Systematic Review of Antibiotic Resistance Rates Among Gram-Negative Bacteria in Children With Sepsis in Resource-Limited Countries

J Pediatric Infect Dis Soc. 2015 Mar;4(1):11-20. doi: 10.1093/jpids/piu014. Epub 2014 Mar 24.


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.

Keywords: Gram-negative bacteremia.; antimicrobial resistance; children; epidemiology.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Africa / epidemiology
  • Anti-Bacterial Agents / therapeutic use
  • Asia / epidemiology
  • Child
  • Developing Countries
  • Drug Resistance, Bacterial*
  • Gram-Negative Bacteria* / drug effects
  • Gram-Negative Bacterial Infections / drug therapy
  • Gram-Negative Bacterial Infections / epidemiology*
  • Humans
  • Poverty
  • Sepsis / drug therapy
  • Sepsis / epidemiology*
  • Sepsis / microbiology*


  • Anti-Bacterial Agents