Antimicrobial resistance among children in sub-Saharan Africa

Phoebe C M Williams, David Isaacs, James A Berkley, Phoebe C M Williams, David Isaacs, James A Berkley

Abstract

Antimicrobial 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.

Copyright © 2018 Elsevier Ltd. All rights reserved.

Figures

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Figure 1
Search strategy
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Figure 2
Study locations

References

    1. Laxminarayan R, Matsoso P, Pant S. Access to effective antimicrobials: a worldwide challenge. Lancet. 2016;387:168–175.
    1. Laxminarayan R, Duse A, Wattal C. Antibiotic resistance—the need for global solutions. Lancet Infect Dis. 2017;13:1057–1098.
    1. WHO . Antimicrobial resistance. Global report on surveillance. World Health Organization; Geneva: 2014.
    1. The World Bank Databank. World development indicators. 2015. (accessed Feb 13, 2017).
    1. Ashley E, Lubell Y, White N, Turner P. Antimicrobial susceptibility of bacterial isolates from community-acquired infections in sub-Saharan Africa and Asian low and middle income countries. Trop Med Int Health. 2011;16:1167–1179.
    1. Leopold S, ven Leth F, Terekegn H, Schultsz C. Antimicrobial drug resistance among clinically relevant bacterial isolates in sub-Saharan Africa: a systematic review. J Antimicrob Chemother. 2014;69:2337–2353.
    1. WHO . Worldwide country situation analysis: response to antimicrobial resistance. World Health Organization; Geneva: 2015.
    1. Bahwere P, Levy J, Hennart P. Community-acquired bacteraemia among hospitalized children in rural central Africa. Int J Infect Dis. 2001;5:180–188.
    1. Reddy E, Shaw A, Crump J. Community-acquired bloodstream infections in Africa: a systematic review and meta-analysis. Lancet Infect Dis. 2010;10:417–432.
    1. Seale A, Davies M, Anampiu K. Invasive group A streptococcus infection among children, rural Kenya. Emerg Infect Dis. 2016;22:224–233.
    1. Kissoon N, Uyeki T. Sepsis and the global burden of disease in children. JAMA Pediatr. 2016;170:107–108.
    1. Omulo S, Thumbi SM, Njenga MK, Call DR. A review of 40 years of enteric antimicrobial resistance research in Eastern Africa: what can be done better? Antimicrob Resist Infect Control. 2015;4:1.
    1. Eager H, Swan G, van Vuuren M. A survey of antimicrobial usage in animals in South Africa with specific reference to food animals. J S Afr Vet Assoc. 2012;83:16.
    1. Blomberg B, Manji K, Urassam W. Antimicrobial resistance predicts death in Tanzanian children with bloodstream infections: a prospective cohort study. BMC Infect Dis. 2007;22:43.
    1. Storberg V. ESBL-producing Enterobacteriaceae in Africa—a non-systematic literature review of research published 2008–2012. Infect Ecol Epidemiol. 2014;4:20342.
    1. Pitout JD, Laupland KB. Extended-spectrum β-lactamase-producing Enterobacteriaceae: an emerging public-health concern. Lancet Infect Dis. 2008;8:159–166.
    1. Murunga EM, Reriani M, Otieno CF, Wanyoike NM. Comparison of antibiotic use between an ‘open’ and a ‘closed’ intensive care unit. East Afr Med J. 2005;82:414–417.
    1. Versporten A, Bielicki J, Drapier N, Sharland M, Goossens H. The worldwide antibiotic resistance and prescribing in European children (ARPEC) point prevalence survey: developing hospital-quality indicators of antibiotic prescribing for children. J Antimicrob Chemother. 2016;71:1106–1117.
    1. Dramowski A, Cotton M, Rabie H, Whitelaw A. Trends in paediatric bloodstream infections at a South African referral hospital. BMC Pediatr. 2015;15:33.
