Staphylococcus aureus bacteremia mortality across country income groups: A secondary analysis of a systematic review. (September 2022)

• Record Type: Journal Article
• Authors: Bai, Anthony D; Lo, Carson KL; Komorowski, Adam S; Suresh, Mallika; Guo, Kevin; Garg, Akhil; Tandon, Pranav; Senecal, Julien; Corpo, Olivier Del; Stefanova, Isabella; Fogarty, Clare; Butler-Laporte, Guillaume; McDonald, Emily G; Cheng, Matthew P; Morris, Andrew M; Loeb, Mark; Lee, Todd C
• Is Part Of: International journal of infectious diseases. Volume 122(2022)
• Page Start: 405
• Page End: 411
• Publication Date: 2022-09
• Subjects: Staphylococcus aureus -- Bacteremia -- Mortality -- Low and middle income countries; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2022.06.026
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: Styphylococcus aureus bacteremia (SAB) is common in low and middle-income countries (LMIC). LMIC are poorly represented in SAB research. In-hospital mortality for SAB is much higher in LMIC than in high-income countries. Abstract: Objectives: Staphylococcus aureus bacteremia (SAB) is a common infection worldwide. We compared SAB mortality in low- and middle-income countries (LMIC) versus high-income countries (HIC) in a meta-analysis. Methods: We searched MEDLINE, Embase, and Cochrane Database of Systematic Reviews from 1991-2021 and included observational, single-country studies on patients with positive blood cultures for S. aureus . The main outcome was the proportion of patients with SAB who died in the hospital. A generalized linear mixed random-effects model was used to pool estimates, and a meta-regression was used to adjust for study-level characteristics. Results: A total of 332 studies involving 517, 671 patients in 39 countries were included. No study was conducted in a low-income country. Only 33 (10%) studies were performed in middle-income countries (MIC), which described 6, 216 patients. The pooled in-hospital mortality was 32.4% (95% confidence interval [CI] 27.2%-38.2%, T 2 = 0.3063) in MIC and 22.3% (95% CI 20.1%-24.6%, T 2 = 0.3257) in HIC. In a meta-regression model, MIC had higher in-hospital mortality (adjusted odds ratio 1.37, 95% CI 1.11-1.71; P = 0.0042) than HIC. Conclusion: In SAB studies, LMIC are poorly represented. In-hospital mortality was significantly higher in MIC than in HIC. Research should be conducted in LMIC to characterize differences in care processes driving the mortality gap.