Program Schedule

Intra-abdominal Infections in Africa and The Middle East; A Systematic Review and Meta-analysis

Session: Poster Abstract Session: Clinical Respiratory Infections
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
  • IAI in AfME IDWeek 2014.pdf (400.9 kB)
  • Background:

    Understanding the epidemiology of the intra-abdominal infections (IAIs) is important for clinical decision making. This was a systematic review and meta-analysis of IAIs studies in adults in Africa and Middle East (AFME) region.


    PubMed and Medline-Plus were searched in Sep 2013 using pre-specified keywords. Non-AFME, case reports, reviews, editorials and study protocols were excluded. Weighted averages with 95% confidence intervals were calculated and data were analyzed using Microsoft Excel and SAS 9.4 (SAS Institute, Cary, USA).


    A total of 220 IAI papers were included (47,796 individuals; 4,798 isolates). Complications were reported in 86 studies, severity of infection in 38 studies and mode of acquisition in 173 studies. Overall, 44.1% (37.7-50.5%) of IAI were caused by Gram-positive bacteria, 42.4% (35.0-49.8%) by Gram-negative bacteria and 7.1% (6.3-8.0%) were caused by fungi. Polymicrobial infection was documented in only 1.2% or IAIs. Regional prevalence of selected pathogens causing IAI in AFME is shown in Figure 1. Complicated IAI constituted 38.3% of IAIs in which the presence of complications was reported. The proportion of complicated IAI increased significantly over time (r= 0.33, P<0.01). Furthermore, the proportion of IAIs caused by Gram-negative bacteria increased (r= 0.32, P< 0.01), while those caused by Gram-positive bacteria decreased (r= 0.45, P<0.001) over time. Patients with complicated IAIs were significantly younger than those with uncomplicated IAIs (34.5 vs. 38.3 years, P< 0.02), whereas patients with hospital-acquired IAIs were significantly older than those with community-acquired IAIs (43.5 vs. 35.2 years, P<0.001). Average length of hospital stay was 18.5 days for patients with peritonitis, 5.2 for appendicitis and 3.1 for surgical site infection (P <0.01). The most commonly used antimicrobial agents were cephalosporins (31.8%), followed by extended-spectrum penicillins (29.4%), aminoglycosides (26.5%) and metronidazole (24.5%). Overall attributable mortality, which was reported in 45 studies, was relatively low at 4.1% (1.6-6.6%).


    Gram-negative bacteria are increasingly important causes of IAI in AFME with decreasing contribution of Gram-positive bacteria.

    Ali Omrani, FRCP FRCPath, Division of Infectious Diseases, Prince Sultan Military Medical City, Riyadh, Saudi Arabia, Ladislav Pecen, CEEOR s.r.o., Prague, Czech Republic, Jan Zigmond, CEEOR s.r.o., Prague, Czech Republic, Petr Hajek, MSc MEng, Health Economics & Outcomes Research, Pfizer Inc., Prague, Czech Republic and Nirvana Raghubir, MD MSc, Pfizer Inc., New York, NY


    A. Omrani, None

    L. Pecen, None

    J. Zigmond, None

    P. Hajek, None

    N. Raghubir, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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