{"title":"西太平洋地区(WPRO)中低收入国家儿童侵袭性细菌感染的抗菌药敏感性概况--系统回顾与荟萃分析","authors":"","doi":"10.1016/j.lanwpc.2024.101177","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Antimicrobial resistance increasingly impacts paediatric mortality, particularly in resource-constrained settings. We aimed to evaluate the susceptibility profiles of bacteria causing infections in children from the Western Pacific region.</p></div><div><h3>Methods</h3><p>We conducted a systematic review and meta-analysis of bacteria responsible for common infections in children. We included studies published from January 2011 to December 2023 (PROSPERO CRD42021248722). Pooled susceptibilities were evaluated against empiric antibiotics recommended to treat common clinical syndromes.</p></div><div><h3>Findings</h3><p>Fifty-one papers met inclusion criteria, incorporating 18,330 bacterial isolates. Of available published data, only six countries from the region were represented. <em>Escherichia coli</em> revealed a pooled susceptibility to ampicillin of 17% (95% CI 12–23%, <em>n</em> = 3292), gentamicin 63% (95% CI 59–67%, <em>n</em> = 3956), and third-generation cephalosporins 59% (95% CI 49–69%, <em>n</em> = 3585). Susceptibility of <em>Klebsiella</em> spp. to gentamicin was 71% (95% CI 61–80%, <em>n</em> = 2323), third-generation cephalosporins 35% (95% CI 22–49%, <em>n</em> = 2076), and carbapenems 89% (95% CI 78–97%, <em>n</em> = 2080). Pooled susceptibility of <em>Staphylococcus aureus</em> to flucloxacillin was 72% (95% CI 58–83%, <em>n</em> = 1666), and susceptibility of <em>Streptococcus pneumoniae</em> meningitis isolates to ampicillin was 26% (95% CI 11–44%, <em>n</em> = 375), and 63% (95% CI 40–84%, <em>n</em> = 246) to third-generation cephalosporins.</p></div><div><h3>Interpretation</h3><p>The burden of antimicrobial resistance among bacteria responsible for common infections in children across the Western Pacific region is significant, and the currently recommended World Health Organization antibiotics to treat these infections may be inefficacious. Strategies to improve the availability of high-quality data to understand the burden of antimicrobial resistance in the region are necessary.</p></div><div><h3>Funding</h3><p>The study was supported by an <span>Australian Government</span> <span>National Health and Medical Research Council</span> Investigator Grant. This research was funded in part by the <span>Wellcome Trust</span> [220211/Z/20/Z]. For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6000,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001718/pdfft?md5=6908bd95081e6d3dfc284138156e102f&pid=1-s2.0-S2666606524001718-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Antimicrobial susceptibility profiles of invasive bacterial infections among children from low- and middle-income countries in the Western Pacific Region (WPRO) – a systematic review and meta-analysis\",\"authors\":\"\",\"doi\":\"10.1016/j.lanwpc.2024.101177\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Antimicrobial resistance increasingly impacts paediatric mortality, particularly in resource-constrained settings. We aimed to evaluate the susceptibility profiles of bacteria causing infections in children from the Western Pacific region.</p></div><div><h3>Methods</h3><p>We conducted a systematic review and meta-analysis of bacteria responsible for common infections in children. We included studies published from January 2011 to December 2023 (PROSPERO CRD42021248722). Pooled susceptibilities were evaluated against empiric antibiotics recommended to treat common clinical syndromes.</p></div><div><h3>Findings</h3><p>Fifty-one papers met inclusion criteria, incorporating 18,330 bacterial isolates. Of available published data, only six countries from the region were represented. <em>Escherichia coli</em> revealed a pooled susceptibility to ampicillin of 17% (95% CI 12–23%, <em>n</em> = 3292), gentamicin 63% (95% CI 59–67%, <em>n</em> = 3956), and third-generation cephalosporins 59% (95% CI 49–69%, <em>n</em> = 3585). Susceptibility of <em>Klebsiella</em> spp. to gentamicin was 71% (95% CI 61–80%, <em>n</em> = 2323), third-generation cephalosporins 35% (95% CI 22–49%, <em>n</em> = 2076), and carbapenems 89% (95% CI 78–97%, <em>n</em> = 2080). Pooled susceptibility of <em>Staphylococcus aureus</em> to flucloxacillin was 72% (95% CI 58–83%, <em>n</em> = 1666), and susceptibility of <em>Streptococcus pneumoniae</em> meningitis isolates to ampicillin was 26% (95% CI 11–44%, <em>n</em> = 375), and 63% (95% CI 40–84%, <em>n</em> = 246) to third-generation cephalosporins.</p></div><div><h3>Interpretation</h3><p>The burden of antimicrobial resistance among bacteria responsible for common infections in children across the Western Pacific region is significant, and the currently recommended World Health Organization antibiotics to treat these infections may be inefficacious. 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引用次数: 0