    1. Smith R, Coast J. The true cost of antimicrobial resistance. BMJ. 2013;346:f1493.
    1. WHO . Pocket book of hospital care for children. Guidelines for the management of common illnesses with limited resources. World Health Organization; Geneva: 2005.
    1. WHO . Guideline. Managing possible serious bacterial infection in young infants when referral is not feasible. World Health Organization; Geneva: 2015.
    1. Downie L, Armiento R, Subhi R, Kelly J, Clifford V, Duke T. Community-acquired neonatal and infant sepsis in developing countries: efficacy of WHO's currently recommended antibiotics—systematic review and meta-analysis. Arch Dis Childhood. 2013;98:146–154.
    1. Alcoba G, Kerac M, Breysse S. Do children with uncomplicated severe acute malnutrition need antibiotics? A systematic review and meta-analysis. PLoS One. 2013;8:e53184.
    1. Le Doare J, Bielicki J, Heath PT, Sharland M. Systematic review of antibiotic resistance rates among Gram-negative bacteria in children with sepsis in resource-limited countries. J Paediatric Infect Dis Soc. 2014;4:11–20.
    1. Talbert AW, Mwaniki M, Mwarumba S, Newton CR, Berkley JA. Invasive bacterial infections in neonates and young infants born outside hospital admitted to a rural hospital in Kenya. Pediatr Infect Dis J. 2010;29:945–950.
    1. Kayange N, Kamugisha E, Mwizamholya D, Jeremiah S, Mshana S. Predictors of positive blood culture and deaths among neonates with suspected neonatal sepsis in a tertiary hospital, Mwanza-Tanzania. BMC Pediatr. 2010;10:39.
    1. Mhada TV, Fredrick F, Matee MI, Massawe A. Neonatal sepsis at Muhimbili National Hospital, Dar es Salaam, Tanzania: aetiology, antimicrobial sensitivity pattern and clinical outcome. BMC Public Health. 2012;12:904.
    1. Nwadioha I, Nwokedi E, Kashibu E, Odimayo MS, Okwori EE. A review of bacterial isolates in blood cultures of children with suspected septicaemia in a Nigerian tertiary hospital. African J Microbiol Res. 2010;4:222–225.
    1. Schaumberg F, Alabi A, Kokou C. High burden of extended-spectrum β-lactamase-producing Enterobacteriaceae in Gabon. J Antimicrob Chemother. 2013;68:2140–2143.
    1. Sigaúque B, Roca A, Mandomando I. Community-acquired bacteraemia among children admitted to a rural hospital in Mozambique. Pediatr Infect Dis J. 2009;28:108–113.
    1. Nielsen M, Sarpong N, Krumkamp R. Incidence and characteristics of bacteremia among children in rural Ghana. PLoS One. 2012;7:e44063.
    1. Marais E, Aithma N, Perovic O, Oosthuysen W, Musenge E, Dusé AG. Antimicrobial susceptibility of methicillin-resistant Staphylococcus aureus isolates from South Africa. S Afr Med J. 2009;99:170–173.
    1. Nantanda R, Hildenwall H, Peterson S, Kaddu-Mulindwa D, Kalyesubula I, Tumwine JK. Bacterial aetiology and outcome in children with severe pneumonia in Uganda. Ann Trop Paediatr. 2008;28:253–260.
    1. Gray MJ, Bennett SL, French N, Phiri AJ, Graham SM. Invasive group B streptococcal infection in infants, Malawi. Emerg Infect Dis. 2007;13:223–230.
    1. Ndir A, Diop A, Faye PM, Cissé MF, Ndoye B, Astagneau P. Epidemiology and burden of bloodstream infections caused by extended-spectrum β-lactamase producing Enterobacteriaceae in a pediatric hospital in Senegal. PLoS One. 2016;11:e0143729.
    1. Enwere G, Biney E, Cheung Y. Epidemiologic and clinical characterstics of community-acquired invasive bacterial infections in children aged 2–29 months in The Gambia. Pediatr Infect Dis J. 2006;25:700–705.
