西太平洋地区低收入和中等收入国家儿童侵袭性细菌感染的抗菌药物敏感性概况——一项系统评价和荟萃分析
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.
作者信息
Moore Nerida, Ashley Elizabeth A, Dickson Benjamin F R, Douangnouvong Anousone, Panyaviseth Pathana, Turner Paul, Williams Phoebe C M
机构信息
Royal Darwin Hospital, 105 Rocklands Dr, Tiwi, NT, 0810, Australia.
Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.
出版信息
Lancet Reg Health West Pac. 2024 Aug 31;51:101177. doi: 10.1016/j.lanwpc.2024.101177. eCollection 2024 Oct.
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. revealed a pooled susceptibility to ampicillin of 17% (95% CI 12-23%, = 3292), gentamicin 63% (95% CI 59-67%, = 3956), and third-generation cephalosporins 59% (95% CI 49-69%, = 3585). Susceptibility of spp. to gentamicin was 71% (95% CI 61-80%, = 2323), third-generation cephalosporins 35% (95% CI 22-49%, = 2076), and carbapenems 89% (95% CI 78-97%, = 2080). Pooled susceptibility of to flucloxacillin was 72% (95% CI 58-83%, = 1666), and susceptibility of meningitis isolates to ampicillin was 26% (95% CI 11-44%, = 375), and 63% (95% CI 40-84%, = 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.
背景
抗菌药物耐药性对儿童死亡率的影响日益增加，尤其是在资源有限的环境中。我们旨在评估西太平洋地区引起儿童感染的细菌的药敏谱。
方法
我们对导致儿童常见感染的细菌进行了系统评价和荟萃分析。我们纳入了2011年1月至2023年12月发表的研究（国际前瞻性系统评价注册库编号CRD42021248722）。针对推荐用于治疗常见临床综合征的经验性抗生素评估汇总药敏情况。
结果
51篇论文符合纳入标准，纳入了18330株细菌分离株。在现有的已发表数据中，该地区仅有6个国家有数据。结果显示，氨苄西林的汇总药敏率为17%（95%置信区间12 - 23%，n = 3292），庆大霉素为63%（95%置信区间59 - 67%，n = 3956），第三代头孢菌素为59%（95%置信区间49 - 69%，n = 3585）。肺炎链球菌对庆大霉素的药敏率为71%（95%置信区间61 - 80%，n = 2323），对第三代头孢菌素为35%（95%置信区间22 - 49%，n = 2076），对碳青霉烯类为89%（95%置信区间78 - 97%，n = 2080）。金黄色葡萄球菌对氟氯西林的汇总药敏率为72%（95%置信区间58 - 83%，n = 1666），脑膜炎分离株对氨苄西林的药敏率为26%（95%置信区间11 - 44%，n = 375），对第三代头孢菌素为63%（95%置信区间40 - 84%，n = 246）。
解读
西太平洋地区引起儿童常见感染的细菌中，抗菌药物耐药负担较重，目前世界卫生组织推荐用于治疗这些感染的抗生素可能无效。有必要采取策略提高高质量数据的可及性，以了解该地区的抗菌药物耐药负担。
资助
本研究由澳大利亚政府国家卫生与医学研究委员会研究员资助金支持。本研究部分由惠康基金会资助[220211/Z/20/Z]。为实现开放获取，作者已对本次提交产生的任何作者接受稿件版本应用了知识共享署名公共版权许可。
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