These are detailed in the Methods section.
ReviewCommunity-acquired bloodstream infections in Africa: a systematic review and meta-analysis
Introduction
Febrile illness is a leading reason for admission to hospital in Africa,1, 2, 3, 4 and rates of febrile illness are fuelled by the HIV epidemic.5, 6, 7, 8, 9 Despite the major contribution of infectious diseases to hospital admission, the availability of diagnostic microbiology services for bloodstream infections other than malaria is often limited by cost, infrastructure, and personnel constraints.10, 11 Consequently, health-care workers must often rely on syndrome-oriented empirical approaches to treatment and might underestimate or overestimate the likelihood of certain diseases, risking poor clinical outcomes and the promotion of antimicrobial resistance.12, 13, 14 Understanding the causes and prevalence of community-acquired bloodstream infection, which is associated with high risk of death, can inform efforts to improve health outcomes in Africa and promote the meeting of millennium development goals for the reduction of child mortality and HIV/AIDS, malaria, and tuberculosis.
Early studies of bloodstream infections in children admitted to African hospitals suggest that the prevalence of bacterial bloodstream infections among inpatients with fever or clinical sepsis exceeds that described in wealthier regions2, 15, 16, 17, 18 and that bacteraemia is a common cause of illness both in areas of high and low malaria prevalence. Gram-negative organisms, particularly Salmonella enterica, rival or exceed Gram-positive organisms in importance in several published reports on bloodstream infections in both adults and children from African countries.19, 20, 21, 22 In recent years, use of blood culture to assess seriously ill patients infected with HIV has led to a growing understanding of their increased risk of a range of invasive bacterial and fungal diseases, including Streptococcus pneumoniae, disseminated tuberculosis, cryptococcosis, and Salmonella bacteraemia caused by non-typhoidal Salmonella.4, 23, 24, 25, 26, 27
We sought to review studies that used blood culture to identify non-malaria bloodstream infections among prospectively sampled adults and children with predefined, replicable, inclusion criteria admitted to hospitals in Africa, and then to aggregate these data to better quantify the prevalence of bloodstream infections and document the most commonly isolated organisms overall and among different subgroups. We postulated that bloodstream infections would be identified among many patients admitted to hospital in Africa, S enterica would be among the most commonly isolated pathogens, and that age, presence of HIV infection, and features of illness would affect the prevalence of bloodstream infections and predominant organisms isolated.
Section snippets
Search strategy and selection criteria
We searched two major scientific databases (PubMed and Embase) and one topical database (African Healthline) with terms defined with the assistance of a library science technologist (Megan Von Isenburg). PubMed was searched with the search string: “Africa and (fever or fevers or bacteremia or bacteremias or septicemia or septicemias) limit humans”. Embase was searched by use of the terms: “Africa” (exploded to all subheadings) and “fever/” or “fever.mp” or “fevers.mp” or “bacteremia/” or
Results
The online database search done on June 11, 2009, yielded 10 412 articles, 7596 of which were unique articles located in at least one of the three databases (figure 1): 3366 were unique to PubMed, 1244 unique to Embase, and 180 unique to African Healthline. Most of these articles were excluded on the basis of a primary topical focus other than assessment of suspected infection in patients admitted to hospital; others were excluded because of the type of study or population. 87 full-text
Discussion
Bacterial or fungal bloodstream infections are common among prospectively sampled adults and children admitted to hospital in Africa, with a mean prevalence of 13·4% (range 8·5–38·2%) among those with fever and 7·4% (4·2–16·9%) among all admissions irrespective of fever history. These data underscore the importance of considering bacterial or fungal bloodstream infections in the differential diagnosis of all patients admitted to hospital, particularly those who are febrile. Our findings suggest
Search strategy and selection criteria
References (118)
- et al.
Community-acquired bacteremia among hospitalized children in rural central Africa
Int J Infect Dis
(2001) - et al.
Pattern of pediatric HIV/AIDS: a five-year experience in a tertiary hospital
J Natl Med Assoc
(2008) - et al.
Incidence of clinically significant bacteraemia in children who present to hospital in Kenya: community-based observational study
Lancet
(2006) Occult bacteremia in young febrile children
Pediatr Clin North Am
(1999)- et al.
Bacteraemia and mortality among adult medical admissions in Malawi—predominance of non-typhi salmonellae and Streptococcus pneumoniae
J Infect
(2001) - et al.
Publication bias in meta-analysis: its causes and consequences
J Clin Epidemiol
(2000) - et al.
Acute fevers of unknown origin in young children in the tropics
J Pediatr
(1993) - et al.
Detection of bloodstream pathogens in a bacille Calmette-Guerin (BCG)-vaccinated pediatric population in Malawi: a pilot study
Clin Microbiol Infect
(2003) - et al.
Seasonal variation in the etiology of bloodstream infections in a febrile inpatient population in a developing country
Int J Infect Dis
(2001) - et al.
