scholarly journals A Systematic Review and Meta-analysis of Ventilator-associated Pneumonia in Adults in Asia: An Analysis of National Income Level on Incidence and Etiology

2018 ◽  
Vol 68 (3) ◽  
pp. 511-518 ◽  
Author(s):  
Ana Bonell ◽  
Ryan Azarrafiy ◽  
Vu Thi Lan Huong ◽  
Thanh Le Viet ◽  
Vu Dinh Phu ◽  
...  
Keyword(s):  
Meta Analysis ◽  
National Income ◽  
Carbapenem Resistance ◽  
Income Level ◽  
Incidence Density ◽  
Ventilator Associated Pneumonia ◽  
Middle Income ◽  
Middle Income Countries ◽  
Ovid Medline ◽  
Gram Negative Organisms

Abstract Background Ventilator-associated pneumonia (VAP) is the commonest hospital-acquired infection (HAI) in intensive care. In Asia, VAP is increasingly caused by resistant gram-negative organisms. Despite the global antimicrobial resistance crisis, the epidemiology of VAP is poorly documented in Asia. Methods We systematically reviewed literature published on Ovid Medline, Embase Classic, and Embase from 1 January 1990 to 17 August 2017 to estimate incidence, prevalence, and etiology of VAP. We performed a meta-analysis to give pooled rates and rates by country income level. Results Pooled incidence density of VAP was high in lower- and upper-middle-income countries and lower in high-income countries (18.5, 15.2, and 9.0 per 1000 ventilator-days, respectively). Acinetobacter baumannii (n = 3687 [26%]) and Pseudomonas aeruginosa (n = 3176 [22%]) were leading causes of VAP; Staphylococcus aureus caused 14% (n = 1999). Carbapenem resistance was common (57.1%). Conclusions VAP remains a common cause of HAI, especially in low- and middle-income countries, and antibiotic resistance is high.

scholarly journals Clinical characteristics, treatment and outcomes of paediatric COVID-19: a systematic review and meta-analysis

2021 ◽  
pp. archdischild-2020-321385
Author(s):  
Omar Irfan ◽  
Fiona Muttalib ◽  
Kun Tang ◽  
Li Jiang ◽  
Zohra S Lassi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Disease Severity ◽  
World Bank ◽  
Low Income ◽  
Meta Analysis ◽  
Severe Disease ◽  
Income Level ◽  
Clinical Findings ◽  
Middle Income ◽  
Middle Income Countries

ObjectiveCompare paediatric COVID-19 disease characteristics, management and outcomes according to World Bank country income level and disease severity.DesignSystematic review and meta-analysis.SettingBetween 1 December 2019 and 8 January 2021, 3350 articles were identified. Two reviewers conducted study screening, data abstraction and quality assessment independently and in duplicate. Observational studies describing laboratory-confirmed paediatric (0–19 years old) COVID-19 were considered for inclusion.Main outcomes and measuresThe pooled proportions of clinical findings, treatment and outcomes were compared according to World Bank country income level and reported disease severity.Results129 studies were included from 31 countries comprising 10 251 children of which 57.4% were hospitalised. Mean age was 7.0 years (SD 3.6), and 27.1% had a comorbidity. Fever (63.3%) and cough (33.7%) were common. Of 3670 cases, 44.1% had radiographic abnormalities. The majority of cases recovered (88.9%); however, 96 hospitalised children died. Compared with high-income countries, in low-income and middle-income countries, a lower proportion of cases were admitted to intensive care units (ICUs) (9.9% vs 26.0%) yet pooled proportion of deaths among hospitalised children was higher (relative risk 2.14, 95% CI 1.43 to 3.20). Children with severe disease received antimicrobials, inotropes and anti-inflammatory agents more frequently than those with non-severe disease. Subgroup analyses showed that a higher proportion of children with multisystem inflammatory syndrome (MIS-C) were admitted to ICU (47.1% vs 22.9%) and a higher proportion of hospitalised children with MIS-C died (4.8% vs 3.6%) compared with the overall sample.ConclusionPaediatric COVID-19 has a favourable prognosis. Further severe disease characterisation in children is needed globally.

scholarly journals Gram-negative neonatal sepsis in low- and lower-middle-income countries and WHO empirical antibiotic recommendations: A systematic review and meta-analysis

PLoS Medicine ◽  
2021 ◽  
Vol 18 (9) ◽  
pp. e1003787
Author(s):  
Sophie C. H. Wen ◽  
Yukiko Ezure ◽  
Lauren Rolley ◽  
Geoff Spurling ◽  
Colleen L. Lau ◽  
...  
Keyword(s):  
Systematic Review ◽  
Neonatal Sepsis ◽  
Regional Differences ◽  
Meta Analysis ◽  
Significant Heterogeneity ◽  
Gram Negative Bacteria ◽  
Middle Income ◽  
Gram Negative ◽  
Middle Income Countries ◽  
Gram Negative Organisms

