Systematic review of antibiotic resistance rates among Gram-negative bacteria in children with sepsis in resource-limited countries
Abstract
BACKGROUND: Gram-negative antimicrobial resistance (AMR) is of global concern, yet there are few reports from low- and low-middle-income countries, where antimicrobial choices are often limited. METHODS: This study offers a systematic review of PubMed, Embase, and World Health Organization (WHO) regional databases of Gram-negative bacteremia in children in low- and low-middle-income countries reporting AMR since 2001. RESULTS: Data included 30 studies comprising 71 326 children, of whom 7056 had positive blood cultures, and Gram-negative organisms were isolated in 4710 (66.8%). In neonates, Klebsiella pneumoniae median resistance to ampicillin was 94% and cephalosporins 84% in Asia; 100% and 50% in Africa. Large regional variations in resistance rates to commonly prescribed antibiotics for Salmonella spp. were identified. Multidrug resistance (resistance to ampicillin, chloramphenicol, and cotrimoxazole) was present in 30% (interquartile range [IQR], 0-59.6) in Asia and 75% (IQR, 30-85.4) in Africa. CONCLUSIONS: There is a need for an international pediatric antimicrobial resistance surveillance system that collects local epidemiological data to improve the evidence base for the WHO guidance for childhood Gram-negative bacteremia.
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Many children are still dying due to a scarcity of access to adequate antibiotics for their infections.
“Compounding this issue is the fact that many children are still dying due to a scarcity of access to adequate antibiotics for their infections.41, 42”
From Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050 (2024) · cites this paper as [42]
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Self-citation
- Authors
- Le Doare, K., Bielicki, J., Heath, P. T., & Sharland, M.
- Affiliations
- St George's, University of London (GB)
- Venue
- Journal of the Pediatric Infectious Diseases Society
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-03-24
- Volume
- 4
- Issue
- 1
- Pages
- 11-20
- ISSN
- 2048-7193 (ISSN-L)
- 2048-7207
- OpenAlex
- W2100694940
- Cited by
- 156
- References
- 56
- Citations by year
- 2026: 7 · 2025: 14 · 2024: 18 · 2023: 14 · 2022: 11 · 2021: 23 · 2020: 13 · 2019: 18 · 2018: 12 · 2017: 18 · 2016: 2 · 2015: 4 · 2014: 2
- FWCI
- 0.58
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the Pediatric Infectious Diseases Society (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Life Sciences › Agricultural and Biological Sciences › Food Science › Salmonella and Campylobacter epidemiology
- Keywords
- antimicrobial resistance, Gram-negative bacteria, pediatric sepsis, bacteremia, low- and middle-income countries, Klebsiella pneumoniae, Salmonella, multidrug resistance, ampicillin resistance, cephalosporin resistance, chloramphenicol resistance, trimethoprim-sulfamethoxazole resistance, antimicrobial resistance surveillance, neonates
- MeSH terms
- Africa, Anti-Bacterial Agents, Asia, Child, Developing Countries, Gram-Negative Bacteria, Humans, Poverty, Gram-Negative Bacterial Infections, Sepsis, Drug Resistance, Bacterial
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