Antimicrobial resistance in neonatal and pediatric sepsis and meningitis in tropical settings: Microbiological profiles, resistance trends, and diagnostic challenges

Abstract

Neonatal and pediatric sepsis and meningitis are morbid and deadly in tropical low and middle-income countries (LMIC), affecting about 3 % of the global disease burden. Tropical Asian, sub-Saharan, and Latin American regions report millions of cases annually, with approximately 10% of cases-fatality rates. Gram-negative bacteria, especially Klebsiella pneumoniae and Escherichia coli , are the most common pathogens, and antimicrobial resistance (AMR) is increasing; approximately 73% of E. coli and 76% of Klebsiella are not susceptible to third-generation cephalosporins. Limited laboratory infrastructure can create diagnostic challenges, making it difficult to identify the pathogen promptly and further complicating antibiotic management and contributing to resistance. Point-of-care diagnostics have the potential to succeed, but are burdened by the cost. Antimicrobial stewardship programs have been used to effectively curb the use of antibiotics in LMIC hospitals. Laboratory-capacity building, revising treatment regimens, and improving stewardship and vaccination services are required in the fight against AMR in pediatric sepsis and meningitis. This review is a synthesis of information about the epidemiology, resistance pattern, diagnostic problems and measures to enhance health outcomes among the affected populations.