Abstract
SummaryBackgroundPneumonia is a leading cause of childhood morbidity and mortality. This study aimed to estimate the global hospitalisation due to Staphylococcus aureus pneumonia in under-5 children.MethodsWe conducted a systematic review and meta-analysis of primary studies following the PRISMA-P guidelines. We searched Medline, Embase, Global Health, CINAHL, Global Index Medicus, Scopus, China National Knowledge Infrastructure, Wanfang, and CQvip. We included studies reporting data on Staphylococcus aureus pneumonia, confirmed by detection of the pathogen in sterile-site samples in under-5 hospitalised children, published in English or Chinese language and conducted between 1st January 1990 and 4th November 2021 and between 1st January 1990 and 30th September 2020, respectively. We excluded those testing upper respiratory tract samples and not reporting data on samples with other bacteria or absence of bacteria. We screened papers against pre-specified criteria, extracted data and assessed the bacteriological quality, and combined epidemiological and microbiological quality of studies using two self-designed checklists. Pooled proportions of hospitalisation episodes for Staphylococcus aureus pneumonia amongst all-cause pneumonia and the 95% confidence intervals were calculated using the random-effects model. The review protocol was registered on PROSPERO (CRD42021236606).FindingsOf 26,218 studies identified, thirty-five studies enroling 20,708 hospitalised pneumonia episodes were included. Out of the total hospitalised pneumonia cases in this population, the pooled proportion of Staphylococcal pneumonia cases was 3% (95% CI 2% to 4%; I2=96%). amongst 12 studies with higher microbiological quality, the pooled estimate was 6% (95% CI 2% to 10%; I2= 98%). Based on the recent global estimates of hospitalised pneumonia in this age group, the 3% and 6% estimates represent 738 thousand and 1.48 million hospitalisations in 2019, respectively. Based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), the overall quality of evidence was considered to be moderate.InterpretationOur findings are probably an underestimate because of the unknown and the likely limited sensitivity of current testing methods for Staphylococcal pneumonia diagnosis and widespread reported use of antibiotics before recruitment (in 46% of cases). Staphylococcus aureus is an important cause of hospitalisation for pneumonia in young children globally.FundingBill and Melinda Gates Foundation (OPP 1,172,551) through a prime award to John Hopkins University.
Highlights
A target of the Sustainable Development Goals (SDGs) is to reduce, by 2030, the under-5 mortality to 25 deaths per 1000 live births.[1]
We searched Medline, Embase, Global Health, CINAHL, Global Index Medicus, Scopus, China National Knowledge Infrastructure, Wanfang, and CQvip using search terms related to aetiology, pneumonia, children, and bacteria
The findings of this review suggest that 3% of hospitalised pneumonia cases (6% in studies of higher microbiological quality) in the under-5 children are due to Staphylococcal aureus and represents about 738,000 (1¢48 million for the estimate of 6% in studies of higher microbiological quality) global hospital admissions in 2019 based on current estimates of hospitalised pneumonia in this age group
Summary
A target of the Sustainable Development Goals (SDGs) is to reduce, by 2030, the under-5 mortality to 25 deaths per 1000 live births.[1]. Liu et al estimated that pneumonia caused about 762,000 deaths in children aged between 1 and 59 months and was the largest infectious killer accounting for 12.8% of all deaths in this group in 2015.2 www.thelancet.com Vol 44 Month , 2022. We searched Medline, Embase, Global Health, CINAHL, Global Index Medicus, Scopus, China National Knowledge Infrastructure, Wanfang, and CQvip using search terms related to aetiology, pneumonia, children, and bacteria. We did not find existing systematic reviews on this topic focussing on the under-5 population and in a global context based on our searches. There seemed to be a lack of consensus within existing literature (primary studies) regarding the importance of Staphylococcus aureus as a cause of pneumonia in the global under-5 population
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