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J Pediatric Infect Dis Soc. 2015 Mar;4(1):11-20. doi: 10.1093/jpids/piu014. Epub 2014 Mar 24.

Systematic Review of Antibiotic Resistance Rates Among Gram-Negative Bacteria in Children With Sepsis in Resource-Limited Countries.

Author information

1
Wellcome Centre for Global Health Research, Imperial College, London Paediatric Infectious Diseases Research Group, St George's University of London, UK.
2
Paediatric Infectious Diseases Research Group, St George's University of London, UK.

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.

KEYWORDS:

Gram-negative bacteremia.; antimicrobial resistance; children; epidemiology

PMID:
26407352
DOI:
10.1093/jpids/piu014
[Indexed for MEDLINE]

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