SynthesisThe Lancet. Microbe2021
Antimicrobial resistance in paediatric
Synthesis in The Lancet. Microbe, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05912010 (A Study on Pathogenic Surveillance and Nasopharyngeal Carriage of Children and Adolescents Based on Hospitals and Communities in Hainan Province), which is not on this map. Cited by 64 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Study on Pathogenic Surveillance and Nasopharyngeal Carriage of Children and Adolescents Based on Hospitals and Communities in Hainan Province
Who cites it
64 citing papers in PubMed, 4 syntheses or guidelines pooled it, 95 citations in OpenAlex.
- Cell wall-inhibiting antibiotics resistance in Streptococcus pneumoniae causing invasive diseases: a global systematic review and meta-analysis in pediatric populations.Italian journal of pediatrics · 2025Pooled it
- Pooled it
- The impact of the introduction of ten- or thirteen-valent pneumococcal conjugate vaccines on antimicrobial-resistant pneumococcal disease and carriage: A systematic literature review.Journal of global health · 2023Pooled it
- Antibiotic Treatment Duration for Community-Acquired Pneumonia in Outpatient Children in High-Income Countries-A Systematic Review and Meta-Analysis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Pooled it
- Epidemiology of Infections Caused by Gram-Positive Cocci-Microorganisms · 2026Review
- Antibacterial and Antibiofilm Activity ofJournal of fungi (Basel, Switzerland) · 2026Article
- Antibiotic non-susceptibility associated serotypes of invasive pneumococcal disease - a nationwide population study from Switzerland, 2012-2022.Pneumonia (Nathan Qld.) · 2026Article
- The Convergence of Antimicrobial Resistance and Virulence inMicroorganisms · 2026Review
- Antimicrobial Resistance in Pediatric Infections: Current Status, Challenges, and Future Directions.Antibiotics (Basel, Switzerland) · 2026Review
- Eliminate pneumococcal colonization by targeting intracellular acidification that promotes H2O2 production to enhance bacterial survival.PLoS pathogens · 2026Article
- Modelling impacts of paediatric amoxicillin shortage management on pneumococcal resistance and invasive disease in Europe.Nature communications · 2026Article
- Fourteen-year genomic surveillance of pediatric invasive Streptococcus pneumoniae: genomic and pan-genomic characterization.BMC microbiology · 2026Article
- In Vitro Antimicrobial Activity of Ceftobiprole and Comparator Agents AgainstAntibiotics (Basel, Switzerland) · 2026Article
- Genomic characterization of invasive disease-causingMicrobial genomics · 2026Article
- Pediatric Pneumococcal Eye Infection and Changes in Antibiotic Susceptibility: A Retrospective Study.Infection & chemotherapy · 2026Article
- Article
- Pneumococcal conjugate vaccines and antimicrobial resistance: serotype replacement, clonal dynamics, and future vaccine perspectives.Frontiers in immunology · 2026Review
- Burden of antimicrobial resistance in the WHO Southeast Asia and Western Pacific Regions, 1990-2021: a cross-country systematic analysis with forecasts to 2050.Military Medical Research · 2026Article
- Childhood sepsis burden: pathogens/antimicrobial-resistant bacteria, 1990-2021 and 2050 forecasts.Frontiers in cellular and infection microbiology · 2026Article
- Pre and post introduction of pneumococcal conjugate vaccines in children in Eastern Mediterranean Region and effect on antimicrobial resistance, a narrative review.Frontiers in microbiology · 2026Review
4 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPneumococcal diseases are a leading cause of morbidity and mortality among children globally, and the burden of these diseases might be worsened by antimicrobial resistance. To understand the effect of pneumococcal conjugate vaccine (PCV) deployment on antimicrobial resistance in pneumococci, we assessed the susceptibility of paediatric pneumococcal isolates to various antimicrobial drugs before and after PCV implementation.
methodsWe did a systematic review of studies reporting antimicrobial susceptibility profiles of paediatric pneumococcal isolates between 2000 and 2020 using PubMed and the Antimicrobial Testing Leadership and Surveillance database (ATLAS; Pfizer). Population-based studies of invasive pneumococcal disease or nasopharyngeal colonisation were eligible for inclusion. As primary outcome measures, we extracted the proportions of isolates that were non-susceptible or resistant to penicillin, macrolides, sulfamethoxazole-trimethoprim, third-generation cephalosporins, and tetracycline from each study. Where available, we also extracted data on pneumococcal serotypes. We estimated changes in the proportion of isolates with reduced susceptibility or resistance to each antibiotic class using random-effects meta-regression models, adjusting for study-level and region-level heterogeneity, as well as secular trends, invasive or colonising isolate source, and countries' per-capita gross domestic product.
findingsFrom 4910 studies screened for inclusion, we extracted data from 559 studies on 312 783 paediatric isolates. Susceptibility of isolates varied substantially across regions both before and after implementation of any PCV product. On average across all regions, we estimated significant absolute reductions in the proportions of pneumococci showing non-susceptibility to penicillin (11·5%, 95% CI 8·6-14·4), sulfamethoxazole-trimethoprim (9·7%, 4·3-15·2), and third-generation cephalosporins (7·5%, 3·1-11·9), over the 10 years after implementation of any PCV product, and absolute reductions in the proportions of pneumococci resistant to penicillin (7·3%, 5·3-9·4), sulfamethoxazole-trimethoprim (16·0%, 11·0-21·2), third-generation cephalosporins (4·5%, 0·3-8·7), macrolides (3·6%, 0·7-6·6) and tetracycline (2·0%, 0·3-3·7). We did not find evidence of changes in the proportion of isolates non-susceptible to macrolides or tetracycline after PCV implementation. Observed changes in penicillin non-susceptibility were driven, in part, by replacement of vaccine-targeted serotypes with non-vaccine serotypes that were less likely to be non-susceptible.
interpretationImplementation of PCVs has reduced the proportion of circulating pneumococci resistant to first-line antibiotic treatments for pneumonia. This effect merits consideration in assessments of vaccine impact and investments in coverage improvements.
fundingBill & Melinda Gates Foundation.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.