title: Systematic Review of Antibiotic Resistance Rates Among Gram-Negative Bacteria in Children With Sepsis in Resource-Limited Countries.
abstract: BACKGROUND
  Gram-negative antimicrobial resistance (AMR) is of global concern, yet there are few reports from low- and low-middle-income countries, where antimicrobial choices are often limited.
  
  
  METHODS
  This study offers a systematic review of PubMed, Embase, and World Health Organization (WHO) regional databases of Gram-negative bacteremia in children in low- and low-middle-income countries reporting AMR since 2001.
  
  
  RESULTS
  Data included 30 studies comprising 71 326 children, of whom 7056 had positive blood cultures, and Gram-negative organisms were isolated in 4710 (66.8%). In neonates, Klebsiella pneumoniae median resistance to ampicillin was 94% and cephalosporins 84% in Asia; 100% and 50% in Africa. Large regional variations in resistance rates to commonly prescribed antibiotics for Salmonella spp. were identified. Multidrug resistance (resistance to ampicillin, chloramphenicol, and cotrimoxazole) was present in 30% (interquartile range [IQR], 0-59.6) in Asia and 75% (IQR, 30-85.4) in Africa.
  
  
  CONCLUSIONS
  There is a need for an international pediatric antimicrobial resistance surveillance system that collects local epidemiological data to improve the evidence base for the WHO guidance for childhood Gram-negative bacteremia.
authors.affiliation: Wellcome Centre for Global Health Research, Imperial College, London Paediatric Infectious Diseases Research Group, St George's University of London, UK.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Le Doare
authors.affiliation: Paediatric Infectious Diseases Research Group, St George's University of London, UK.
authors.forename: Julia
authors.initials: J
authors.lastname: Bielicki
authors.affiliation: Paediatric Infectious Diseases Research Group, St George's University of London, UK.
authors.forename: Paul T
authors.initials: PT
authors.lastname: Heath
authors.affiliation: Paediatric Infectious Diseases Research Group, St George's University of London, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: Sharland
mesh_terms: D000349:Africa / Q000453:epidemiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001208:Asia / Q000453:epidemiology; D002648:Child; D003906:Developing Countries; D024881:Drug Resistance, Bacterial; D006090:Gram-Negative Bacteria / Q000187:drug effects; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D011203:Poverty; D018805:Sepsis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Gram-negative bacteremia.; antimicrobial resistance; children; epidemiology