770Intra-abdominal Infections in Africa and The Middle East; A Systematic Review and Meta-analysis

Ali Omrani, Ladislav Pecen, Jan Zigmond, Petr Hajek, Nirvana Raghubir
2014 Open Forum Infectious Diseases  
Background. Understanding the epidemiology of the intra-abdominal infections (IAIs) is important for clinical decision making. This was a systematic review and meta-analysis of IAIs studies in adults in Africa and Middle East (AFME) region. Methods. PubMed and Medline-Plus were searched in September 2013 using prespecified keywords. Non-AFME, case reports, reviews, editorials and study protocols were excluded. Weighted averages with 95% confidence intervals were calculated and data were
more » ... using Microsoft Excel and SAS 9.4 (SAS Institute, Cary, NC). Results. A total of 220 IAI papers were included (47,796 individuals; 4,798 isolates). Complications were reported in 86 studies, severity of infection in 38 studies and mode of acquisition in 173 studies. Overall, 44.1% (37.7-50.5%) of IAI were caused by Gram-positive bacteria, 42.4% (35.0-49.8%) by Gram-negative bacteria and 7.1% (6.3-8.0%) were caused by fungi. Polymicrobial infection was documented in only 1.2% or IAIs. Regional prevalence of selected pathogens causing IAI in AFME is shown in Figure 1 . Complicated IAI constituted 38.3% of IAIs in which the presence of complications was reported. The proportion of complicated IAI increased significantly over time (r= 0.33, P < 0.01). Furthermore, the proportion of IAIs caused by Gram-negative bacteria increased (r= 0.32, P< 0.01), while those caused by Gram-positive bacteria decreased (r= 0.45, P < 0.001) over time. Patients with complicated IAIs were significantly younger than those with uncomplicated IAIs (34.5 vs 38.3 years, P < 0.02), whereas patients with hospital-acquired IAIs were significantly older than those with community-acquired IAIs (43.5 vs 35.2 years, P < 0.001). Average length of hospital stay was 18.5 days for patients with peritonitis, 5.2 for appendicitis and 3.1 for surgical site infection (P <0.01). The most commonly used antimicrobial agents were cephalosporins (31.8%), followed by extended-spectrum penicillins (29.4%),
doi:10.1093/ofid/ofu052.478 fatcat:dvpezwoyqncinkemyomcgmyd3q