The Prevalence of Healthcare-Associated Infections in Mainland China: A Systematic Review and Meta-analysis

OBJECTIVETo assess the prevalence of healthcare-associated infections (HAIs) in mainland China.DESIGNSystematic review and meta-analysis.SETTINGAdults and children from secondary and tertiary acute-care hospitals in mainland China.METHODSWe searched PubMed, the China National Knowledge Infrastructure, and Wan Fang for multicenter point-prevalence surveys of acute-care hospitals in mainland China from January 2006 to August 2016. All reports related to HAI, using a point-prevalence methodology and published either in English or Chinese were eligible.RESULTSIn total, 3,021 publications were identified; 115 were eligible for quality assessment and data abstraction. The weighted HAI prevalence (95% confidence interval [CI]) overall, in general hospitals, children's hospitals, maternal and child health hospitals, and oncology hospitals were 3.12% (95% CI, 2.94%-3.29%), 3.02% (95% CI, 2.79%-3.26%), 4.43% (95% CI, 3.39%-5.47%), 1.88% (95% CI, 1.47%-2.29%), and 3.96% (95% CI, 3.12%-4.79%), respectively. In general hospitals, prevalence was highest in adult intensive care units (26.07%; 95% CI, 23.03%-29.12%), followed by surgery (3.26%; 95% CI, 2.96%-3.57%), and internal medicine (3.06%; 95% CI, 2.67%-3.46%). Overall, lower respiratory tract infection was the most frequent HAI (24,185, 47.28%), followed by urinary tract infection (5,773, 11.29%) and upper respiratory tract infection (5,194, 10.15%). Gram-negative bacilli were the most frequently isolated pathogens, and Pseudomonas aeruginosa (3,395, 14.91%), and Escherichia coli (2,918, 12.82%) were the most common single microorganisms.CONCLUSIONSThis study is the largest systematic review on the prevalence of HAI in mainland China. These results provide a benchmark for future PPSs and a reference for infection prevention and control strategies in mainland China.Infect Control Hosp Epidemiol 2018;39:701-709