Available #evidence of #antibiotic #resistance from #ESBL-producing #Enterobacteriaceae in #paediatric patients in 20 countries: a systematic review and meta-analysis (Bull World Health Organ., abstract)

[Source: Bulletin of the World Health Organization, full page: (LINK). Abstract, edited.]

Available evidence of antibiotic resistance from extended-spectrum β-lactamase-producing Enterobacteriaceae in paediatric patients in 20 countries: a systematic review and meta-analysis

Yanhong Jessika Hu,a, Anju Ogyu,a, Benjamin J Cowling,a, Keiji Fukuda a & Herbert H Pang a

{a} School of Public Health, Patrick Manson Building (North Wing), 7 Sassoon Road, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special
Administrative Region, China.

Correspondence to Yanhong Jessika Hu (email: huhubest@gmail.com).

Submitted: 20 October 2018 – Revised version received: 8 April 2019 – Accepted: 9 April 2019 – Published online: 14 May 2019

Bull World Health Organ 2019;97:486–501B | doi: http://dx.doi.org/10.2471/BLT.18.225698

 

Abstract

Objective

To make a systematic review of risk factors, outcomes and prevalence of extended-spectrum β-lactamase-associated infection in children and young adults in South-East Asia and the Western Pacific.

Methods

Up to June 2018 we searched online databases for published studies of infection with extended-spectrum β-lactamase-producing Enterobacteriaceae in individuals aged 0–21 years. We included case–control, cohort, cross-sectional and observational studies reporting patients positive and negative for these organisms. For the meta-analysis we used random-effects modelling of risk factors and outcomes for infection, and meta-regression for analysis of subgroups. We mapped the prevalence of these infections in 20 countries and areas using available surveillance data.

Findings

Of 6665 articles scanned, we included 40 studies from 11 countries and areas in the meta-analysis. The pooled studies included 2411 samples testing positive and 2874 negative. A higher risk of infectionwith extended-spectrum β-lactamase-producing bacteria was associated with previous hospital care, notably intensive care unit stays (pooled odds ratio, OR: 6.5; 95% confidence interval, CI: 3.04 to 13.73); antibiotic exposure (OR: 4.8; 95% CI: 2.25 to 10.27); and certain co-existing conditions. Empirical antibiotic therapy was protective against infection (OR: 0.29; 95% CI: 0.11 to 0.79). Infected patients had longer hospital stays (26 days; 95% CI: 12.81 to 38.89) and higher risk of death (OR: 3.2; 95% CI: 1.82 to 5.80). The population prevalence of infection was high in these regions and surveillance data for children were scarce.

Conclusion

Antibiotic stewardship policies to prevent infection and encourage appropriate treatment are needed in South-East Asia and the Western Pacific

Keywords: Antibiotics; Drugs Resistance; Pediatrics; Asia Region.

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Giuseppe Michieli

I am an Italian blogger, active since 2005 with main focus on emerging infectious diseases such as avian influenza, SARS, antibiotics resistance, and many other global Health issues. Other fields of interest are: climate change, global warming, geological and biological sciences. My activity consists mainly in collection and analysis of news, public services updates, confronting sources and making decision about what are the 'signals' of an impending crisis (an outbreak, for example). When a signal is detected, I follow traces during the entire course of an event. I started in 2005 my blog ''A TIME'S MEMORY'', now with more than 40,000 posts and 3 millions of web interactions. Subsequently I added an Italian Language blog, then discontinued because of very low traffic and interest. I contributed for seven years to a public forum (FluTrackers.com) in the midst of the Ebola epidemic in West Africa in 2014, I left the site to continue alone my data tracking job.