    1. Schwarz N, Sarpong N, Hünger F. Systemic bacteraemia in children presenting with clinical pneumonia and the impact of non-typhoid salmonella (NTS) BMC Infect Dis. 2010;10:319.
    1. Mandomando I, Jaintilal D, Pons MJ. Antimicrobial susceptibility and mechanisms of resistance in Shigella and Salmonella isolates from children under five years of age with diarrhoea in rural Mozambique. Antimicrob Agents Chemother. 2009;53:2450–2454.
    1. Phoba MF, De Boeck H, Ifeka BB. Epidemic increase in Salmonella bloodstream infection in children, Bwamanda, the Democratic Republic of Congo. Eur J Clin Microbiol Infect Dis. 2014;33:79–87.
    1. Ginsburg AS, Tinkham L, Riley K, Kay NA, Klugman KP, Gill CJ. Antibiotic non-susceptibility among Streptococcus pneumoniae and Haemophilus influenzae isolates identified in African cohorts: a meta-analysis of three decades of published studies. Int J Antimicrob Agents. 2013;42:482–491.
    1. Aamodt H, Mohn SC, Maselle S. Genetic relatedness and risk factor analysis of ampicillin-resistant and high-level gentamicin-resistant enterococci causing bloodstream infections in Tanzanian children. BMC Infect Dis. 2015;15:107.
    1. Usha G, Chunderika M, Prashini M, Willem S, Yusuf E. Characterisation of extended-spectrum beta-lactamases in Salmonella spp at a tertiary hospital in Durban, South Africa. Diagn Microbiol Infect Dis. 2008;62:86–91.
    1. Zaidi AK, Huskins WC, Thaver D, Bhutta ZA, Abbas Z, Goldmann DA. Hospital-acquired neonatal infections in developing countries. Lancet. 2005;365:1175–1188.
    1. Lubell Y, Turner P, Ashley E, White N. Susceptibility of bacterial isolates from community-acquired infections in sub-Saharan Africa and Asia to macrolide antibiotics. Trop Med Int Health. 2011;16:1192–1205.
    1. Balshem H, Helfand M, Schünemann HJ. GRADE guidelines: 3. rating the quality of the evidence. J Clin Epidemiol. 2011;64:401–406.
    1. Vlieghe E, Phoba M, Tamfun J, Jacobs J. Antibiotic resistance among bacterial pathogens in Central Africa: a review of the published literature between 1955 and 2008. Int J Antimicrob Agents. 2009;34:295–303.
    1. Roca A, Bassat Q, Morais L. Surveillance of acute bacterial meningitis among children admitted to a district hospital in rural Mozambique. Clin Infect Dis. 2009;48(suppl 2):S172–S181.
    1. Falade AG, Lagunju IA, Bakare RA, Odekanmi AA, Adegbola RA. Invasive pneumococcal disease in children aged <5 years admitted to 3 urban hospitals in Ibadan, Nigeria. Clin Infect Dis. 2009;48(suppl 2):S190–S196.
    1. Falade AG, Ayede AI. Epidemiology, aetiology and management of childhood acute community-acquired pneumonia in developing countries—a review. Afr J Med Med Sci. 2011;40:293–308.
    1. Woerther PL, Angebault C, Jacquier H. Massive increase, spread and exchange of extended spectrum β-lactamase-encoding genes among intestinal Enterobacteriaceae in hospitalized children with severe acute malnutrition in Niger. Clin Infect Dis. 2011;53:677–685.
    1. Huynh BT, Padget M, Garin B. Burden of bacterial resistance among neonatal infections in low income countries: how convincing is the epidemiological evidence? BMC Infect Dis. 2015;15:127.
    1. Sinha L, Russell LB, Tomcysk S. Disease burden of group B Streptococcus among infants in sub-Saharan Africa: a systematic review and meta-analysis. Pediatr Infect Dis J. 2016;35:933–942.
    1. Hamer G, Darmstadt GL, Carlin JB. Etiology of bacteraemia in young infants in six countries. Pediatr Infect Dis J. 2015;34:e1–e8.