Bacteraemia complicating severe malaria in children
Trans R Soc Trop Med Hyg
(1999)
Life-threatening bacteraemia in HIV-1 seropositive adults admitted to hospital in Nairobi, Kenya
Lancet
Bacteremia in adults admitted to the Department of Medicine of Bangui Community Hospital (Central African Republic)
Acta Trop
Community-acquired bacteraemia in African children
Lancet
Unrecognised Mycobacterium tuberculosis bacteraemia among hospital inpatients in less developed countries
Lancet
The disease profile of hospitalized Third World urban black adolescents
J Adolesc Health Care
Analysis of hospital records in four African countries, 1975–1990, with emphasis on infectious diseases
J Trop Med Hyg
Invasive pneumococcal infections among hospitalized children in Bamako, Mali
Pediatr Infect Dis J
A prospective study of bloodstream infections as cause of fever in Malawi: clinical predictors and implications for management
Trop Med Int Health
Admission trends in a rural South African hospital during the early years of the HIV epidemic
JAMA
HIV/AIDS occurrence in the main university teaching hospital in Cameroon: audit of the 2001 activities of the service of internal medicine
J Int Assoc Physicians AIDS Care (Chic Ill)
South African cause-of-death profile in transition—1996 and future trends
S Afr Med J
HIV-associated morbidity, mortality and diagnostic testing opportunities among inpatients at a referral hospital in northern Tanzania
Ann Trop Med Parasitol
Clinical microbiology in developing countries
Emerg Infect Dis
Laboratory medicine in Africa: a barrier to effective health care
Clin Infect Dis
Evaluation of an algorithm for integrated management of childhood illness in an area of Kenya with high malaria transmission
Bull World Health Organ
Hypothetical performance of syndrome-based management of acute paediatric admissions of children aged more than 60 days in a Kenyan district hospital
Bull World Health Organ
A prospective study of septicaemia in Zaria, northern Nigeria
East Afr Med J
Bacteraemia in febrile children presenting to a paediatric emergency department
Med J Aust
Septicaemia in the tropics: a prospective epidemiological study of 146 patients with a high case fatality rate
Scand J Infect Dis
Relative contribution of bacteraemia and malaria to acute fever without localizing signs of infection in under-five children
J Trop Pediatr
Aetiological agents, clinical features and outcome of septicaemia in infants in Ibadan
West Afr J Med
Epidemiology of bloodstream infections in a bacille Calmette-Guerin-vaccinated pediatric population in Malawi
J Infect Dis
Pathogens and predictors of fatal septicemia associated with human immunodeficiency virus infection in Ivory Coast, west Africa
J Infect Dis
Increased prevalence of HIV-2 infection in hospitalized patients with severe bacterial diseases in Guinea-Bissau
Scand J Infect Dis
Natural history and spectrum of disease in adults with HIV/AIDS in Africa
AIDS
A prospective study of community-acquired bloodstream infections among febrile adults admitted to Mulago Hospital in Kampala, Uganda
J Acquir Immune Defic Syndr Hum Retrovirol
Trends in bloodstream infections among human immunodeficiency virus-infected adults admitted to a hospital in Nairobi, Kenya, during the last decade
Clin Infect Dis
Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group
JAMA
AIDS epidemic update
Bacterial isolates in the sick young infant in Ile-Ife, Nigeria
J Trop Pediatr
Hospital-based surveillance for acute febrile illness in Egypt: a focus on community-acquired bloodstream infections
Am J Trop Med Hyg
Bacterial isolates involved in cases of septicaemia in a Nigerian hospital
East Afr Med J
Pattern of infections in children under-six years old presenting with convulsions associated with fever of acute onset in a children's emergency room in Benin City, Nigeria
J Trop Pediatr
Pattern of bacterial diseases in a cohort of HIV-1 infected adults receiving cotrimoxazole prophylaxis in Abidjan, Côte d'Ivoire
AIDS
Predominant bacterial agents of childhood septicaemia in Jos
Niger J Med
Fatal Mycobacterium tuberculosis bloodstream infections in febrile hospitalized adults in Dar es Salaam, Tanzania
Clin Infect Dis
A hospital-based prevalence survey of bloodstream infections in febrile patients in Malawi: implications for diagnosis and therapy
J Infect Dis
Gram negative septicaemia in Ibadan, Nigeria
East Afr Med J
Concurrent bacteraemia and malaria in febrile Nigerian infants
Trop Doct
Predictors of bacteraemia among febrile infants in Ibadan, Nigeria
J Health Popul Nutr
Cited by (505)
Biology of Anemia: A Public Health Perspective
2023, Journal of NutritionSalmonella Typhi and Salmonella Paratyphi
2023, Molecular Medical Microbiology, Third EditionIssues and Challenges of Public Health Research in Developing Countries
2023, Manson's Tropical Diseases, Fourth Edition