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

BMC Infectious Diseases

Research Article

Perlinot Herindrainy¹  Benoit Garin²  Elsa Kermorvant-Duchemin³  Laurence Watier⁴  Didier Guillemot⁴  Elisabeth Delarocque-Astagneau⁵  Michael Padget⁵  Bich-Tram Huynh⁵ 

[1] Epidemiology Unit Institut Pasteur, Antananarivo, Madagascar;Experimental Bacteriology Laboratory, Institut Pasteur, Antananarivo, Madagascar;Necker Hospital, Department of Neonatal medicine, Paris Descartes University, Paris, France;Pharmacoepidemiology and Infectious diseases Unit, Institut Pasteur, UVSQ, EA 4499, Versailles, INSERM Unit 657 Paris, France AP-HP, Hospital Raymond-Poincaré, Garches, France;Pharmacoepidemiology and Infectious diseases Unit, Institut Pasteur, UVSQ, EA 4499, Versailles, INSERM Unit 657, 25,28 rue du Docteur Roux, 75724, Paris, France;

关键词: Antibiotic resistant bacterial infection;    Developing countries;    Neonatal;    Epidemiology;    Community;   

DOI  :  10.1186/s12879-015-0843-x

 received in 2014-10-17, accepted in 2015-02-19,  发布年份 2015

来源: Springer

【 摘 要 】

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.

【 授权许可】

Unknown   
© Huynh et al.; licensee BioMed Central. 2015. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.