · cites this paper as [5]
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]”
From Antimicrobial-resistant infections among postpartum women at a Ugandan referral hospital (2017) · cites this paper as [5]
Mounting evidence demonstrates the emergence of Acinetobacter as a cause of hospital-associated and occasionally community-acquired infection in resource-limited settings.
“mounting evidence demonstrates the emergence of this pathogen as a cause of hospital-associated and occasionally community-acquired infection in resource-limited settings.[5, 16–20]”
From Antimicrobial-resistant infections among postpartum women at a Ugandan referral hospital (2017) · cites this paper as [5]
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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
- Licence
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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