Background:
Septicemia in children in mainland China has recently become a public health concern. Methods: A meta-analysis was performed on studies investigating the prevalence of
cephalosporin-resistant Escherichia coli isolated from children with
septicemia in mainland China from 2007 to 2017 following a search of relevant databases. Results: A total of 43 articles reporting 11
cephalosporins were included in the review. The results of the meta-analysis revealed that for the
first-generation cephalosporins, the pooled summarized prevalence of resistance to
cefazolin was 74.96% (95% confidence interval [CI]: 64.79-83.91) and
cephalothin resistance was 62.28% (95% CI: 36.45-100). Regarding the
second-generation cephalosporins,
cefoxitin-resistant E. coli comprised 23.85% (95% CI: 10.60-40.40) and
cefuroxime resistance was 60.32% (95% CI: 51.25-68.73). For the
third-generation cephalosporins, the pooled summarized prevalence of resistance was 51.34% for
cefotaxime (95% CI: 40.08-62.54), 40.43% for
ceftazidime (95% CI: 31.07-50.15), 45.51% for
cefoperazone (95% CI: 20.41-70.61), 12.10% for
cefoperazone/
sulbactam (95% CI: 6.55-18.76), 62.99% for
ceftriaxone (95% CI: 55.00-70.98), and 0% for
cefotetan. Among the fourth-generation
cephalosporins, resistance to
cefepime was 34.08% (95% CI: 25.91-43.31). Conclusions: Most
third-generation cephalosporins (e.g.,
cefotaxime and
ceftriaxone) retained high resistance rates throughout the 11-year study period without significant changes. The new fourth-generation
cephalosporin,
cefepime, is rapidly gaining resistance. Interestingly,
ceftazidime,
cefepime, and
cefoperazone/
sulbactam showed a recent decreasing trend of drug resistance. These situations may present a risk for treating children with
septicemia and should be closely monitored and treated.