Abstract:
Antimicrobial resistance is an important threat to international health. Therapeutic
guidelines for empirical treatment of common life-threatening infections depend on
available information regarding microbial aetiology and antimicrobial susceptibility, but
sub-Saharan Africa lacks diagnostic capacity and antimicrobial resistance surveillance.
We systematically reviewed studies of antimicrobial resistance among children in subSaharan Africa since 2005. 18 of 1075 articles reviewed met inclusion criteria, providing
data from 67 451 invasive bacterial isolates from inconsistently defined populations in
predominantly urban tertiary settings. Among neonates, Gram-negative organisms were
the predominant cause of early-onset neonatal sepsis, with a high prevalence of
extended-spectrum β-lactamase-producing organisms. Gram-positive bacteria were
responsible for a high proportion of infections among children beyond the neon atal
period, with high reported prevalence of non-susceptibility to treatment advocated by the
WHO therapeutic guidelines. There are few up-to-date or representative studies given the
magnitude of the problem of antimicrobial resistance, especially regarding community acquired infections. Research should focus on differentiating resistance in community acquired versus hospital-acquired infections, implementation of standardised reporting
systems, and pragmatic clinical trials to assess the efficacy of alternative treatment
regimens.