{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T17:04:52Z","timestamp":1793639092403,"version":"4.5.1"},"reference-count":172,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2023,6,22]],"date-time":"2023-06-22T00:00:00Z","timestamp":1687392000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100020884","name":"Agencia Nacional de Investigaci\u00f3n y Desarrollo","doi-asserted-by":"publisher","award":["73200098"],"award-info":[{"award-number":["73200098"]}],"id":[{"id":"10.13039\/501100020884","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002850","name":"Fondo Nacional de Desarrollo Cient\u00edfico y Tecnol\u00f3gico","doi-asserted-by":"publisher","award":["1211933"],"award-info":[{"award-number":["1211933"]}],"id":[{"id":"10.13039\/501100002850","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100018735","name":"Fondo de Financiamiento de Centros de Investigaci\u00f3n en \u00c1reas Prioritarias","doi-asserted-by":"publisher","award":["1522A0005"],"award-info":[{"award-number":["1522A0005"]}],"id":[{"id":"10.13039\/501100018735","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Bloodstream infections (BSIs) produced by antibiotic-resistant bacteria (ARB) cause a substantial disease burden worldwide. However, most estimates come from high-income settings and thus are not globally representative. This study quantifies the excess mortality, length of hospital stay (LOS), intensive care unit (ICU) admission, and economic costs associated with ARB BSIs, compared to antibiotic-sensitive bacteria (ASB), among adult inpatients in low- and middle-income countries (LMICs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods and findings<\/jats:title>\n                    <jats:p>\n                      We conducted a systematic review by searching 4 medical databases (PubMed, SCIELO, Scopus, and WHO\u2019s Global Index Medicus; initial search\n                      <jats:italic>n<\/jats:italic>\n                      = 13,012 from their inception to August 1, 2022). We only included quantitative studies. Our final sample consisted of\n                      <jats:italic>n<\/jats:italic>\n                      = 109 articles, excluding studies from high-income countries, without our outcomes of interest, or without a clear source of bloodstream infection. Crude mortality, ICU admission, and LOS were meta-analysed using the inverse variance heterogeneity model for the general and subgroup analyses including bacterial Gram type, family, and resistance type. For economic costs, direct medical costs per bed-day were sourced from WHO-CHOICE. Mortality costs were estimated based on productivity loss from years of potential life lost due to premature mortality. All costs were in 2020 USD. We assessed studies\u2019 quality and risk of publication bias using the MASTER framework. Multivariable meta-regressions were employed for the mortality and ICU admission outcomes only. Most included studies showed a significant increase in crude mortality (odds ratio (OR) 1.58, 95% CI [1.35 to 1.80],\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001), total LOS (standardised mean difference \u201cSMD\u201d 0.49, 95% CI [0.20 to 0.78],\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001), and ICU admission (OR 1.96, 95% CI [1.56 to 2.47],\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001) for ARB versus ASB BSIs. Studies analysing Enterobacteriaceae,\n                      <jats:italic>Acinetobacter baumanii<\/jats:italic>\n                      , and\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      in upper-middle-income countries from the African and Western Pacific regions showed the highest excess mortality, LOS, and ICU admission for ARB versus ASB BSIs per patient. Multivariable meta-regressions indicated that patients with resistant\n                      <jats:italic>Acinetobacter baumanii<\/jats:italic>\n                      BSIs had higher mortality odds when comparing ARB versus ASB BSI patients (OR 1.67, 95% CI [1.18 to 2.36],\n                      <jats:italic>p<\/jats:italic>\n                      0.004). Excess direct medical costs were estimated at $12,442 (95% CI [$6,693 to $18,191]) for ARB versus ASB BSI per patient, with an average cost of $41,103 (95% CI [$30,931 to $51,274]) due to premature mortality. Limitations included the poor quality of some of the reviewed studies regarding the high risk of selective sampling or failure to adequately account for relevant confounders.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We provide an overview of the impact ARB BSIs in limited resource settings derived from the existing literature. Drug resistance was associated with a substantial disease and economic burden in LMICs. Although, our results show wide heterogeneity between WHO regions, income groups, and pathogen\u2013drug combinations. Overall, there is a paucity of BSI data from LMICs, which hinders implementation of country-specific policies and tracking of health progress.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pmed.1004199","type":"journal-article","created":{"date-parts":[[2023,6,23]],"date-time":"2023-06-23T16:08:33Z","timestamp":1687536513000},"page":"e1004199","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":77,"title":["The impact of inpatient bloodstream infections caused by antibiotic-resistant bacteria in low- and middle-income countries: A systematic review and meta-analysis"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2144-7181","authenticated-orcid":true,"given":"Kasim","family":"Allel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Stone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4425-1253","authenticated-orcid":true,"given":"Eduardo A.","family":"Undurraga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8605-3661","authenticated-orcid":true,"given":"Lucy","family":"Day","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8639-9846","authenticated-orcid":true,"given":"Catrin E.","family":"Moore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4123-4762","authenticated-orcid":true,"given":"Leesa","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Furuya-Kanamori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8639-4511","authenticated-orcid":true,"given":"Laith","family":"Yakob","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,6,22]]},"reference":[{"key":"pmed.1004199.ref001","author":"Organisation for Economic Cooperation and Development","year":"2019","journal-title":"Stemming the Superbug Tide: Just a Few Dollars More: OECD"},{"issue":"8","key":"pmed.1004199.ref002","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1016\/S1473-3099(05)70189-4","article-title":"Antimicrobial resistance in developing countries. 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