Okumu Noah O, Muloi Dishon M, Moodley Arshnee, Watson Julie, Kiarie Alice, Ochieng Linnet, Wasonga Joseph O, Mutisya Christine, Alumasa Lorren, Ngeranwa Joseph J N, Cumming Oliver, Cook Elizabeth A J
Health Program, International Livestock Research Institute, Nairobi, Kenya.
Department of Biochemistry, Biotechnology and Microbiology, Kenyatta University, Nairobi, Kenya.
Front Microbiol. 2025 Apr 28;16:1539160. doi: 10.3389/fmicb.2025.1539160. eCollection 2025.
Antimicrobial resistance (AMR) is a global health priority. This systematic review summarizes the prevalence of AMR in enteric pathogens originating from the community, specifically among ≤10-year-old children in low-and middle-income countries (LMICs). In addition, it presents the proportions of pooled resistance in spp., , spp., and spp. (CESS) to clinically relevant antibiotics.
Six online repositories, namely PubMed, Medline, Web of Science, Cochrane Library, CABI, and EMBASE were searched for articles published between January 2005 and September 2024. Random-effects meta-analysis models were constructed to estimate the pooled AMR proportions for CESS pathogens, and a subgroup analysis by region was also carried out.
A total of 64 publications from 23 LMICs met our inclusion criteria. The pooled estimates of AMR for clinically important antibiotics were as follows: sulfamethoxazole/trimethoprim (SXT) 71% [95%CI: 57-82%]; ampicillin (AMP) 56% [95%CI: 44-67%]; ciprofloxacin (CIP) 10% [95%CI: 5-20%]; and ceftriaxone (CRO) 8% [95%CI: 2-31%]. The proportions of AMR detected in spp. were AMP 76% [95%CI: 60-87%]; nalidixic acid (NA) 9% [95%CI: 2-31%]; CIP 3% [95%CI: 0-15%]; and CRO 2% [95%CI: 0-19%]. The proportions of spp. AMR were AMP 55% [95%CI: 35-73%] and SXT 25% [95%CI: 15-38%]. The proportions of spp. AMR were erythromycin (ERY) 33% [95%CI: 12-64%] and CIP 27% [95%CI: 8-61%]. There was high variability in the regional subgroup analysis, with high interstudy and regional heterogeneity ≥ 75%.
Our results shed light on drug-resistant enteric bacterial pathogens in young children, providing evidence that CESS pathogens are becoming increasingly resistant to clinically important antimicrobials. Regional differences in resistance patterns between these community isolates highlight the need for strong national and regional surveillance to detect regional variations and inform treatment and appropriate antibiotic stewardship programs. The limitations of our findings include high regional variability, significant interstudy heterogeneity, and underrepresentation of certain LMICs.
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抗菌药物耐药性（AMR）是全球卫生重点问题。本系统评价总结了源自社区的肠道病原体中AMR的流行情况，特别是在低收入和中等收入国家（LMICs）10岁及以下儿童中的流行情况。此外，还呈现了肺炎克雷伯菌、大肠埃希菌、沙门菌属和志贺菌属（CESS）对临床相关抗生素的合并耐药比例。
检索了六个在线数据库，即PubMed、Medline、科学网、考克兰图书馆、CABI和EMBASE，以查找2005年1月至2024年9月期间发表的文章。构建随机效应荟萃分析模型，以估计CESS病原体的合并AMR比例，并按地区进行亚组分析。
来自23个LMICs的64篇出版物符合纳入标准。临床上重要抗生素的AMR合并估计值如下：磺胺甲恶唑/甲氧苄啶（SXT）71%[95%置信区间：57 - 82%]；氨苄西林（AMP）56%[95%置信区间：44 - 67%]；环丙沙星（CIP）10%[95%置信区间：5 - 20%]；头孢曲松（CRO）8%[95%置信区间：2 - 31%]。肺炎克雷伯菌中检测到的AMR比例为：AMP 76%[95%置信区间： 60 - 87%]；萘啶酸（NA）9%[95%置信区间：2 - 31%]；CIP 3%[95%置信区间：0 - 15%]；CRO 2%[95%置信区间：0 - 19%]。大肠埃希菌的AMR比例为：AMP 55%[95%置信区间：35 - 73%]和SXT 25%[95%置信区间：15 - 38%]。沙门菌属的AMR比例为：红霉素（ERY）33%[95%置信区间：12 - 64%]和CIP 27%[95%置信区间：8 - 61%]。在区域亚组分析中存在高度变异性，研究间和区域异质性较高（I²≥75%）。
我们的结果揭示了幼儿中耐药肠道细菌病原体的情况，表明CESS病原体对临床重要抗菌药物的耐药性日益增强。这些社区分离株之间耐药模式的区域差异凸显了加强国家和区域监测以发现区域差异并为治疗和适当的抗生素管理计划提供信息的必要性。我们研究结果的局限性包括区域变异性高、研究间显著异质性以及某些LMICs代表性不足。
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