A systematic review of healthcare-associated infections in Africa: An antimicrobial resistance perspective.

Emmanuel O Irek,Temitope O Obadare,Adewale A Amupitan,Aaron O Aboderin

doi:10.4102/ajlm.v7i2.796

Abstract

BackgroundHealthcare-associated infection (HCAI) is a global health challenge, not only as an issue of patient safety but also as a major driver of antimicrobial resistance (AMR). It is a major cause of morbidity and mortality with economic consequences.ObjectiveThis review provides an update on the occurrence of HCAI, as well as the contribution of emerging AMR on healthcare delivery in Africa.MethodsWe searched PubMed, Cochrane database, African Journals Online and Google Scholar for relevant articles on HCAI in Africa between 2010 and 2017. Preferred reporting items of systematic reviews and meta-analyses guidelines were followed for selection. Thirty-five eligible articles were considered for the qualitative synthesis.ResultsOf the 35 eligible articles, more than half (n = 21, 60%) were from East Africa. Klebsiella spp., Staphylococcus aureus, Escherichia coli and Pseudomonas spp. were the common pathogens reported in bloodstream infection, (catheter-associated) urinary tract infection, surgical site infection and healthcare-associated pneumonia. Among these various subtypes of HCAI, methicillin-resistant S. aureus (3.9% – 56.8%) and extended-spectrum beta-lactamase producing Gram-negative bacilli (1.9% – 53.0%) were the most reported antimicrobial resistant pathogens.ConclusionThis review shows a paucity of HCAI surveillance in Africa and an emergence of AMR priority pathogens. Hence, there is a need for a coordinated national and regional surveillance of both HCAI and AMR in Africa.

Highlights

Healthcare-associated infection (HCAI) is a global health challenge, as an issue of patient safety and as a major driver of antimicrobial resistance (AMR)
Two-thirds of the reviewed articles were from PubMed, one-third were from African Journals Online and Google Scholar, and none were retrieved from the Cochrane library
The phenotypic method was mostly utilised for the identification of the microorganisms in the laboratory according to Clinical and Laboratory Standards Institute guidelines.[15,16,19,22,23,25,27,31,41,42,43,44,45,46,47,48]

Summary

Introduction

Healthcare-associated infection (HCAI) is a global health challenge, as an issue of patient safety and as a major driver of antimicrobial resistance (AMR) It is a major cause of morbidity and mortality with economic consequences. Multidrug-resistant organisms account for 25% of HCAI globally.[2,5]

Results

Discussion

Conclusion