Antimicrobial resistance among neonatal pathogens in developing countries.

INTRODUCTION Knowledge of antimicrobial resistance and trends in resistance patterns among major pathogens causing infections in young infants (up to 90 days of life) is an important component of developing community-based management strategies. Hospital-based data suggest alarming rates of resistance to ampicillin and gentamicin, the first-line antimicrobial agents recommended by WHO for treatment of serious infections in young infants. METHODS We searched the literature published since 1990 for studies from developing countries reporting resistance among serious community-acquired infections (including sepsis, pneumonia, and meningitis) in young infants. RESULTS Only 10 relevant reports were retrieved. Among the 3 major pathogens studied (Escherichia coli, Staphyloccoccus aureus, and Klebsiella species), a high proportion of E. coli were ampicillin (72%) and cotrimoxazole (78%) resistant; 19% were resistant to third generation cephalosporins. Among Klebsiella species, almost all were resistant to ampicillin, 45% to cotrimoxazole, and 66% to third generation cephalosporins. Resistance to gentamicin was low among E. coli (13%), but much higher among Klebsiella species (60%). Methicillin resistance S. aureus (MRSA) was rare (1 of 33 isolates) but 46% were resistant to cotrimoxazole. CONCLUSIONS Antimicrobial resistance data for infections in young infants from community-based studies were extremely limited. Significant resistance, in particular to cotrimoxazole among all pathogens, and to gentamicin and third generation cephalosporins among Klebsiella and emerging resistance in E. coli is cause for concern. Limited data pose a challenge in devising simple community-based management strategies. Further studies from different developing country regions are needed to determine prevalence of resistant strains, as well as assess regional and time trends.