Prevalence of community-acquired bloodstream infections among hospitalized patients in Africa and Asia: a systematic review and meta-analysis.


Community-acquired bloodstream infections (CA-BSI) are major causes of severe febrile illness and death worldwide. In light of new data and the growing problem of antimicrobial resistance (AMR) among pathogens causing BSI, we undertook a systematic review of hospital-based studies of CA-BSI among patients hospitalized with fever. Without restriction to language or country, we searched PubMed, Web of Science, and Scopus for prospective hospital-based studies of community-acquired, culture-confirmed BSI among febrile inpatients. We determined by study the prevalence of BSI among participants, pathogens responsible for BSI, and antimicrobial susceptibility patterns of pathogens causing BSI in place and time. Thirty-four (77.3%) of 44 eligible studies recruited 29,022 participants in Africa and Asia combined. Among participants in these two regions, the median (range) prevalence of BSI was 12.5% (2.0-48.4%) and of 3,220 pathogens isolated, 1,119 (34.8%) were , 425 (13.2%) , and 282 (8.8%) Antimicrobial susceptibility testing was reported in 16 (36.4%) studies. When comparing isolates prior to 2008 to the period 2008 through 2018, the proportion of typhoidal and isolates resistant to several clinically relevant antimicrobials increased over time, while susceptibility was stable. Community-acquired BSIs remain a major cause of severe febrile illness among hospitalized patients in Africa and Asia, with , and predominating. There is a concerning growth of AMR among serious infections cause by community-acquired pathogens. Ongoing surveillance is needed to inform empiric management and strategies to control AMR.