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Antimicrobial resistance in Enterobacterales infections among children in sub-Saharan Africa: a systematic review and meta-analysis.
Kowalski, Morgane; Minka Obama, Basilice; Catho, Gaud; Dewez, Juan Emmanuel; Merglen, Arnaud; Ruef, Micaela; Andrey, Diego O; Hassoun-Kheir, Nasreen; de Kraker, Marlieke E A; Combescure, Christophe; Emonet, Stephane; Galetto-Lacour, Annick; Wagner, Noémie.
Afiliación
  • Kowalski M; Children's Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
  • Minka Obama B; Paediatric Infectious Diseases Unit, Children's Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
  • Catho G; Regional Hospital Centre for Ebolowa, Ebolowa, Cameroon.
  • Dewez JE; Division of Infectious Diseases, Central Institute, Hospital of Valais, Switzerland.
  • Merglen A; Infection Control Division, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
  • Ruef M; Medical Department, Médecins Sans Frontières, Operational Centre Geneva, Geneva, Switzerland.
  • Andrey DO; Division of General Paediatrics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
  • Hassoun-Kheir N; Children's Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
  • de Kraker MEA; Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
  • Combescure C; Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
  • Emonet S; Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, WHO Collaborating Centre, Geneva, Switzerland.
  • Galetto-Lacour A; Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, WHO Collaborating Centre, Geneva, Switzerland.
  • Wagner N; Centre for Clinical Research, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
EClinicalMedicine ; 70: 102512, 2024 Apr.
Article en En | MEDLINE | ID: mdl-38495519
ABSTRACT

Background:

The burden of antimicrobial resistance (AMR) has been estimated to be the highest in sub-Saharan Africa (SSA). The current study estimated the proportion of drug-resistant Enterobacterales causing infections in SSA children.

Methods:

We searched MEDLINE/PubMed, Embase and the Cochrane Library to identify retrospective and prospective studies published from 01/01/2005 to 01/06/2022 reporting AMR of Enterobacterales causing infections in sub-Saharan children (0-18 years old). Studies were excluded if they had unclear documentation of antimicrobial susceptibility testing methods or fewer than ten observations per bacteria. Data extraction and quality appraisal were conducted by two authors independently. The primary outcome was the proportion of Enterobacterales resistant to antibiotics commonly used in paediatrics. Proportions were combined across studies using mixed-effects logistic regression models per bacteria and per antibiotic. Between-study heterogeneity was assessed using the I2 statistic. The protocol was registered with PROSPERO (CRD42021260157).

Findings:

After screening 1111 records, 122 relevant studies were included, providing data on more than 30,000 blood, urine and stool isolates. Escherichia coli and Klebsiella spp. were the predominant species, both presenting high proportions of resistance to third-generation cephalosporins, especially in blood cultures 40.6% (95% CI 27.7%-55%; I2 85.7%, number of isolates (n) 1032) and 84.9% (72.8%-92.2%; I2 94.1%, n 2067), respectively. High proportions of resistance to other commonly used antibiotics were also observed. E. coli had high proportions of resistance, especially for ampicillin (92.5%; 95% CI 76.4%-97.9%; I2 89.8%, n 888) and gentamicin (42.7%; 95% CI 30%-56.5%; I2 71.9%, n 968). Gentamicin-resistant Klebsiella spp. were also frequently reported (77.6%; 95% CI 65.5%-86.3%; I2 91.6%, n 1886).

Interpretation:

High proportions of resistance to antibiotics commonly used for empirical treatment of infectious syndromes were found for Enterobacterales in sub-Saharan children. There is a critical need to better identify local patterns of AMR to inform and update clinical guidelines for better treatment outcomes.

Funding:

No funding was received.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: EClinicalMedicine Año: 2024 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: EClinicalMedicine Año: 2024 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Reino Unido