Antimicrobial resistance among children in Southeast Asia: a systematic review
Abstract
Introduction: There is increasing evidence that antimicrobial resistance (AMR) is responsible for a large burden of morbidity and mortality in children, potentially compounded by reduced efficacy of many commonly recommended empirical antibiotic regimens to treat infections in children.
Methods: We used the PRISMA framework to systematically review studies describing AMR in children (0 to 18 years) in Southeast Asia. We analysed bacterial pathogens with a focus on the Global Antimicrobial Resistance Surveillance System (GLASS) reported in studies published between 2010 and 2023. For each pathogen, non-susceptibility to currently recommended WHO empirical antibiotics was analysed with descriptive statistics.
Results: We evaluated AMR profiles for 21 191 bacterial isolates collated across 111 studies incorporating 484 540 children. Most published data (71 studies) arose from India. High levels of non-susceptibility were evident in gram-negative pathogens, with Klebsiella spp. exhibiting particularly high levels of resistance to gentamicin (median: 64%; IQR 38 to 81, n=2097) and third-generation cephalosporins (median 76%; IQR 40 to 92, n=2415). Furthermore, a median of 73% (IQR 50 to 86, n=4405) of Escherichia coli isolates were non-susceptible to third-generation cephalosporins, and 48% (IQR 32 to 64, n=3659) were non-susceptible to gentamicin. Among gram-positive pathogens, the median methicillin resistance to Staphylococcus aureus was 43% (IQR 33 to 60, n=1139).…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 4,405 participants or records.
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