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Cited by 35Antibiotic Use and ResistanceAntibiotic Resistance in BacteriaNeonatal and Maternal Infections

Coverage gaps in empiric antibiotic regimens used to treat serious bacterial infections in neonates and children in Southeast Asia and the Pacific

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Williams, Phoebe C.M., Jones, Mark, Snelling, Thomas L., Duguid, Robert, Moore, Nerida, Dickson, Benjamin, Wu, Yue, Saunders, Jessica +4 more·2024·The Lancet Regional Health - Southeast Asia
DOI 10.1016/j.lansea.2023.100291PMC PMC10934317
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Abstract

Background: High levels of antimicrobial resistance (AMR) are propagating deaths due to neonatal and paediatric infections globally. This is of particular concern in Southeast Asia and the Pacific, where healthcare resources are constrained and access to newer agents to treat multidrug-resistant pathogens is limited. Methods: To assess the coverage provided by commonly prescribed empiric antibiotic regimens for children in low- and middle-income countries in Southeast Asia and the Pacific, we built a weighted incidence syndromic combination antibiogram (WISCA), parameterised using data obtained from a systematic review of published literature incorporating WHO-defined SEARO and WPRO regions in Ovid MEDLINE, EMBASE, Global Health and PubMed. Susceptibility data for bacterial pathogens were extracted to provide coverage estimates for pre-specified antibiotics (aminopenicillins, gentamicin, third-generation cephalosporins and carbapenems), reported at the regional level. Findings: 6648 bacterial isolates from 11 countries across 86 papers were included in the Bayesian WISCA model, which weighted bacterial incidence and antimicrobial susceptibility of relevant isolates. Coverage provided by aminopenicillins in neonatal sepsis/meningitis was 26% (80% credible interval: 16-49) whilst gentamicin coverage was 45% (29-62). Third-generation cephalosporin coverage was only 29% (16-49) in neonatal sepsis/meningitis, 51% (38-64) in paediatric sepsis and 65% (51-77) in paediatric meningitis. Carbapenems were estimated to provide the highest coverage: 81% (65-90) in neonatal sepsis/meningitis, 83% (72-90) in paediatric sepsis and 79% (62-91) in paediatric meningitis. Interpretation: These findings reveal alarmingly high rates of resistance to commonly prescribed empirical therapies for neonatal and paediatric sepsis and meningitis in the Asia-Pacific region. Funding: This research was funded in whole, or in part, by the Wellcome Trust [220211]. For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. PCMW is supported by a National Health and Medical Research Council (NHMRC) Investigator Grant. NHMRC had no involvement in the design or conduct of the research.

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Authors
Williams, P. C. M., Jones, M., Snelling, T. L., Duguid, R., Moore, N., Dickson, B., Wu, Y., Saunders, J., Wijeratne, P., Douangnouvong, A., Ashley, E. A., & Turner, P.
Affiliations
  • The University of Sydney (AU)
  • Sydney Children's Hospital (AU)
  • Royal Darwin Hospital (AU)
  • Mahosot Hospital (LA)
  • Angkor Hospital for Children (KH)
Corresponding author
Williams, Phoebe C.M.
ORCID
Venue
The Lancet Regional Health - Southeast Asia
Publisher
Elsevier BV
Published
2024-03
Volume
22
Pages
100291
ISSN
2772-3682 (ISSN-L)
DOI
10.1016/j.lansea.2023.100291
PMC
PMC10934317
OpenAlex
W4388049518
Cited by
35
References
2
Citations by year
2026: 8 · 2025: 16 · 2024: 11
FWCI
6.68
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet Regional Health - Southeast Asia (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by-nc-sa)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • Wellcome Trust (220211)
  • NHMRC (119735)
Topics
  • Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Neonatal and Maternal Infections
Keywords
antimicrobial resistance, coverage gaps, neonatal sepsis, neonatal meningitis, pediatric sepsis, pediatric meningitis, multidrug-resistant bacteria, carbapenems, third-generation cephalosporins, aminopenicillins, gentamicin, antibiogram, bacterial susceptibility

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