Coverage gaps in empiric antibiotic regimens used to treat serious bacterial infections in neonates and children in Southeast Asia and the PacificResearch in context
Summary: Background: High levels of antimicrobial resistance (AMR) are propagating deaths due to neonatal and paediatric infections globally. This is of particular concern in Southeast Asia and the Pacific, where healthcare resources are constrained and access to newer agents to treat multidrug-res...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-03-01
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| Series: | The Lancet Regional Health - Southeast Asia |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772368223001518 |
| _version_ | 1797265517302513664 |
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| author | Phoebe C.M. Williams Mark Jones Thomas L. Snelling Robert Duguid Nerida Moore Benjamin Dickson Yue Wu Jessica Saunders Priyali Wijeratne Anousone Douangnouvong Elizabeth A. Ashley Paul Turner |
| author_facet | Phoebe C.M. Williams Mark Jones Thomas L. Snelling Robert Duguid Nerida Moore Benjamin Dickson Yue Wu Jessica Saunders Priyali Wijeratne Anousone Douangnouvong Elizabeth A. Ashley Paul Turner |
| author_sort | Phoebe C.M. Williams |
| collection | DOAJ |
| description | Summary: Background: High levels of antimicrobial resistance (AMR) are propagating deaths due to neonatal and paediatric infections globally. This is of particular concern in Southeast Asia and the Pacific, where healthcare resources are constrained and access to newer agents to treat multidrug-resistant pathogens is limited. Methods: To assess the coverage provided by commonly prescribed empiric antibiotic regimens for children in low- and middle-income countries in Southeast Asia and the Pacific, we built a weighted incidence syndromic combination antibiogram (WISCA), parameterised using data obtained from a systematic review of published literature incorporating WHO-defined SEARO and WPRO regions in Ovid MEDLINE, EMBASE, Global Health and PubMed. Susceptibility data for bacterial pathogens were extracted to provide coverage estimates for pre-specified antibiotics (aminopenicillins, gentamicin, third-generation cephalosporins and carbapenems), reported at the regional level. Findings: 6648 bacterial isolates from 11 countries across 86 papers were included in the Bayesian WISCA model, which weighted bacterial incidence and antimicrobial susceptibility of relevant isolates. Coverage provided by aminopenicillins in neonatal sepsis/meningitis was 26% (80% credible interval: 16–49) whilst gentamicin coverage was 45% (29–62). Third-generation cephalosporin coverage was only 29% (16–49) in neonatal sepsis/meningitis, 51% (38–64) in paediatric sepsis and 65% (51–77) in paediatric meningitis. Carbapenems were estimated to provide the highest coverage: 81% (65–90) in neonatal sepsis/meningitis, 83% (72–90) in paediatric sepsis and 79% (62–91) in paediatric meningitis. Interpretation: These findings reveal alarmingly high rates of resistance to commonly prescribed empirical therapies for neonatal and paediatric sepsis and meningitis in the Asia–Pacific region. Funding: This research was funded in whole, or in part, by the Wellcome Trust [220211]. For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. PCMW is supported by a National Health and Medical Research Council (NHMRC) Investigator Grant. NHMRC had no involvement in the design or conduct of the research. |
| first_indexed | 2024-04-25T00:46:03Z |
| format | Article |
| id | doaj.art-3192d131bc5844a68dc6ad585c013fc2 |
| institution | Directory Open Access Journal |
| issn | 2772-3682 |
| language | English |
| last_indexed | 2024-04-25T00:46:03Z |
| publishDate | 2024-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health - Southeast Asia |
| spelling | doaj.art-3192d131bc5844a68dc6ad585c013fc22024-03-12T04:16:57ZengElsevierThe Lancet Regional Health - Southeast Asia2772-36822024-03-0122100291Coverage gaps in empiric antibiotic regimens used to treat serious bacterial infections in neonates and children in Southeast Asia and the PacificResearch in contextPhoebe C.M. Williams0Mark Jones1Thomas L. Snelling2Robert Duguid3Nerida Moore4Benjamin Dickson5Yue Wu6Jessica Saunders7Priyali Wijeratne8Anousone Douangnouvong9Elizabeth A. Ashley10Paul Turner11Faculty of Medicine, School of Public Health, The University of Sydney, Sydney, NSW, Australia; Department of Infectious Diseases, Sydney Children's Hospital Network, Sydney, NSW, Australia; Sydney Institute of Infectious Diseases (Sydney ID), Sydney, NSW, Australia; Corresponding author. Faculty of Medicine, School of Public Health, The University of Sydney, Edward Ford Building, Camperdown, NSW, Australia.Faculty of Medicine, School of Public Health, The University of Sydney, Sydney, NSW, AustraliaFaculty of Medicine, School of Public Health, The University of Sydney, Sydney, NSW, AustraliaDepartment of Infectious Diseases, Sydney Children's Hospital