The Prevalence of Hospital-Acquired Infections in the EMRO: A Systematic Review and Meta-Analysis from 2000 to 2018

Abstract

Background and aim: Hospital-Acquired Infection (HAI) is one of the major concerns in the Eastern Mediterranean Regional Office (EMRO) due to the existence of underdeveloped and developing countries. Governments spend exorbitant costs annually to control and reduce the incidence of HAIs. The present systematic review and meta-analysis were designed to investigate the prevalence rate of HAIs in the EMRO, whose findings can be valuable for managers and healthcare providers, help them formulate an effective control program, reduce the financial burden of these infections in the area and lead to cost savings. Materials and methods: All English language articles were searched systematically in the main databases, including Embase, PubMed, Web of Science, Scopus, Cochrane, and Google Scholar between 2000 and January 2018. Eligible studies were independently evaluated and data extracted and analyzed by two authors and, if necessary, a third author. Fourteen main features were considered for each study: year of publication, title of journal and conference, publisher, country of study, prevalence of infection, sample size, gender, age, duration of hospitalization, type of infection, type of bacteria, hospital ward, type of study, quality of study. We also used STROBE checklist to assess the quality of included studies. Results: Of the 1371 articles identified, 70 studies were eligible for inclusions. The total sample size was 2,771,154 people, 28,302 of which suffered from HAIs. The results of the analysis based on the Random Effect Model showed that the prevalence of HAI was 16% (95% CI, 15 -18) in EMRO, its significance level was P<0.00 and I2=99.80 Tunisia has the highest prevalence rate of HAI, with 38% (95% CI, 13-67), and Bahrain has the lowest prevalence rate of HAI, with 1% (95% CI, 0-2). Among the infections, Bloodstream infection showed the highest rate of infection in people with HAI, with 44% (95% CI, 32-56), with urinary tract infection second, with a prevalence rate of 41% (95% CI, 26-56). Among the common bacteria that infected patients with HAI, Klebsiella pneumonia accounted for the highest rate of infection, 21% (95% CI, 7-38), in the patients; 44 studies reported this bacterium. Infections in ICU accounted for the largest percentage of infection, 32% (95% CI, 24-41). Men are 8.1% (95% CI, 6.5 -10.2) more likely to have HAI than women (P-value≥0.05), and the prevalence rate of HAI dropped by about 0.19 per year. Conclusion: The prevalence rate of HAI in developed countries is far less than that of developing countries. This is naturally because of further technology and facilities in these countries and their policies on alternatives which can decrease HAI like hand hygiene, antibiotic control and etc. For various reasons, the Eastern Mediterranean region has a higher prevalence rate of HAI compared to other areas defined by the World Health Organization. Funding: There is no foundation sources. Declaration of Interest: All authors declare have no conflict of interest for publishing this manuscript in The Lancet Infectious Diseases.