부산대학교 도서관

Background: Hospital-associated infections (HAIs) are an important cause of morbidity and mortality around the world. Many HAIs are caused by drug-resistant bacterial pathogens, but there are major gaps in our understanding of the number of hospital-associated drug-resistant infections (HARIs) worldwide. As such, we estimated trends in prevalence of HARIs caused by high priority pathogens (Escherichia coli, Acinetobacter spp., Klebsiella spp., Staphylococcus aureus, Enterobacter spp., and Pseudomonas spp.) in 195 countries. Methods and findings: Resistance prevalence estimates were extracted from 474-point prevalence surveys (PPS) from 99 countries published between 2010 and 2020 coupled with country-level estimates of hospitalization rates and length of stay. Prevalence estimates were transformed in yearly incidence of HARIs per year by country and income group. We estimate the global number of HARIs per year to be 136 million (95% credible interval (CI) 26 to 246 million) per year, with the highest burden in China (52 million, 95% CI 10 to 95 million), Pakistan (10 million, 95% CI 2 to 18 million), and India (9 million, 95% CI 3 to 15 million). Among income groups, middle-income countries bore the highest burden of HARIs per year (119 million, 95% CI 23 to 215 million). Our analysis was constrained by the limited number of PPS for HARIs, lack of community-associated data on antibiotic-resistant infections, and our population level analysis. Conclusions: In this study, we observe, in the absence of systematic surveillance systems for HARIs, a baseline overview of their rates. Our yearly estimates highlight the global threat of HARIs and may help define strategies to tackle resistance in hospital settings. Ruchita Balasubramanian and colleagues, estimate the incidence of hospital-associated infections resistant to antibiotics in 195 countries using point prevalence survey data from across the globe. Author summary: Why was this study done?: Low- and middle-income settings (LMICs) that have poor antimicrobial stewardship and limited microbiology diagnostic capacities are grossly affected by hospital-associated drug-resistant infections (HARIs). In the absence of robust national surveillance networks in LMICs to appropriately identify the threat of HARIs, we have identified a critical need to quantify the burden of HARIs in low-, middle-, and high-income countries, specifically those caused by common pathogens including E. coli, Klebsiella species (spp.), Acinetobacter spp., Pseudomonas spp., Staphylococcus spp, and Enterobacter spp. What did the researchers do and find?: We extracted data from point prevalence surveys (PPS), conducted over 10 years across 195 countries, coupled with country-level estimates of hospitalization rates and durations. We analyzed the data to illustrate global trends in HARIs based on country, income group, and pathogen that could help to focus public health intervention. We estimate the global number of HARIs per year to be 136 million, with the highest burden in China, Pakistan, and India, emphasizing the need for ongoing surveillance. Compared to other income groups, middle-income groups demonstrate the highest burden of HARIs per year. What do these findings mean?: Although our study was limited by the number of PPS for HARIs, lack of community-associated data on antibiotic-resistant infections, and our population analysis, in the absence of systematic surveillance systems for HARIs, we provide a baseline overview of their rates. While antimicrobial resistance (AMR) is not currently recognized as a challenge on par with the "big three" including HIV, TB, and malaria, our results show that the burden of HARIs is substantial and is thus worthy of further recognition by world leaders. [ABSTRACT FROM AUTHOR]