{
  "abstract": "Background Antimicrobial resistance (AMR) is a major public health challenge, especially in the pediatric population in low- and middle-income countries, particularly India, where the burden of pediatric infections is high. However, nationally representative, pediatric-specific estimates of AMR with geographic stratification remain lacking. We conducted a systematic review and meta-analysis to define the magnitude and regional variation of AMR among Indian children. Methods We conducted a systematic review and meta-analysis in accordance with PRISMA 2020 and the Joanna Briggs Institute guidelines. PubMed/MEDLINE, Scopus, and the Cochrane Library were searched from inception to December 2025 for studies reporting antimicrobial resistance in bacterial isolates from children (≤ 18 years) in India. Given substantial clinical and methodological heterogeneity across pathogens, antibiotic classes, and settings, we conducted stratified random-effects meta-analyses by geographic zone for key resistance phenotypes. Results Forty-seven studies met the inclusion criteria, of which 23 contributed to the quantitative synthesis. Pronounced geographic heterogeneity in AMR was observed across India. The number of studies contributing to each pooled estimate ranged from 2 to 8, and heterogeneity (I²) ranged from 19% to 79%. Carbapenem resistance among neonatal intensive care unit isolates ranged from 12% (95% CI 8–18) in Central India to 80% (70–88) in North India. Extended-spectrum β-lactamase production was consistently high (60–80%) across most regions, but lower in Central India (38%). Methicillin-resistant Staphylococcus aureus prevalence ranged from 35% (26–44) to 61% (49–72). Fluoroquinolone resistance exceeded 85% in North, South, and East/Northeast regions, whereas colistin resistance remained ≤ 8% nationally. Genomic data demonstrated widespread dissemination of blaCTX-M-15 and regional clustering of carbapenemase genes (blaNDM, blaOXA), supporting both clonal spread and horizontal gene transfer. Conclusion Antimicrobial resistance in Indian children is highly prevalent and geographically heterogeneous, with up to five-fold regional differences in carbapenem resistance. In high-burden regions, these resistance levels are likely to compromise the effectiveness of standard empirical therapies, particularly in neonatal and critical care settings. These findings support the urgent need for region-specific empirical treatment guidelines, pediatric-focused antimicrobial stewardship, and integrated phenotypic–genomic surveillance systems.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Pharmacology, LN Medical college & Research Centre",
    "Department of Pharmacology, All India Institute of Medical Sciences",
    "Department of General Medicine, Birsa Munda Medical College",
    "Department of Pharmacology, MediCiti Institute of Medical Sciences",
    "Department of CFM, LN Medical College and Research Centre",
    "Department of Pediatrics, LN Medical College and Research Centre",
    "Department of General Medicine, LN Medical College and Research Centre",
    "Department of Pharmacology, Chirayu Medical College and Hospital",
    "MVJ Medical College and Research Hospital",
    "Department of Bioinformatics, Saint Louis University"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 17,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Sunil Kumar"
    },
    {
      "affs": [
        1
      ],
      "name": "Santenna Chenchula"
    },
    {
      "affs": [
        0
      ],
      "name": "Rahul Bhalsenge"
    },
    {
      "affs": [
        2
      ],
      "name": "Rupesh Kumar Gupta"
    },
    {
      "affs": [
        3
      ],
      "name": "Padmavathi R"
    },
    {
      "affs": [
        4
      ],
      "name": "Manav Yadav"
    },
    {
      "affs": [
        5
      ],
      "name": "Manjari Gupta"
    },
    {
      "affs": [
        1
      ],
      "name": "Shubham Atal"
    },
    {
      "affs": [
        5
      ],
      "name": "Chandramohan S Reddy"
    },
    {
      "affs": [
        6
      ],
      "name": "Sharad Yadav"
    },
    {
      "affs": [
        6
      ],
      "name": "Diwakar Patel"
    },
    {
      "affs": [
        0
      ],
      "name": "Niket Rai"
    },
    {
      "affs": [
        7
      ],
      "name": "Tushaar Chandrakant Baheti"
    },
    {
      "affs": [
        7
      ],
      "name": "Raj Kumar Sharma"
    },
    {
      "affs": [
        1
      ],
      "name": "Ashrai Padavala"
    },
    {
      "affs": [
        8
      ],
      "name": "Mohan Krishna Ghanta"
    },
    {
      "affs": [
        9
      ],
      "name": "Sri Vasista T"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/2h1nvfh1jdkjv.bib",
  "cited_by": 0,
  "doi": "10.1186/s12887-026-07389-y",
  "fulltext_url": "https://doi.org/10.1186/s12887-026-07389-y",
  "id": "2h1nvfh1jdkjv",
  "issns": [
    "1471-2431"
  ],
  "landing_url": "https://doi.org/10.1186/s12887-026-07389-y",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RJ1-570"
    ],
    [
      "openalex",
      "2402|Antibiotic Use and Resistance"
    ]
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  "openalex": "W7171321800",
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-07-01",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/2h1nvfh1jdkjv.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T13:46:21Z",
      "native_id": "5a25f55e90234c87871e403a5154ea8d",
      "source": "doaj",
      "url": "https://doi.org/10.1186/s12887-026-07389-y"
    }
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  "subjects": [
    {
      "field": "biology",
      "origin": "openalex:2402|Antibiotic Use and Resistance",
      "subfield": "microbiology"
    }
  ],
  "title": "Geographic and genomic determinants of antimicrobial resistance in indian children: a systematic review and meta-analysis",
  "title_text": "Geographic and genomic determinants of antimicrobial resistance in indian children: a systematic review and meta-analysis",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:46:21Z",
  "url": "https://research.draconitic.com/paper/2h1nvfh1jdkjv",
  "venue": "BMC Pediatrics",
  "versions": []
}