Global healthcare-associated respiratory tract infections among inpatients: a systematic review and meta-analysis

Abstract

Background: Healthcare-associated respiratory tract infections are common among hospitalized patients. The infec­tions are associated with high mortality, antimicrobial resistance, and health care costs. While there is growing evi­dence on health care-associated infections (HCAIs) overall, specific evidence for respiratory tract infections (HCA-RTIs) is scarce. Therefore, this study, which estimates the pooled prevalence of HCA-RTIs, provides valuable input for policymakers designing appropriate interventions.

Methods: This review was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol. Databases such as Scopus, PubMed, Web of Science, DOAJ, and MedNar were used to search published articles from electronic databases from May 27, 2023, to August 25, 2023, with no restriction on the year of publication or study design. Articles were retrieved using Boolean logic operators (AND, OR, and NOT), MeSH terms, and main keywords. The data were analyzed using Comprehensive Meta-Analysis version 4. A random effects model was employed to determine the pooled prevalence of healthcare-associated respiratory tract infections among the inpatients. The Joanna Briggs Insti­tute Critical Assessment Tool for prevalence and cohort studies was employed to assess the quality of the studies. Subgroup analysis and meta-regression were employed to determine the potential sources of heterogeneity. Further­more, publication bias was evaluated using funnel plots. Sensitivity analysis was employed to examine the influence of extreme values on the overall pooled prevalence.

Results: A total of 33 studies, including cross-sectional and cohort studies conducted on 95,051 inpatients, were used in the analysis. The review revealed that the global pooled prevalence of healthcare-associated respiratory tract infections among inpatients was 2.5% (95% CI: 1.4, 4.2%). The subgroup analysis based on the World Health Organ­ization’s region and survey year shows that the highest prevalence was reported in the Southeast Asian Region (16.9%) and the studies performed between 2008 and 2013 (3.4%), respectively.

Conclusion: This study revealed that one out of 40 inpatients had healthcare-associated respiratory tract infections. This finding indicates that there is a need to implement safety measures to reduce healthcare-associated respiratory tract infections.

Keywords: Global, Respiratory Tract Infections, Healthcare-Associated Infections, Inpatients, Systematic Review, and Meta-Analysis