Emerging resistance to empiric antimicrobial regimens for pediatric bloodstream infections in Malawi (1998-2017).

Iroh Tam, Pui-Ying ORCID: https://orcid.org/0000-0002-3682-8892, Musicha, Patrick, Kawaza, Kondwani, Cornick, Jenifer, Denis, Brigitte, Freyne, Bridget, Everett, Dean, Dube, Queen, French, Neil, Feasey, Nicholas ORCID: https://orcid.org/0000-0003-4041-1405 and Heyderman, Robert (2019) 'Emerging resistance to empiric antimicrobial regimens for pediatric bloodstream infections in Malawi (1998-2017).'. Clinical Infectious Diseases, Vol 69, Issue 1, pp. 61-68.

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Abstract

Background
The adequacy of the WHO Integrated Management of Childhood Illness (IMCI) antimicrobial guidelines for the treatment of suspected severe bacterial infections is dependent on a low prevalence of antimicrobial resistance (AMR). We describe trends in etiologies and susceptibility patterns of bloodstream infections (BSI) in hospitalized children in Malawi.

Methods
We determined the change in population-based incidence of BSI in children admitted to Queen Elizabeth Central Hospital, Blantyre, Malawi (1998-2017). AMR profiles were assessed by the disc diffusion method and trends over time were evaluated.

Results
A total 89,643 pediatric blood cultures were performed, and 10,621 pathogens were included in the analysis. Estimated minimum incidence rates of BSI for those ≤5 years of age fell from a peak of 11.4 per 1,000 persons in 2002 to 3.4 per 1,000 persons in 2017. Over two decades, resistance of Gram-negative pathogens to all empiric first-line antimicrobials (ampicillin/penicillin, gentamicin, ceftriaxone) among children ≤5 years increased from 3.4% to 30.2% (p<0.001). Among those ≤60 days, AMR to all first-line antimicrobials increased from 7.0% to 67.7% (p<0.001). Among children ≤5 years, Klebsiella spp. resistance to all first-line antimicrobial regimens increased from 5.9% to 93.7% (p<0.001).

Conclusions
The incidence of BSI among hospitalized children has decreased substantially over the last 20 years, although gains have been offset by increases in Gram-negative pathogens resistant to all empiric first-line antimicrobials. There is an urgent need to address the broader challenge of adapting IMCI guidelines to the local setting in the face of rapidly expanding AMR in childhood BSI.

Item Type:	Article
Subjects:	WS Pediatrics > WS 20 Research (General) WS Pediatrics > Diseases of Children and Adolescents > By System > WS 300 Hemic and lymphatic system
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1093/cid/ciy834
Depositing User:	Julie Franco
Date Deposited:	11 Oct 2018 15:37
Last Modified:	13 Sep 2019 19:37
URI:	https://archive.lstmed.ac.uk/id/eprint/9452

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