Burden of bacterial resistance among neonatal infections in low income countries: how convincing is the epidemiological evidence?

Abstract

BackgroundAntibiotic resistance is a threat in developing countries (DCs) because of the high burden of bacterial disease and the presence of risk factors for its emergence and spread. This threat is of particular concern for neonates in DCs where over one-third of neonatal deaths may be attributable to severe infections and factors such as malnutrition and HIV infection may increase the risk of death. Additional, undocumented deaths due to severe infection may also occur due to the high frequency of at-home births in DCs.MethodsWe conducted a systematic review of studies published after 2000 on community-acquired invasive bacterial infections and antibiotic resistance among neonates in DCs. Twenty-one articles met all inclusion criteria and were included in the final analysis.ResultsNinety percent of studies recruited participants at large or university hospitals. The majority of studies were conducted in Sub-Saharan Africa (n = 10) and the Indian subcontinent (n = 8). Neonatal infection incidence ranged from 2.9 (95% CI 1.9–4.2) to 24 (95% CI 21.8–25.7) for 1000 live births. The three most common bacterial isolates in neonatal sepsis were Staphylococcus aureus, Escherichia coli, and Klebsiella. Information on antibiotic resistance was sparse and often relied on few isolates. The majority of resistance studies were conducted prior to 2008. No conclusions could be drawn on Enterobacteriaceae resistance to third generation cephalosporins or methicillin resistance among Staphylococcus aureus.ConclusionsAvailable data were found insufficient to draw a true, recent, and accurate picture of antibiotic resistance in DCs among severe bacterial infection in neonates, particularly at the community level. Existing neonatal sepsis treatment guidelines may no longer be appropriate, and these data are needed as the basis for updated guidelines. Reliable microbiological and epidemiological data at the community level are needed in DCs to combat the global challenge of antibiotic resistance especially among neonates among whom the burden is greatest.

Impact of introduction of rapid diagnostic tests for malaria on antibiotic prescribing: analysis of observational and randomised studies in public and private healthcare settings

“…[18][19][20][21][22][23][24] Similarly, monitoring and surveillance of antimicrobial resistance is not conducted in most lower and middle income countries, but available data do show clinically relevant resistance in many common bacterial pathogens. [25][26][27][28][29][30][31][32][33][34][35] The ACT Consortium (www.actconsortium.org) included several studies that evaluated the potential of rapid diagnostic tests for malaria to improve case management for patients with undifferentiated fever in malaria endemic areas. Data from these studies, conducted in multiple geographical, epidemiological, and health system settings, provide the largest and most varied sample to date to assess whether changes in antimalarial prescribing behaviour are associated with shifts in antibiotic prescrib-ing.…”

Hand hygiene adherence according to World Health Organization Recommendations in a Neonatal Intensive Care Unit

“…26 The multi-faceted and complex nature of HAI is such that hand hygiene is necessary, but not sufficient alone to reduce HAI. According to Huynh et al 27 the incidence of neonatal infection in developing countries is the leading cause of death in children under 5 years due to a number of risk factors like the emergence and spread of antibiotic resistance.…”

An overview of Staphylococcus epidermidis and Staphylococcus aureus with a focus on developing countries

“…In Africa alone, infectious diseases account for over 76% of deaths among children, and an estimated 36% of neonatal deaths worldwide are directly attributable to severe infections [21]. In these studies, S. aureus MRSA was reported to be the pathogen responsible for 3% to 63% of deaths [22].…”