Shruti Murthy

Background We aimed to update consolidated evidence on the causes of community-onset bloodstream infections (COBSI) and antimicrobial susceptibility among bloodstream isolates in Africa and Asia. Methods We updated our systematic review published in 2019 on causes of COBSI among hospitalised febrile patients in Africa and Asia. We searched PubMed, Scopus, Web of Science, and PubMed Central to identify prospective hospital-based studies enrolling consecutive febrile participants with blood culture-confirmed COBSI, published from 1 September 2018 through 30 June 2025. We assessed COBSI prevalence, causative pathogens, their antimicrobial susceptibility, and compared antimicrobial susceptibility between studies with median year of sample collection before 2010 ('earlier' period) and from 2010 onwards ('contemporary' period). Findings Of 5023 studies identified through updated search 12 were included in the update and 34 from the 2019 review for a total of 46 studies comprising 45 578 participants. The pooled prevalence of COBSI was 13·2% (95% CI 10·7–16·1, I2=97·3%). Of 4851 pathogens isolated, 1753 (36·1%) were Salmonella enterica, 522 (10·8%) Streptococcus pneumoniae and 511 (10·5%) Escherichia coli. In the contemporary period, susceptibility of E. coli to ceftriaxone, ciprofloxacin, and gentamicin was 60·1 (95% CI 22·0–89·0)%, 58·4 (32·2–80·6)%, and 57·1 (25·0–84·2)%, respectively. For the same period among typhoidal Salmonella and non-typhoidal Salmonella, simultaneous susceptibility to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole was 38·2 (7·5–82·5)% and 23·6 (0·6–94·0)%, respectively, and among S. aureus, susceptibility to methicillin was 54·9 (22·5–83·7). Interpretation COBSI remains common among hospitalised patients in Africa and Asia. Antimicrobial susceptibility patterns in the contemporary period warrant review of empiric treatment guidelines.

Prevalence and incidence are fundamental metrics with numerous applications in epidemiology. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline lacks specific items for reporting studies of disease prevalence or incidence. To address this gap, the STROBE Enhanced Prevalence and Incidence Criteria (STROBE EPIC) extension was developed in accordance with established methods for reporting guideline development. The authors generated an initial list of reporting items, conducted a modified Delphi process, and convened a face-to-face consensus meeting to confirm the need for a STROBE extension and to generate an early version of the checklist. They conducted 2 further Delphi surveys, first extending from typhoid and other invasive salmonelloses to all infectious diseases, and then to noncommunicable diseases and injuries. Finally, experts piloted the checklist on relevant manuscripts to critically assess if it was clear, concise, complete, and free of errors. An executive group curated the checklist after every survey round. The STROBE EPIC checklist comprises 47 items in the domains of title (1 item), abstract (2 items), introduction (1 item), methods (25 items), results (6 items), discussion (7 items), and other information (5 items). STROBE EPIC items address reporting of study design, adjustment factors for underreporting and underdiagnosis, denominator population estimation, case ascertainment methods, factors producing artefactual changes to observed disease prevalence or incidence, limitations of incomplete surveillance coverage, generalizability of short-duration studies, and data availability. The authors anticipate that the STROBE EPIC extension will be used by researchers, authors, modelers, burden-of-disease researchers, peer reviewers, and journal editors to optimize the presentation of epidemiologic evidence to support diverse health policy decisions.

Objective We aimed to review global studies reporting on mortality, morbidity, and post-operative complications in patients with typhoid intestinal perforation (TIP). Summary Background Data TIP is a serious and life-threatening complication of typhoid fever that requires emergency surgery and an important driver of typhoid burden. Methods We searched multiple databases for articles reporting case-fatality ratio (CFR) or complications in patients with TIP undergoing surgery published from 1980 through 30 January 2024. We described the prevalence of each reported complication. Of patients with TIP, we pooled CFR using random-effects meta-analysis and stratified by United Nations region, sex, and number of perforations per patient. Results We included 46 articles reporting on 4,317 patients with TIP. The most prevalent post-operative complications were wound or surgical site infection in 1,537 (50.7%) of 3,030 patients, wound dehiscence in 308 (16.1%) of 1,909, and chest infection in 136 (15.6%) of 872. Overall, the pooled CFR (95%CI) of patients with TIP was 15.6% (12.5-18.9%), and was 20.5% (17.1-23.9%) in 30 observations from the African region, 5.7% (2.6-9.6%) in 15 observations from the Asian region, and 12.2% (0.90-30.4%) in three observations from the Americas. The Pearson’s correlation coefficient of median year of data collection and CFR was -0.01 (p=0.95) for Africa and -0.69 (p Conclusions Disability and death associated with TIP remains substantial. Efforts to reduce the occurrence of TIP through typhoid prevention with vaccine and non-vaccine measures, and increased access to and quality of surgical services for those with TIP are warranted.

To inform coverage by potential vaccines, we aimed to systematically review evidence on the prevalence and distribution of non-typhoidal Salmonella enterica serogroups and serovars. We searched four databases from inception through 4 June 2021. Articles were included that reported at least one non-typhoidal S. enterica strain by serogroup or serovar isolated from a normally sterile site. Of serogrouped isolates, we pooled the prevalence of serogroup O:4, serogroup O:9, and other serogroups using random-effects meta-analyses. Of serotyped isolates, we pooled the prevalence of Salmonella Typhimurium (member of serogroup O:4), Salmonella Enteritidis (member of serogroup O:9), and other serovars. Of 82 studies yielding 24,253 serogrouped isolates, the pooled prevalence (95% CI) was 44.6% (36.2%–48.2%) for serogroup O:4, 45.5% (37.0%–49.1%) for serogroup O:9, and 9.9% (6.1%–13.3%) for other serogroups. Of serotyped isolates, the pooled prevalence (95%CI) was 36.8% (29.9%–44.0%) for Salmonella Typhimurium, 37.8% (33.2%–42.4%) for Salmonella Enteritidis, and 18.4% (11.4%–22.9%) for other serovars. Of global serogrouped non-typhoidal Salmonella isolates from normally sterile sites, serogroup O:4 and O:9 together accounted for 90%, and among serotyped isolates, serovars Typhimurium and Enteritidis together accounted for 75%. Vaccine development strategies covering serogroups O:4 and O:9, or serovars Typhimurium and Enteritidis, have the potential to prevent the majority of non-typhoidal Salmonella invasive disease.