Infections and antimicrobial resistance in intensive care units in lower-middle income countries: a scoping review

YR Saharman, A Karuniawati, Juliette Severin, Henri Verbrugh

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Abstract

Background: Intensive care units (ICUs) in lower-middle income countries (LMICs) are suspected to constitute a special risk for patients of acquiring infection due to multiple antibiotic resistant organisms. The aim of this systematic scoping review was to present the data published on ICU-acquired infections and on antimicrobial resistance observed in ICUs in LMICs over a 13-year period. A systematic scoping review was conducted according to the PRISMA extension guideline for scoping reviews and registered in the Open Science Framework. Main body of the abstract: Articles were sought that reported on ICU-acquired infection in LMICs between 2005 and 2018. Two reviewers parallelly reviewed 1961 titles and abstracts retrieved from five data banks, found 274 eligible and finally included 51. Most LMICs had not produced reports in Q1 or Q2 journals in this period, constituting a large gap in knowledge. However, from the reported evidence it is clear that the rate of ICU-acquired infections was comparable, albeit approximately 10% higher, in LMICs compared to high income countries. In contrast, ICU mortality was much higher in LMICs (33.6%) than in high income countries (< 20%). Multidrug-resistant Gram-negative species, especially Acinetobacter baumannii and Pseudomonas aeruginosa, and Klebsiella pneumoniae played a much more dominant role in LMIC ICUs than in those in high income countries. However, interventions to improve this situation have been shown to be feasible and effective, even cost-effective. Conclusions: Compared to high income countries the burden of ICU-acquired infection is higher in LMICs, as is the level of antimicrobial resistance; the pathogen distribution is also different. However, there is evidence that interventions are feasible and may be quite effective in these settings. Protocol Registration The protocol was registered with Open Science Framework (https://osf.io/c8vjk)

Original languageEnglish
Article number22
JournalAntimicrobial Resistance and Infection Control
Volume10
Issue number1
DOIs
Publication statusPublished - Dec 2021

Bibliographical note

Funding Information:
This work was supported by ‘The Directorate General of Higher Education of Indonesia Ministry of Research, Technology and Higher Education of the Republic of Indonesia’ and ‘Department of Medical Microbiology and Infectious Diseases, Erasmus MC in Rotterdam, The Netherlands’.

Funding Information:
We are thankful to The Directorate General of Higher Education of Indonesia Ministry of Research, Technology and Higher Education?of the Republic of Indonesia, Dean of Faculty of Medicine Universitas Indonesia, Board of Directors of Dr. Cipto Mangunkusumo National General Hospital Jakarta Indonesia, Department of Medical Microbiology and Infectious Diseases. We acknowledge the contribution of Dr. Wichor M. Bramer, PhD, biomedical information specialist from Erasmus MC Medical Library, his expert assistance with the development of the systematic review search strategy and retrieving the eligible studies from the data banks is much appreciated.

Funding Information:
YRS is an awardee of the DIKTI-NESO Scholarship by The Directorate General of Higher Education of Indonesia Ministry of Research, Technology and Higher Education of the Republic of Indonesia, and Department of Medical Microbiology and Infectious Diseases, Erasmus MC in Rotterdam, The Netherlands. All authors report no conflict of interest relevant to this article.

Publisher Copyright:
© 2021, The Author(s).

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  • EMC OR-01

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