Antimicrobial resistance among children in Southeast Asia: a systematic review
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 use...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2025-05-01
|
| Series: | BMJ Public Health |
| Online Access: | https://bmjpublichealth.bmj.com/content/3/1/e001312.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849428423731052544 |
|---|---|
| author | Paul Turner Elizabeth A Ashley Phoebe CM Williams Robert C Duguid Anousone Douangnouvong Pathana Panyaviseth Priyali Wijeratne Jessica Saunders |
| author_facet | Paul Turner Elizabeth A Ashley Phoebe CM Williams Robert C Duguid Anousone Douangnouvong Pathana Panyaviseth Priyali Wijeratne Jessica Saunders |
| author_sort | Paul Turner |
| collection | DOAJ |
| description | 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).Conclusions There are very high rates of AMR in pathogens isolated from children with common infectious illnesses in Southeast Asia. However, published data available are of variable quality and are heavily weighted towards South Asian countries (India, Nepal and Bangladesh), limiting the generalisability of these findings and highlighting the need for enhanced clinical surveillance networks to improve the surveillance within this populous and high-burden region.PROSPERO registration number CRD42021259320. |
| format | Article |
| id | doaj-art-2e506375d47c467aba3b3adeb39d9028 |
| institution | Kabale University |
| issn | 2753-4294 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Public Health |
| spelling | doaj-art-2e506375d47c467aba3b3adeb39d90282025-08-20T03:28:43ZengBMJ Publishing GroupBMJ Public Health2753-42942025-05-013110.1136/bmjph-2024-001312Antimicrobial resistance among children in Southeast Asia: a systematic reviewPaul Turner0Elizabeth A Ashley1Phoebe CM Williams2Robert C Duguid3Anousone Douangnouvong4Pathana Panyaviseth5Priyali Wijeratne6Jessica Saunders73 Nuffield Department of Medicine, University of Oxford, Oxford, UK2 Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Lao People’s Democratic Republic5 Paediatric Infectious Diseases Group, School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia1 Department of Infectious Diseases, Sydney Children’s Hospital Randwick, Randwick, New South Wales, Australia2 Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Lao People’s Democratic Republic2 Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Lao People’s Democratic Republic1 Department of Infectious Diseases, Sydney Children’s Hospital Randwick, Randwick, New South Wales, Australia1 Department of Infectious Diseases, Sydney Children’s Hospital Randwick, Randwick, New South Wales, AustraliaIntroduction 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).Conclusions There are very high rates of AMR in pathogens isolated from children with common infectious illnesses in Southeast Asia. However, published data available are of variable quality and are heavily weighted towards South Asian countries (India, Nepal and Bangladesh), limiting the generalisability of these findings and highlighting the need for enhanced clinical surveillance networks to improve the surveillance within this populous and high-burden region.PROSPERO registration number CRD42021259320.https://bmjpublichealth.bmj.com/content/3/1/e001312.full |
| spellingShingle | Paul Turner Elizabeth A Ashley Phoebe CM Williams Robert C Duguid Anousone Douangnouvong Pathana Panyaviseth Priyali Wijeratne Jessica Saunders Antimicrobial resistance among children in Southeast Asia: a systematic review BMJ Public Health |
| title | Antimicrobial resistance among children in Southeast Asia: a systematic review |
| title_full | Antimicrobial resistance among children in Southeast Asia: a systematic review |
| title_fullStr | Antimicrobial resistance among children in Southeast Asia: a systematic review |
| title_full_unstemmed | Antimicrobial resistance among children in Southeast Asia: a systematic review |
| title_short | Antimicrobial resistance among children in Southeast Asia: a systematic review |
| title_sort | antimicrobial resistance among children in southeast asia a systematic review |
| url | https://bmjpublichealth.bmj.com/content/3/1/e001312.full |
| work_keys_str_mv | AT paulturner antimicrobialresistanceamongchildreninsoutheastasiaasystematicreview AT elizabethaashley antimicrobialresistanceamongchildreninsoutheastasiaasystematicreview AT phoebecmwilliams antimicrobialresistanceamongchildreninsoutheastasiaasystematicreview AT robertcduguid antimicrobialresistanceamongchildreninsoutheastasiaasystematicreview AT anousonedouangnouvong antimicrobialresistanceamongchildreninsoutheastasiaasystematicreview AT pathanapanyaviseth antimicrobialresistanceamongchildreninsoutheastasiaasystematicreview AT priyaliwijeratne antimicrobialresistanceamongchildreninsoutheastasiaasystematicreview AT jessicasaunders antimicrobialresistanceamongchildreninsoutheastasiaasystematicreview |