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dc.contributor.authorBunduki, Gabriel Kambale
dc.contributor.authorMasoamphambe, Effita
dc.contributor.authorFox, Tilly
dc.contributor.authorMusaya, Janelisa
dc.contributor.authorMusicha, Patrick
dc.contributor.authorFeasey, Nicholas
dc.identifier.citationBunduki , G K , Masoamphambe , E , Fox , T , Musaya , J , Musicha , P & Feasey , N 2024 , ' Prevalence, risk factors, and antimicrobial resistance of endemic healthcare-associated infections in Africa : a systematic review and meta-analysis ' , BMC Infectious Diseases , vol. 24 , 158 .
dc.identifier.otherJisc: 1730311
dc.identifier.otherpublisher-id: s12879-024-09038-0
dc.identifier.othermanuscript: 9038
dc.identifier.otherORCID: /0000-0003-4041-1405/work/157140370
dc.descriptionNF and GKB were funded by the NIHR Global Health Professorship (NIHR301627), and PM by a Wellcome International Training Fellowship (223012/Z/21/Z). GKB was also funded by the Else Kröner-Fresenius-Stiftung through the BEBUC Excellence Scholarship.en
dc.description.abstractBackground Healthcare-associated infections (HCAI) place a significant burden on healthcare systems globally. This systematic review and meta-analysis aimed to investigate the prevalence, risk factors, and aetiologic agents of endemic HCAI in Africa. Methods MEDLINE/PubMed, CINAHL, and Global Health databases (EBSCOhost interface) were searched for studies published in English and French describing HCAI in Africa from 2010 to 2022. We extracted data on prevalence of HCAI, risk factors, aetiologic agents, and associated antimicrobial resistance patterns. We used random-effects models to estimate parameter values with 95% confidence intervals for risk factors associated with HCAI. This study was registered in PROSPERO (CRD42022374559) and followed PRISMA 2020 guidelines. Results Of 2541 records screened, 92 were included, comprising data from 81,968 patients. Prevalence of HCAI varied between 1.6 and 90.2% with a median of 15% across studies. Heterogeneity (I2) varied from 93 to 99%. Contaminated wound (OR: 1.75, 95% CI: 1.31–2.19), long hospital stay (OR: 1.39, 95% CI: 0.92–1.80), urinary catheter (OR: 1.57, 95% CI: 0.35–2.78), intubation and ventilation (OR: 1.53, 95% CI: 0.85–2.22), vascular catheters (OR: 1.49, 95% CI: 0.52–2.45) were among risk factors associated with HCAI. Bacteria reported from included studies comprised 6463 isolates, with E. coli (18.3%, n = 1182), S. aureus (17.3%, n = 1118), Klebsiella spp. (17.2%, n = 1115), Pseudomonas spp. (10.3%, n = 671), and Acinetobacter spp. (6.8%, n = 438) being most common. Resistance to multiple antibiotics was common; 70.3% (IQR: 50–100) of Enterobacterales were 3rd -generation cephalosporin resistant, 70.5% (IQR: 58.8–80.3) of S. aureus were methicillin resistant and 55% (IQR: 27.3–81.3) Pseudomonas spp. were resistant to all agents tested. Conclusions HCAI is a greater problem in Africa than other regions, however, there remains a paucity of data to guide local action. There is a clear need to develop and validate sustainable HCAI definitions in Africa to support the implementation of routine HCAI surveillance and inform implementation of context appropriate infection prevention and control strategies.
dc.relation.ispartofBMC Infectious Diseasesen
dc.subjectSurgical site infectionen
dc.subjectHealthcare-associated infectionen
dc.subjectUrinary tract infectionen
dc.titlePrevalence, risk factors, and antimicrobial resistance of endemic healthcare-associated infections in Africa : a systematic review and meta-analysisen
dc.typeJournal articleen
dc.contributor.institutionUniversity of St Andrews. School of Medicineen
dc.description.statusPeer revieweden

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