Antimicrobial resistance in Enterobacterales infections among children in sub-Saharan Africa: a systematic review and meta-analysis

作者：Morgane Kowalski, Basilice Minka Obama, Gaud Catho, Juan Emmanuel Dewez, Arnaud Merglen, Micaela Ruef, Diego O. Andrey, Nasreen Hassoun‐Kheir, Marlieke E.A. de Kraker, Christophe Combescure, Stéphane Emonet, Annick Galetto-Lacour, Noémie Wagner · 发表于：EClinicalMedicine · 年份：2024 · DOI：10.1016/j.eclinm.2024.102512 · 被引用次数：31 · 研究领域：Antibiotic Use and Resistance、Antibiotic Resistance in Bacteria、Pneumonia and Respiratory Infections

Background The burden of antimicrobial resistance (AMR) has been estimated to be the highest in sub-Saharan Africa (SSA). The current study estimated the proportion of drug-resistant Enterobacterales causing infections in SSA children. Methods We searched MEDLINE/PubMed, Embase and the Cochrane Library to identify retrospective and prospective studies published from 01/01/2005 to 01/06/2022 reporting AMR of Enterobacterales causing infections in sub-Saharan children (0–18 years old). Studies were excluded if they had unclear documentation of antimicrobial susceptibility testing methods or fewer than ten observations per bacteria. Data extraction and quality appraisal were conducted by two authors independently. The primary outcome was the proportion of Enterobacterales resistant to antibiotics commonly used in paediatrics. Proportions were combined across studies using mixed-effects logistic regression models per bacteria and per antibiotic. Between-study heterogeneity was assessed using the I 2 statistic. The protocol was registered with PROSPERO (CRD42021260157). Findings After screening 1111 records, 122 relevant studies were included, providing data on more than 30,000 blood, urine and stool isolates. Escherichia coli and Klebsiella spp. were the predominant species, both presenting high proportions of resistance to third-generation cephalosporins, especially in blood cultures: 40.6% (95% CI: 27.7%–55%; I 2 : 85.7%, number of isolates (n): 1032) and 84.9% (72.8%–92.2%; I ...