    1. Zaidi AK, Thaver D, Ali SA, Khan TA. Pathogens associated with sepsis in newborns and young infants in developing countries. Pediatr Infect Dis J. 2009;28(suppl 1):S10–S18.
    1. Waters D, Jawad I, Ahmad A. Aetiology of community-acquired neonatal sepsis in low and middle-income countries. J Glob Health. 2011;1:154–170.
    1. Kabwe M, Tembo J, Chilukutu L. Etiology, antibiotic resistance and risk factors for neonatal sepsis in a large referral centre in Zambia. Pediatr Infect Dis J. 2016;35:e191–e198.
    1. The World Health Organization Causes of Child Mortality. 2015. (accessed Jan 10, 2016).
    1. Davies NE, Karstaedt AS. Shigella bacteraemia over a decade in Soweto, South Africa. Trans R Soc Trop Med Hyg. 2008;102:1269–1273.
    1. Usuf E, Bottomley C, Adegbola RA, Hall A. Pneumococcal carriage in sub-Saharan Africa—a systematic review. PLoS One. 2014;9:e85001.
    1. von Gottberg A, de Gouveia L, Tempia S. Effects of vaccination on invasive pneumococcal disease in South Africa. N Engl J Med. 2014;371:1889–1899.
    1. The World Bank World development indicators: population dynamics. (accessed Dec 10, 2016).
    1. McNeil JC. Staphylococcus aureus—antimicrobial resistance and the immunocompromised child. Infect Drug Resist. 2014;7:117–127.
    1. Cotton MF, Wasserman E, Smit J, Whitelaw A, Zar HJ. High incidence of antimicrobial resistant organisms including extended spectrum beta-lactamase producing Enterobacteriaceae and methicillin-resistant Staphylococcus aureus in nasopharyngeal and blood isolates of HIV-infected children from Cape Town, South Africa. BMC Infect Dis. 2008;8:40.
    1. Groome M, Albrich W, Wadula J, Khoosal M, Madhi SA. Community-onset Staphylococcus aureus bacteraemia in hospitalized African children: high incidence in HIV-infected children and high prevalence of multidrug resistance. Paediatr Int Child Health. 2012;32:140–146.
    1. Tan CK, Lai CC, Liao CH, Lin SH, Huang YT, Hsueh PR. Increased rifampicin resistance in blood isolates of meticillin-resistant Staphylococcus aureus (MRSA) amongst patients exposed to rifampicin-containing antituberculosis treatment. Int J Antimicrob Agents. 2011;37:550–553.
    1. Bruinsma N, Hutchinson JM, van den Bogaard AE, Giamarellou H, Degener J, Stobberingh EE. Influence of population density on antibiotic resistance. J Antimicrob Chemother. 2003;51:385–390.
    1. Huynh BT, Padget M, Garin B, Delarocque-Astagneau E, Guillemot D. Bacterial neonatal sepsis and antibiotic resistance in low-income countries. Lancet. 2016;387:533–534.
    1. Kariuki S, Revathi G, Kiiru J. Typhoid in Kenya is associated with a dominant multidrug-resistant Salmonella enterica serovar Typhi haplotype that is also widespread in southeast Asia. J Clin Microbiol. 2010;48:2171–2176.
    1. Sangare SA, Rondinaud E, Maataoui N. Very high prevalence of extended-spectrum beta-lactamase-producing Enterobacteriaceae in bacteriemic patients hospitalized in teaching hospitals in Bamako, Mali. PLoS One. 2017;12:e0172652.
    1. Schuts EC, Hulscher ME, Mouton JW. Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis. Lancet Infect Dis. 2016;16:847–856.
    1. Laxminarayan R, Bhutta ZA. Antimicrobial resistance—a threat to neonate survival. Lancet Glob Health. 2017;4:e676–e677.
    1. Thaver D, Ali SA, Zaidi AK. Antimicrobial resistance among neonatal pathogens in developing countries. Pediatr Infect Dis J. 2009;28(suppl 1):S19–S21.
    1. WHO . Global antimicrobial resistance surveillance system. Manual for early implementation. World Health Organization; Geneva: 2015.

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