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Health care-associated infections more common in developing vs. high-income nations
Allegranzi B.Lancet.2010;doi:10.1016/SO140-6736(10)61458-4.
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The burden of health care-associated infections is highest in developing countries and, therefore, requires improvements in surveillance and infection-control practices, according to new findings from a systemic review and meta-analysis published in The Lancet.
Compared with the prevalence of health care-associated infections in Europe and the US, the prevalence was significantly higher in developing countries (95% CI, 12.6–18.9).
For the study, researchers examined the epidemiology of endemic health care-associated infections in developing countries compared with developed countries. Data were pooled from electronic databases and reference lists for articles published between1995 and 2008. The researchers grouped studies as low-quality or high-quality based upon predefined criteria.
The incidence for overall health care-associated infections in adult ICUs in developing countries was 47.9 per 1,000 patient-days (95% CI, 36.7-59.1) — more than three-fold as high as those reported in the US.
Specifically, surgical-site infection was the leading type of infection in hospitals with a pooled cumulative incidence of 5.6 per 100 surgical procedures vs. 2.6 in the US and 1.6 in Germany.
In addition, gram-negative bacilli accounted for the most common type of nosocomial isolates. Although few data indicated antimicrobial resistance, methicillin-resistant Staphylococcus aureus was identified in 158 out of 290 isolates from eight studies.
Researchers proposed the following for improvements in health care-associated infections in developing countries:
- Improve reporting information in clinical records;
- Ensure minimum requirements in terms of facilities and resources available for surveillance;
- Improve capacity-building for clinical microbiological laboratories;
- Ensure core components for infection control are in place;
- and promote staff education on infection control and surveillance of health-care-associated infection.
In an accompanying editorial, Victor D. Rosenthal, MD, of the International Nosocomial Infection Control Consortium in Buenos Aires, wrote that, “I firmly believe that [this] study will be extensively discussed in coming years, because regional and international benchmarking data from developed and developing countries are essential to further advance the prevention of health care-associated infection, by enabling health care workers and researchers to make accurate and useful comparisons and increase their awareness of this affliction."
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