Antimicrobial resistance among children in Southeast Asia: a systematic review

IntroductionThere is increasing evidence that antimicrobial resistance (AMR) is responsible for a large burden of morbidity and mortality in children, potentially compounded by reduced efficacy of many commonly recommended empirical antibiotic regimens to treat infections in children.MethodsWe used the PRISMA framework to systematically review studies describing AMR in children (0 to 18 years) in Southeast Asia. We analysed bacterial pathogens with a focus on the Global Antimicrobial Resistance Surveillance System (GLASS) reported in studies published between 2010 and 2023. For each pathogen, non-susceptibility to currently recommended WHO empirical antibiotics was analysed with descriptive statistics.ResultsWe evaluated AMR profiles for 21 191 bacterial isolates collated across 111 studies incorporating 484 540 children. Most published data (71 studies) arose from India. High levels of non-susceptibility were evident in gram-negative pathogens, withKlebsiellaspp. exhibiting particularly high levels of resistance to gentamicin (median: 64%; IQR 38 to 81, n=2097) and third-generation cephalosporins (median 76%; IQR 40 to 92, n=2415). Furthermore, a median of 73% (IQR 50 to 86, n=4405) ofEscherichia coliisolates were non-susceptible to third-generation cephalosporins, and 48% (IQR 32 to 64, n=3659) were non-susceptible to gentamicin. Among gram-positive pathogens, the median methicillin resistance toStaphylococcus aureuswas 43% (IQR 33 to 60, n=1139).ConclusionsThere are very high rates of AMR in pathogens isolated from children with common infectious illnesses in Southeast Asia. However, published data available are of variable quality and are heavily weighted towards South Asian countries (India, Nepal and Bangladesh), limiting the generalisability of these findings and highlighting the need for enhanced clinical surveillance networks to improve the surveillance within this populous and high-burden region.PROSPERO registration numberCRD42021259320.