TY - JOUR
T1 - Longitudinal Trends in Pediatric Non-Salmonella Gram-Negative Enterobacterales Infections at a Tertiary Care Center in West Africa, 2005–2023
AU - Cherukumilli, Sumanth
AU - Keita, Adama M.
AU - Still, William
AU - Wei, Kuangyi Charles
AU - Juma, Jane
AU - Diallo, Hamidou
AU - Traore, Allaye
AU - Coulibaly, Oumar
AU - Togo, Boubacar
AU - Holmes, Mark A.
AU - Baker, Kate S.
AU - Johnson, J. Kristie
AU - Tapia, Milagritos D.
AU - Sow, Samba O.
AU - Kotloff, Karen L.
N1 - Publisher Copyright:
© The Author(s) 2026. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected]. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights)
PY - 2026/5/15
Y1 - 2026/5/15
N2 - Background: Despite data demonstrating the high prevalence of third-generation cephalosporin resistant Gram-negative Enterobacterales (GNE) among children in sub-Saharan Africa, longitudinal descriptions of resistance among these pathogens from Francophone West Africa remain rare. Methods: We conducted a retrospective analysis of pathogen-positive children 0–15 years old included in an invasive bacterial infection study at l’Hôpital Gabriel Touré (in Bamako, Mali) from 2005 to 2023. We aimed to describe changes in pathogen burden and non-Salmonella GNE resistance over time and compare in-hospital mortality between patients with and without non-Salmonella GNE pathogens. Isolates from 2021 to 2023 underwent whole-genome sequencing to identify genes conferring antimicrobial resistance. Results: Of 3803 pathogen-positive patients, 392 grew at least 1 non-Salmonella GNE pathogen. The proportion of pathogen-positive patients with non-Salmonella GNE increased (6% vs 38%) from 2005–2023. Third-generation cephalosporin and multidrug resistance among non-Salmonella GNE increased from 30% and 55%, respectively, in 2005–2009, to 93% (both) by 2021–2023. Children 0–2 months old from outside Bamako and 3 months-15 years old from and from outside Bamako with non-Salmonella GNE had higher mortality odds (3.17, 95% CI 1.69–5.95; 2.13, 95% CI 1.44–3.14; and 2.25, 95% CI 1.38–3.66, respectively) than similar patients with other pathogens. Sequencing confirmed the presence of the emerging pathogen Pantoea dispersa and revealed genes conferring multidrug resistance. Conclusions: Data from this large pediatric referral center in Mali show a high and rising burden of multidrug-resistant Gram-negative Enterobacterales. These patterns reflect concerns increasingly reported across sub-Saharan Africa, highlighting the urgency of strengthening antimicrobial access, diagnostics, and stewardship strategies in similar settings.
AB - Background: Despite data demonstrating the high prevalence of third-generation cephalosporin resistant Gram-negative Enterobacterales (GNE) among children in sub-Saharan Africa, longitudinal descriptions of resistance among these pathogens from Francophone West Africa remain rare. Methods: We conducted a retrospective analysis of pathogen-positive children 0–15 years old included in an invasive bacterial infection study at l’Hôpital Gabriel Touré (in Bamako, Mali) from 2005 to 2023. We aimed to describe changes in pathogen burden and non-Salmonella GNE resistance over time and compare in-hospital mortality between patients with and without non-Salmonella GNE pathogens. Isolates from 2021 to 2023 underwent whole-genome sequencing to identify genes conferring antimicrobial resistance. Results: Of 3803 pathogen-positive patients, 392 grew at least 1 non-Salmonella GNE pathogen. The proportion of pathogen-positive patients with non-Salmonella GNE increased (6% vs 38%) from 2005–2023. Third-generation cephalosporin and multidrug resistance among non-Salmonella GNE increased from 30% and 55%, respectively, in 2005–2009, to 93% (both) by 2021–2023. Children 0–2 months old from outside Bamako and 3 months-15 years old from and from outside Bamako with non-Salmonella GNE had higher mortality odds (3.17, 95% CI 1.69–5.95; 2.13, 95% CI 1.44–3.14; and 2.25, 95% CI 1.38–3.66, respectively) than similar patients with other pathogens. Sequencing confirmed the presence of the emerging pathogen Pantoea dispersa and revealed genes conferring multidrug resistance. Conclusions: Data from this large pediatric referral center in Mali show a high and rising burden of multidrug-resistant Gram-negative Enterobacterales. These patterns reflect concerns increasingly reported across sub-Saharan Africa, highlighting the urgency of strengthening antimicrobial access, diagnostics, and stewardship strategies in similar settings.
KW - antimicrobial resistance
KW - ESBL
KW - global health
KW - Gram-negative Enterobacterales
KW - neonatal sepsis
UR - https://www.scopus.com/pages/publications/105039162826
UR - https://www.scopus.com/pages/publications/105039162826#tab=citedBy
U2 - 10.1093/infdis/jiag027
DO - 10.1093/infdis/jiag027
M3 - Article
C2 - 41525800
AN - SCOPUS:105039162826
SN - 0022-1899
VL - 233
SP - 946
EP - 956
JO - Journal of Infectious Diseases
JF - Journal of Infectious Diseases
IS - 5
ER -