Staphylococcus aureus bacteremia mortality across country income groups: A secondary analysis of a systematic review

• Published in: International journal of infectious diseases 2022-09, Vol.122, p.405-411
• Main 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
• Format: Article
• Language: English
• Subjects: Bacteremia; Humans; Low and middle income countries; Mortality; Odds Ratio; Staphylococcal Infections; Staphylococcus aureus
• ISSN: 1201-9712; 1878-3511
• DOI: 10.1016/j.ijid.2022.06.026

•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. 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. 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. 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%, T2 = 0.3063) in MIC and 22.3% (95% CI 20.1%-24.6%, T2 = 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. 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.