Prevalence and susceptibility of respiratory pathogens in inpatient and outpatient children in the Kyrgyz Republic: First data from Central Asia

Background: Mortality rates from respiratory tract infections (RTI) in children in Central Asia remains high. Most RTIs in children are caused by viruses but irrational use of antibiotics is widespread, which could lead to an increase in antimicrobial resistance.

Methods: We conducted a cross-sectional study from November 2022 to July 2023. Eligible patients were children presenting with an acute RTI. Samples were taken from all eligible patients using sputum, naso- and/or oropharyngeal swaps. Bacteria were identified by biochemical tests; virus and atypical bacteria were identified by PCR. Resistance was determined with disc diffusion and MIC test, according to EUCAST guidelines.

Results: Of 1174 samples from outpatients and 300 from inpatients, 402 (27.3%) had significant growth (Figure 1). The most common bacteria were S. pneumoniae (inpatients, 62 (66%); outpatients, 119 (39%)) and others. A subset of 694 outpatient and 296 inpatient samples was tested by PCR (Figure 2). Of those, 64% and 55%, respectively had at least one virus. Co-infection with bacteria was detected in 16% and 18%, respectively. 43% of S. aureus were MRSA and 90% of S. pneumonia were penicillin resistant according to oxacillin screening.

Conclusions: Viruses were the most common cause of RTIs. The most common bacterial airway pathogen was S. pneumoniae. Together with the high rate of MRSA found in this study, this highlights the need for a national strategy to reduce the unnecessary use of antibiotics. Additional research is needed to address the problem of AMR in Kyrgyz Republic.