Risk factors for carriage of antimicrobial-resistant bacteria in community dwelling-children in the Asia-Pacific region: a systematic review and meta-analysis

Abstract

Abstract Background Antimicrobial resistance is an increasingly important issue in public health as antibiotics are overused. Resistance to antimicrobial agents can pose significant challenges to infection treatment. Objectives To evaluate risk factors associated with carriage of antimicrobial-resistant (AMR) bacteria in children in the Asia-Pacific region to consolidate evidence for future implementation of antibiotic prescribing practice. Methods Three electronic databases—PubMed, EMBASE and Cochrane Library—were searched. Observational studies that investigated the risk factors for carriage of MRSA, penicillin-resistant Streptococcus pneumoniae, ESBL-producing Escherichia coli and Klebsiella pneumoniae among the paediatric population in community settings in the Asia-Pacific region were considered eligible. Summary statistics from the identified studies were pooled using meta-analyses. Results From the 4145 search results, 25 papers were included in this review. Sixteen papers were included in the meta-analysis based on reported risk factors. Young age of 2–6 months compared with children aged 7–60 months (OR 2.74, 95% CI: 1.75–4.29), antibiotic use within the past 3 months (OR 2.65, 95% CI: 1.70–4.12), daycare attendance (OR 1.49, 95% CI: 1.17–1.91) and hospital admission within the past 3 months (OR 3.43, 95% CI: 2.13–5.51) were found to be significant risk factors for AMR bacterial carriage, whilst breastfeeding (OR 0.69, 95% CI: 0.60–0.81) and concurrent colonization of S. pneumoniae (OR 0.59, 95% CI: 0.38–0.91) are protective factors. Conclusions The findings support that there are a number of significant risk factors associated with carriage of AMR bacteria in the Asia-Pacific paediatric population. To combat antimicrobial resistance in the future, these risk factors should be considered, and measures taken to mitigate associated carriage.