摘要
背景抗菌药耐药性对儿科死亡率的影响越来越大,尤其是在资源有限的环境中。我们旨在评估引起西太平洋地区儿童感染的细菌的敏感性概况。方法我们对引起儿童常见感染的细菌进行了系统回顾和荟萃分析。我们纳入了 2011 年 1 月至 2023 年 12 月期间发表的研究(PROSPERO CRD42021248722)。研究结果51篇论文符合纳入标准,共纳入18,330株细菌分离物。在已发表的数据中,该地区仅有 6 个国家有代表性。大肠埃希菌对氨苄西林的总敏感率为 17%(95% CI 12-23%,n = 3292),对庆大霉素的敏感率为 63%(95% CI 59-67%,n = 3956),对第三代头孢菌素的敏感率为 59%(95% CI 49-69%,n = 3585)。克雷伯菌属对庆大霉素的敏感率为 71%(95% CI 61-80%,n = 2323),对第三代头孢菌素的敏感率为 35%(95% CI 22-49%,n = 2076),对碳青霉烯类的敏感率为 89%(95% CI 78-97%,n = 2080)。金黄色葡萄球菌对氟氯西林的总敏感率为72%(95% CI 58-83%,n = 1666),肺炎链球菌脑膜炎分离株对氨苄西林的敏感率为26%(95% CI 11-44%,n = 375),对第三代头孢菌素的敏感率为63%(95% CI 40-84%,n = 246)。解释:西太平洋地区儿童常见感染病菌的抗菌药耐药性负担沉重,目前世界卫生组织推荐的治疗这些感染的抗生素可能无效。有必要制定战略,改善高质量数据的可用性,以了解该地区的抗菌药耐药性负担。本研究的部分资金来自威康信托基金[220211/Z/20/Z]。出于开放存取的目的,作者已对本论文的任何作者接受稿件版本申请了 CC BY 公共版权许可。
Antimicrobial susceptibility profiles of invasive bacterial infections among children from low- and middle-income countries in the Western Pacific Region (WPRO) – a systematic review and meta-analysis
Background
Antimicrobial resistance increasingly impacts paediatric mortality, particularly in resource-constrained settings. We aimed to evaluate the susceptibility profiles of bacteria causing infections in children from the Western Pacific region.
Methods
We conducted a systematic review and meta-analysis of bacteria responsible for common infections in children. We included studies published from January 2011 to December 2023 (PROSPERO CRD42021248722). Pooled susceptibilities were evaluated against empiric antibiotics recommended to treat common clinical syndromes.
Findings
Fifty-one papers met inclusion criteria, incorporating 18,330 bacterial isolates. Of available published data, only six countries from the region were represented. Escherichia coli revealed a pooled susceptibility to ampicillin of 17% (95% CI 12–23%, n = 3292), gentamicin 63% (95% CI 59–67%, n = 3956), and third-generation cephalosporins 59% (95% CI 49–69%, n = 3585). Susceptibility of Klebsiella spp. to gentamicin was 71% (95% CI 61–80%, n = 2323), third-generation cephalosporins 35% (95% CI 22–49%, n = 2076), and carbapenems 89% (95% CI 78–97%, n = 2080). Pooled susceptibility of Staphylococcus aureus to flucloxacillin was 72% (95% CI 58–83%, n = 1666), and susceptibility of Streptococcus pneumoniae meningitis isolates to ampicillin was 26% (95% CI 11–44%, n = 375), and 63% (95% CI 40–84%, n = 246) to third-generation cephalosporins.
Interpretation
The burden of antimicrobial resistance among bacteria responsible for common infections in children across the Western Pacific region is significant, and the currently recommended World Health Organization antibiotics to treat these infections may be inefficacious. Strategies to improve the availability of high-quality data to understand the burden of antimicrobial resistance in the region are necessary.
Funding
The study was supported by an Australian GovernmentNational Health and Medical Research Council Investigator Grant. This research was funded in part by the Wellcome Trust [220211/Z/20/Z]. For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.
期刊介绍:
The Lancet Regional Health – Western Pacific, a gold open access journal, is an integral part of The Lancet's global initiative advocating for healthcare quality and access worldwide. It aims to advance clinical practice and health policy in the Western Pacific region, contributing to enhanced health outcomes. The journal publishes high-quality original research shedding light on clinical practice and health policy in the region. It also includes reviews, commentaries, and opinion pieces covering diverse regional health topics, such as infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, aging health, mental health, the health workforce and systems, and health policy.