Network, Sydney, NSW, AustraliaDepartment of Infectious Diseases, Royal Darwin Hospital, Tiwi, Northern Territory, AustraliaFaculty of Medicine, School of Public Health, The University of Sydney, Sydney, NSW, Australia; Department of Global Health, London School of Hygiene and Tropical Medicine, London, UKFaculty of Medicine, School of Public Health, The University of Sydney, Sydney, NSW, AustraliaDepartment of Infectious Diseases, Sydney Children's Hospital Network, Sydney, NSW, AustraliaDepartment of Infectious Diseases, Sydney Children's Hospital Network, Sydney, NSW, AustraliaLao-Oxford Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao PDRLao-Oxford Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao PDR; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UKCentre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, CambodiaSummary: Background: High levels of antimicrobial resistance (AMR) are propagating deaths due to neonatal and paediatric infections globally. This is of particular concern in Southeast Asia and the Pacific, where healthcare resources are constrained and access to newer agents to treat multidrug-resistant pathogens is limited. Methods: To assess the coverage provided by commonly prescribed empiric antibiotic regimens for children in low- and middle-income countries in Southeast Asia and the Pacific, we built a weighted incidence syndromic combination antibiogram (WISCA), parameterised using data obtained from a systematic review of published literature incorporating WHO-defined SEARO and WPRO regions in Ovid MEDLINE, EMBASE, Global Health and PubMed. Susceptibility data for bacterial pathogens were extracted to provide coverage estimates for pre-specified antibiotics (aminopenicillins, gentamicin, third-generation cephalosporins and carbapenems), reported at the regional level. Findings: 6648 bacterial isolates from 11 countries across 86 papers were included in the Bayesian WISCA model, which weighted bacterial incidence and antimicrobial susceptibility of relevant isolates. Coverage provided by aminopenicillins in neonatal sepsis/meningitis was 26% (80% credible interval: 16–49) whilst gentamicin coverage was 45% (29–62). Third-generation cephalosporin coverage was only 29% (16–49) in neonatal sepsis/meningitis, 51% (38–64) in paediatric sepsis and 65% (51–77) in paediatric meningitis. Carbapenems were estimated to provide the highest coverage: 81% (65–90) in neonatal sepsis/meningitis, 83% (72–90) in paediatric sepsis and 79% (62–91) in paediatric meningitis. Interpretation: These findings reveal alarmingly high rates of resistance to commonly prescribed empirical therapies for neonatal and paediatric sepsis and meningitis in the Asia–Pacific region. Funding: This research was funded in whole, or in part, by the Wellcome Trust [220211]. For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. PCMW is supported by a National Health and Medical Research Council (NHMRC) Investigator Grant. NHMRC had no involvement in the design or conduct of the research.http://www.sciencedirect.com/science/article/pii/S2772368223001518Child healthAntimicrobial resistanceWISCAAntibiogramNeonatal sepsisPaediatric sepsis |
| spellingShingle | Phoebe C.M. Williams Mark Jones Thomas L. Snelling Robert Duguid Nerida Moore Benjamin Dickson Yue Wu Jessica Saunders Priyali Wijeratne Anousone Douangnouvong Elizabeth A. Ashley Paul Turner Coverage gaps in empiric antibiotic regimens used to treat serious bacterial infections in neonates and children in Southeast Asia and the PacificResearch in context The Lancet Regional Health - Southeast Asia Child health Antimicrobial resistance WISCA Antibiogram Neonatal sepsis Paediatric sepsis |
| title | Coverage gaps in empiric antibiotic regimens used to treat serious bacterial infections in neonates and children in Southeast Asia and the PacificResearch in context |
| title_full | Coverage gaps in empiric antibiotic regimens used to treat serious bacterial infections in neonates and children in Southeast Asia and the PacificResearch in context |
| title_fullStr | Coverage gaps in empiric antibiotic regimens used to treat serious bacterial infections in neonates and children in Southeast Asia and the PacificResearch in context |
| title_full_unstemmed | Coverage gaps in empiric antibiotic regimens used to treat serious bacterial infections in neonates and children in Southeast Asia and the PacificResearch in context |
| title_short | Coverage gaps in empiric antibiotic regimens used to treat serious bacterial infections in neonates and children in Southeast Asia and the PacificResearch in context |
| title_sort | coverage gaps in empiric antibiotic regimens used to treat serious bacterial infections in neonates and children in southeast asia and the pacificresearch in context |
| topic | Child health Antimicrobial resistance WISCA Antibiogram Neonatal sepsis Paediatric sepsis |
| url | http://www.sciencedirect.com/science/article/pii/S2772368223001518 |
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