Two studies by Geneva University Hospital and the University of Geneva found alarming rates of antibiotic-resistant bacteria in sub-Saharan African children. They focused on Enterobacteria, which cause many severe infections in newborns. The first study showed that 41% of Escherichia coli and 85% of Klebsiella bacteria in children’s blood resist common treatments.
The second study found that one-third of children carry cephalosporin-resistant Enterobacteria. In this region, alternative treatments are often unavailable if the first-line treatment fails. The studies are published in eclinical medicine by The Lancet.
Antibiotic resistance is a global health crisis, particularly severe in sub-Saharan Africa, especially West Africa, where over 100 people per 100,000 die from it. Children and newborns are most at risk, with 30% of newborns with sepsis dying due to resistant infections.
Despite the severity, little data exists on how this affects children, which is crucial for developing effective treatments. Dr. Noémie Wagner and Annick Galetto-Lacour led the studies to address this gap.
The first study aimed to measure the proportion of antibiotic-resistant Enterobacteria in infected children in sub-Saharan Africa. These bacteria, often found in severe infections, are known for their antibiotic resistance.
Researchers reviewed 1,111 studies on children with infections from 2005 to 2022. They selected 122 studies and analyzed data from over 30,000 blood, urine, and stool samples from children aged 0 to 18.
Researchers found a high proportion of antibiotic-resistant bacteria, especially in the blood of young patients. The most common strains were Escherichia coli and Klebsiella spp. The study revealed significant resistance to antibiotics like ampicillin and gentamicin, first-line sepsis treatments. E. coli showed 92.5% resistance to ampicillin and 42.7% to gentamicin.
Klebsiella spp. were always resistant to ampicillin and 77.6% resistant to gentamicin. They also showed high resistance to third-generation cephalosporins, the second-line treatment for sepsis, with 40.6% resistance in E. coli and 84.9% in Klebsiella. These findings suggest very high resistance levels to both first-line and second-line antibiotics for treating sepsis in children.
The second study aimed to estimate the number of children in sub-Saharan Africa colonized by Enterobacteria resistant to third-generation cephalosporins. Colonization means finding these bacteria in a child’s stool without infection.
Forty studies involving 9,408 children were selected from 1,111 studies, making it the most extensive review for this region. The study found that 32.2% of children carry cephalosporin-resistant Enterobacteria. These high rates are worrying because these drugs are used when first-line treatments fail, and alternatives are often unavailable. The study also found that 53.8% of children not carriers at hospital admission had these resistant bacteria at discharge.
Additionally, the risk of carrying multi-resistant Enterobacteria is three times higher after antibiotic treatment within the last three months. In sub-Saharan Africa, 83-100% of hospitalized children receive antibiotics, often without clear evidence of a bacterial infection due to a lack of proper diagnostic tools. According to Dr. Wagner, this misuse of antibiotics increases resistant bacteria, making infections harder to treat.
The high rates of antibiotic-resistant bacteria in sub-Saharan Africa are very concerning and much higher than past estimates. This highlights the urgent need for targeted actions to manage and control antibiotic resistance.
Reducing antibiotic resistance requires multiple actions. These include proper antibiotic use, hygiene measures to limit infection spread, and better access to lab tests to reduce unnecessary antibiotic use. Adapting treatments to the bacteria found and adjusting recommendations based on local resistance patterns are also crucial.
The Mini-Lab, developed by Médecins Sans Frontières, is an affordable, portable, all-in-one lab that can help. However, more studies, especially from remote areas, are needed.
Journal reference:
- Micaela Ruef, Stephane Emonet et al., Carriage of third-generation cephalosporin-resistant and carbapenem-resistant Enterobacterales among children in sub-Saharan Africa: a systematic review and meta-analysis. eClinicalMedicine. DOI: 10.1016/j.eclinm.2024.102508.
- Micaela Ruef, Stephane Emonet, et al., Carriage of third-generation cephalosporin-resistant and carbapenem-resistant Enterobacterales among children in sub-Saharan Africa: a systematic review and meta-analysis. eClinicalMedicine. DOI: 10.1016/j.eclinm.2024.102508.