Background Neonatal sepsis is a significant global health issue associated with marked regional disparities in mortality. Antimicrobial resistance (AMR) is a growing concern in Gram-negative organisms, which increasingly predominate in neonatal sepsis, and existing WHO empirical antibiotic recommendations may no longer be appropriate. Previous systematic reviews have been limited to specific low- and middle-income countries. We therefore completed a systematic review and meta-analysis of available data from all low- and lower-middle-income countries (LLMICs) since 2010, with a focus on regional differences in Gram-negative infections and AMR. Methods and findings All studies published from 1 January 2010 to 21 April 2021 about microbiologically confirmed bloodstream infections or meningitis in neonates and AMR in LLMICs were assessed for eligibility. Small case series, studies with a small number of Gram-negative isolates (<10), and studies with a majority of isolates prior to 2010 were excluded. Main outcomes were pooled proportions of Escherichia coli, Klebsiella, Enterobacter, Pseudomonas, Acinetobacter and AMR. We included 88 studies (4 cohort studies, 3 randomised controlled studies, and 81 cross-sectional studies) comprising 10,458 Gram-negative isolates from 19 LLMICs. No studies were identified outside of Africa and Asia. The estimated pooled proportion of neonatal sepsis caused by Gram-negative organisms was 60% (95% CI 55% to 65%). Klebsiella spp. was the most common, with a pooled proportion of 38% of Gram-negative sepsis (95% CI 33% to 43%). Regional differences were observed, with higher proportions of Acinetobacter spp. in Asia and Klebsiella spp. in Africa. Resistance to aminoglycosides and third-generation cephalosporins ranged from 42% to 69% and from 59% to 84%, respectively. Study limitations include significant heterogeneity among included studies, exclusion of upper-middle-income countries, and potential sampling bias, with the majority of studies from tertiary hospital settings, which may overestimate the burden caused by Gram-negative bacteria. Conclusions Gram-negative bacteria are an important cause of neonatal sepsis in LLMICs and are associated with significant rates of resistance to WHO-recommended first- and second-line empirical antibiotics. AMR surveillance should underpin region-specific empirical treatment recommendations. Meanwhile, a significant global commitment to accessible and effective antimicrobials for neonates is required.

scholarly journals Estimating the prevalence of hepatitis C among intravenous drug users in upper middle income countries: A systematic review and meta-analysis

PLoS ONE ◽  
2019 ◽  
Vol 14 (2) ◽  
pp. e0212558 ◽  
Author(s):  
Víctor Granados-García ◽  
Yvonne N. Flores ◽  
Lizbeth I. Díaz-Trejo ◽  
Lucia Méndez-Sánchez ◽  
Stephanie Liu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hepatitis C ◽  
Drug Users ◽  
Meta Analysis ◽  
Intravenous Drug ◽  
Intravenous Drug Users ◽  
Middle Income ◽  
Middle Income Countries

scholarly journals Erythropoietin monotherapy for neuroprotection after neonatal encephalopathy in low-to-middle income countries: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Phoebe Ivain ◽  
Paolo Montaldo ◽  
Aamir Khan ◽  
Ramyia Elagovan ◽  
Constance Burgod ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Neonatal Encephalopathy ◽  
Neurodevelopmental Outcomes ◽  
Term Infants ◽  
Middle Income ◽  
Middle Income Countries ◽  
Pooled Data ◽  
Risk Of Death ◽  
Low Middle Income Countries ◽  
Near Term

Abstract Objective We examined whether erythropoietin monotherapy improves neurodevelopmental outcomes in near-term and term infants with neonatal encephalopathy (NE) in low-middle income countries (LMICs). Methods We searched Pubmed, Embase, and Web of Science databases to identify studies that used erythropoietin (1500–12,500 units/kg/dose) or a derivative to treat NE. Results Five studies, with a total of 348 infants in LMICs, were retrieved. However, only three of the five studies met the primary outcome of death or neuro-disability at 18 months of age or later. Erythropoietin reduced the risk of death (during the neonatal period and at follow-up) or neuro-disability at 18 months or later (p < 0.05). Death or neuro-disability occurred in 27.6% of the erythropoietin group and 49.7% of the comparison group (risk ratio 0.56 (95% CI: 0.42–0.75)). Conclusion The pooled data suggest that erythropoietin monotherapy may improve outcomes after NE in LMICs where therapeutic hypothermia is not available.

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