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Lancet Infect Dis. 2018 Feb;18(2):e33-e44. doi: 10.1016/S1473-3099(17)30467-X. Epub 2017 Oct 9.

Antimicrobial resistance among children in sub-Saharan Africa.

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Nuffield Department of Medicine, The University of Oxford, Oxford, UK. Electronic address:
Department of Infectious Diseases & Microbiology, Children's Hospital at Westmead, Westmead, NSW, Australia.
Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Programme, Kilifi, Kenya; The Childhood Acute Illness & Nutrition (CHAIN) Network, Kilifi, Kenya; Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, The University of Oxford, Oxford, UK.


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.

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