Superbug infections are causing disproportionate harm in sub-Saharan Africa, where levels of multi-resistant bacteria among young children are “extremely worrying”, two studies warned on Thursday.
The World Health Organization has declared antimicrobial resistance, which occurs when bacteria become resistant to antibiotics, a global health crisis.
Analyses by Geneva University Hospitals (HUG) and the University of Geneva (UNIGE) concluded that the situation in sub-Saharan Africa was particularly “worrying”.
“We observed a strong presence of antibiotic-resistant bacteria, especially in the blood of younger patients,” explains Noemi Wagner from HUG's pediatric infections unit.
Both analyses focused on Enterobacteriaceae, which are found in the digestive tract and are known for their ability to develop antibiotic resistance.
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They account for the most aggressive infections among newborns in the region, the researchers said.
The first analysis evaluated antibiotic-resistant bacteria found in the blood of young children in the region during the infection.
The results demonstrate “high levels of resistance to first- and second-line antibiotics recommended for the treatment of sepsis in children,” the researchers said in a statement.
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The most common strains identified were E. coli and Klebsiella spp., which showed considerable resistance to the recommended first-line antibiotics for sepsis – ampicillin and gentamicin.
The analysis reviewed more than 1,000 studies published since 2005 and conducted an in-depth meta-analysis on 122 of them.
It was found that 92.5 percent of E. coli found in the blood of infected children were resistant to ampicillin and 42.7 percent were resistant to gentamicin.
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Klebsiella species are always resistant to ampicillin, and the study found that 77.6 percent of the species were also resistant to gentamicin.
The analysis showed that the proportion of resistance to cephalosporins, a third-generation antibiotic, is very high and is considered a second-line treatment for sepsis in children.
The second study aimed to estimate the prevalence of children “infected” with cephalosporin-resistant Enterobacteriaceae — meaning the bacteria are present in their stool even when there is no infection.
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After analyzing 40 studies involving more than 9,400 children, researchers found that nearly one-third of them carried Enterobacteriaceae that were resistant to wide-spectrum cephalosporins.
“These ratios are very high and worrying,” said Annick Galleteau-Lacour, of HUG's Pediatric Admissions and Emergency Division.
If first- and second-line treatments fail, “there are often no treatment options available in this area,” he said.
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The study found that more than half of the children who were hospitalised did not have resistant Enterobacteriaceae but tested positive for the bacteria when discharged.
It also showed that people who had received antibiotic treatment in the previous three months had a three-fold increased risk of becoming carriers of resistant Enterobacteriaceae.
This worries experts, because all hospitalized children in sub-Saharan Africa are systematically treated with antibiotics.
“Since bacterial infections are the leading cause of death in this region, children are often given antibiotics when they are hospitalized, even when there is no strong argument for a bacterial infection,” Wagner said.
And most medical facilities do not have access to tests that help distinguish between bacterial infections (which require antibiotics) and viral infections (which do not require antibiotics).
“It's a vicious cycle,” Wagner said.
“Inappropriate use of antibiotics increases the proportion of resistant bacteria, which become even more difficult to treat.”
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