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Isolation and Identification of Waterborne Antibiotic-Resistant Bacteria and Molecular Characterization of their Antibiotic Resistance Genes
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Isolation and Identification of Waterborne Antibiotic-Resistant Bacteria and Molecular Characterization of their Antibiotic Resistance Genes

Published on: March 3, 2023

Antibiotic resistance in the paediatric population in Pakistan (1996-2025): a systematic review and meta-analysis

Muhammad Kamran1, Adeel Shahid2, Muhammad Ans Ahmar3

  • 1Faculty of Health and Life Sciences, Capital University of Science and Technology, Islamabad, Pakistan.

The Journal of Hospital Infection
|July 28, 2026
PubMed

Insights

Pakistan

Area of Science:

  • Global Health
  • Infectious Diseases
  • Pediatric Medicine

Background:

  • Pakistan faces a critical antimicrobial resistance (AMR) crisis, disproportionately affecting its pediatric population.
  • Limited synthesis of pediatric-specific AMR data has existed in the country until this review.
  • Widespread antibiotic use contributes to the escalating AMR challenge.

Purpose of the Study:

  • To systematically review and synthesize available pediatric AMR data in Pakistan.
  • To analyze trends in antibiotic resistance among pediatric infections.
  • To highlight the urgent need for improved antimicrobial stewardship.

Main Methods:

  • A systematic review and meta-analysis adhering to PRISMA 2020 guidelines.
  • Searched major scientific databases for studies on pediatric antibiotic susceptibility in Pakistan (1996-2025).
  • Pooled data using random-effects models for comparable outcomes; narrative synthesis for others.

Main Results:

  • Twenty-five studies were included, revealing a 24.9% positivity rate for sepsis/bloodstream infections in children.
  • Significant multidrug resistance was found in Salmonella typhi/paratyphi (55.2%), with rising trends.
  • High rates of carbapenem resistance (70.5% in one center) and ESBL production (67.3% in neonatal sepsis) were observed, alongside near-universal empirical antibiotic prescribing (82.1%-97%) with minimal culture guidance (2.0%).

Conclusions:

  • Evidence confirms a worsening pediatric AMR crisis in Pakistan, including carbapenem resistance, extensively drug-resistant typhoid, MRSA, and ESBL-producing organisms.
  • The crisis is exacerbated by widespread empirical antibiotic prescribing without culture guidance.
  • Urgent national strategies for stewardship, enhanced surveillance, and diagnostic investment are crucial.
Abstract

Keywords:
Antibiotic ResistanceAntimicrobial Resistance (AMR)Meta-AnalysisMultidrug-Resistant TyphoidPaediatric PopulationPakistanSepsisSystematic Review

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