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Antimicrobial resistance among children in sub-Saharan Africa
Phoebe C M Williams1, David Isaacs2, James A Berkley3
1Nuffield Department of Medicine, The University of Oxford, Oxford, UK.
Insights
Antimicrobial resistance is a major global health threat. In sub-Saharan Africa, children face high rates of resistance to common antibiotics, particularly for Gram-positive infections, complicating treatment.
Area of Science:
- Global Health
- Infectious Diseases
- Microbiology
Background:
- Antimicrobial resistance (AMR) poses a significant threat to global health.
- Sub-Saharan Africa faces challenges in diagnostic capacity and AMR surveillance.
- Current therapeutic guidelines rely on local resistance data, which is scarce in the region.
Purpose of the Study:
- To systematically review antimicrobial resistance patterns among children in sub-Saharan Africa since 2005.
- To identify predominant pathogens and their susceptibility profiles in pediatric infections.
- To highlight gaps in current research and surveillance.
Main Methods:
- Systematic review of studies published since 2005.
- Inclusion of articles reporting on invasive bacterial isolates from children.
- Data extraction on microbial etiology and antimicrobial susceptibility.
Main Results:
- 18 studies met inclusion criteria, analyzing 67,451 bacterial isolates.
- Gram-negative organisms, often extended-spectrum β-lactamase producers, predominated in neonatal sepsis.
- Gram-positive bacteria caused significant infections in older children, with high resistance to WHO-recommended treatments.
Conclusions:
- Limited up-to-date and representative data exist on pediatric AMR in sub-Saharan Africa, especially for community-acquired infections.
- Further research is needed to distinguish community- vs. hospital-acquired resistance.
- Standardized reporting and clinical trials for alternative treatments are crucial.
Abstract:
Antimicrobial resistance is an important threat to international health. Therapeutic guidelines for empirical treatment of common life-threatening infections depend on available information regarding microbial aetiology and antimicrobial susceptibility, but sub-Saharan Africa lacks diagnostic capacity and antimicrobial resistance surveillance. We systematically reviewed studies of antimicrobial resistance among children in sub-Saharan Africa since 2005. 18 of 1075 articles reviewed met inclusion criteria, providing data from 67 451 invasive bacterial isolates from inconsistently defined populations in predominantly urban tertiary settings. Among neonates, Gram-negative organisms were the predominant cause of early-onset neonatal sepsis, with a high prevalence of extended-spectrum β-lactamase-producing organisms. Gram-positive bacteria were responsible for a high proportion of infections among children beyond the neon atal period, with high reported prevalence of non-susceptibility to treatment advocated by the WHO therapeutic guidelines. There are few up-to-date or representative studies given the magnitude of the problem of antimicrobial resistance, especially regarding community-acquired infections. Research should focus on differentiating resistance in community-acquired versus hospital-acquired infections, implementation of standardised reporting systems, and pragmatic clinical trials to assess the efficacy of alternative treatment regimens.