Antimicrobial resistance among children in sub-Saharan Africa

Abstract

SummaryAntimicrobial 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.

Molecular epidemiology and mechanisms of antibiotic resistance inEnterococcusspp.,Staphylococcusspp., andStreptococcusspp. in Africa: a systematic review from a One Health perspective

“…Comparing our analysis to other recent systematic reviews in Africa and the recent WHO Global Antimicrobial Resistance Surveillance System (GLASS) report, there is close alignment and specific differences. For instance, in five West African countries, Bernabé et al .…”

“…This is not to suggest, however, that antibiotic resistance in Gram‐positive bacteria is not an imminent and serious threat, particularly in Africa. In a recent review, Gram‐positive bacteria were responsible for infections, including sepsis, pneumonia, osteomyelitis, and meningitis among children, with a high rate of resistance to World Health Organization (WHO)‐recommended drugs in Africa . In some African regions, 80% of S. aureus infections are MRSA, which show resistance to most standard licensed drugs, including fluoroquinolones and peptides, aminoglycosides, macrolides, and tetracycline (TET).…”

“…For instance, varying antibiotic resistance has been recorded among bloodstream infections caused by S. aureus in humans from Ghana, Gambia, Burkina Faso, Niger, and Togo . MRSA prevalence ranging from 9.4% to 13.5% has been reported in sepsis and meningitis infections, while S. aureus is responsible for causing sepsis and pneumonia at resistance rates of 90%, 29%, and 20% to ampicillin (AMP), gentamycin (GEN), and cloxacillin, respectively, among children in Africa . Furthermore, Founou et al .…”

Molecular Epidemiology and Mechanisms of Antibiotic Resistance in Gram-positive Bacteria in Africa: A Systematic Review and Meta-Analysis from a One Health Perspective

“…In a recent review, Gram-positive bacteria (GPB) were responsible for a high proportion of infections among children and showed a high level of resistance to WHO-recommended drugs in Africa 4 . In some African regions, as many as 80% of Staphylococcus aureus infections are methicillin-resistant S. aureus (MRSA), which show resistance to most standard licensed drugs including quinolones and peptides 25 .…”

“…Excellent reviews addressing antimicrobial resistance in some GPB and Gram-Negative ones in Africa have been published 4,39-44 However, reviews discussing the molecular epidemiology and mechanisms of ABR in GPB such as Staphylococcus spp., Streptococcus spp. and Enterococcus spp.…”