ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2019
Emerging Resistance to Empiric Antimicrobial Regimens for Pediatric Bloodstream Infections in Malawi (1998-2017).
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 51 papers, 4 of them syntheses that pooled it.
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Who cites it
51 citing papers in PubMed, 4 syntheses or guidelines pooled it, 96 citations in OpenAlex.
- Gram-negative neonatal sepsis in low- and lower-middle-income countries and WHO empirical antibiotic recommendations: A systematic review and meta-analysis.PLoS medicine · 2021Pooled it
- Invasive non-typhoidal Salmonella infections in sub-Saharan Africa: a systematic review on antimicrobial resistance and treatment.BMC medicine · 2020Pooled it
- Prevalence and outcome of bloodstream infections due to third-generation cephalosporin-resistant Enterobacteriaceae in sub-Saharan Africa: a systematic review.The Journal of antimicrobial chemotherapy · 2020Pooled it
- Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children.Intensive care medicine · 2020Guideline
- Early-life gut microbiome associates with positive vaccine take and shedding in neonatal schedule of the human neonatal rotavirus vaccine RV3-BB.Nature communications · 2025Trial
- Simultaneous pharmacokinetic/pharmacodynamic (PKPD) assessment of ampicillin and gentamicin in the treatment of neonatal sepsis.The Journal of antimicrobial chemotherapy · 2022Trial
- IV and oral fosfomycin pharmacokinetics in neonates with suspected clinical sepsis.The Journal of antimicrobial chemotherapy · 2021Trial
- Antibiotic Resistance Profiles of Invasive Bacterial Isolates from Hospitalized Pediatric Patients in Serbia: A Multicenter Surveillance Study, 2020-2024.Antibiotics (Basel, Switzerland) · 2026Article
- Article
- Molecular Characterization of Staphylococcus aureus and Coagulase-Negative Staphylococci Isolates at a Rural Hospital in Southern Malawi.BioMed research international · 2026Article
- Antimicrobial resistance trends of Escherichia coli and Staphylococcus aureus isolated from clinical blood cultures in Namibia: a nine-year (2011-2019) retrospective study.BMC infectious diseases · 2025Article
- Gut bacterial dysbiosis in pediatric severe malaria associates with post-discharge mortality.Nature communications · 2025Article
- Diagnostic Underuse and Antimicrobial Resistance Patterns Among Hospitalized Children in a National Referral Hospital in Kenya: A Five-Year Retrospective Study.Antibiotics (Basel, Switzerland) · 2025Article
- High diversity of Escherichia coli causing invasive disease in neonates in Malawi poses challenges for O-antigen based vaccine approach.Communications medicine · 2025Article
- Carbapenem-Resistant Gram-Negative Bacteria in Hospitalized Patients: A Five-Year Surveillance in Italy.Infectious disease reports · 2025Article
- Aetiologies, neuroradiological features, and risk factors for mortality and long-term neurosequelae of febrile coma in Malawian children: a prospective cohort study.The Lancet. Global health · 2025Article
- Prevalence of Extended-Spectrum β-Lactamase-ProducingAntibiotics (Basel, Switzerland) · 2025Article
- Parental involvement in infection prevention and control in low- and middle-income country neonatal units: a scoping review protocol.BMJ open · 2025Article
- Systemic Inflammatory Response Syndrome, Thromboinflammation, and Septic Shock in Fetuses and Neonates.International journal of molecular sciences · 2025Review
- Infections and Antibiotic Resistance in Malawian Children Under Five-Years Old Hospitalized With Severe Acute Malnutrition.Journal of the Pediatric Infectious Diseases Society · 2025Article
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Authors and funding
11 authors at 2 institutions in 2 countries.
Funding
Abstract
backgroundThe adequacy of the World Health Organization's Integrated Management of Childhood Illness (IMCI) antimicrobial guidelines for the treatment of suspected severe bacterial infections is dependent on a low prevalence of antimicrobial resistance (AMR). We describe trends in etiologies and susceptibility patterns of bloodstream infections (BSI) in hospitalized children in Malawi.
methodsWe determined the change in the population-based incidence of BSI in children admitted to Queen Elizabeth Central Hospital, Blantyre, Malawi (1998-2017). AMR profiles were assessed by the disc diffusion method, and trends over time were evaluated.
resultsA total 89643 pediatric blood cultures were performed, and 10621 pathogens were included in the analysis. Estimated minimum incidence rates of BSI for those ≤5 years of age fell from a peak of 11.4 per 1000 persons in 2002 to 3.4 per 1000 persons in 2017. Over 2 decades, the resistance of Gram-negative pathogens to all empiric, first-line antimicrobials (ampicillin/penicillin, gentamicin, ceftriaxone) among children ≤5 years increased from 3.4% to 30.2% (P < .001). Among those ≤60 days, AMR to all first-line antimicrobials increased from 7.0% to 67.7% (P < .001). Among children ≤5 years, Klebsiella spp. resistance to all first-line antimicrobial regimens increased from 5.9% to 93.7% (P < .001).
conclusionsThe incidence of BSI among hospitalized children has decreased substantially over the last 20 years, although gains have been offset by increases in Gram-negative pathogens' resistance to all empiric first-line antimicrobials. There is an urgent need to address the broader challenge of adapting IMCI guidelines to the local setting in the face of rapidly-expanding AMR in childhood BSI.
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