HAI Rate in Developing Countries Could be More Than Double That of the U.S.

Benedetta Allegranzi MD, of the First Global Patient Safety Challenge, WHO Patient Safety, Geneva, Switzerland, and colleagues assessed the epidemiology of endemic healthcare-associated infection (HAI) in developing countries and suggest that the HAI rate could be as much as double that in the United States. Their research was published in the Dec. 10, 2010 early online edition of The Lancet.

Allegranzi, et al. (2010) report that they conducted a literature search of papers published from 1995 to 2008 and included in their review studies containing full or partial data from developing countries related to infection prevalence or incidence, including overall HAI and major infection sites and their microbiological cause.

The researchers report that of 271 selected articles, 220 were included in the final analysis. Limited data were retrieved from some regions and many countries were not represented. 118 (54 percent) studies were low quality. In general, infection frequencies reported in high-quality studies were greater than those from low-quality studies. Prevalence of HAIs was much higher than proportions reported from Europe and the U.S. Pooled overall HAI density in adult intensive-care units was 47·9 per 1,000 patient-days (95% CI 36·759·1), at least three times as high as densities reported from the U.S. Surgical site infection was the leading infection in hospitals (pooled cumulative incidence 5·6 per 100 surgical procedures), strikingly higher than proportions recorded in developed countries. Gram-negative bacilli represented the most common nosocomial isolates. Apart from methicillin resistance, noted in 158 of 290 (54 percent) Staphylococcus aureus isolates (in eight studies), very few articles reported antimicrobial resistance.

The researchers conclude that the burden of HAIs in developing countries is significant and that their findings indicate a need to improve surveillance and infection control practices.

Reference: Allegranzi B, et al. Burden of endemic healthcare-associated infection in developing countries: systematic review and meta-analysis. The Lancet. Dec. 10, 2010.

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