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

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.