Antibiotic-resistant infections in children have become increasingly common over the past 20 years, according to a new study. Researchers warn that pediatric antimicrobial resistance could continue to rise unless countries strengthen infection prevention, antibiotic stewardship and public health systems.
The research, published in July in JAMA Pediatrics, analyzed antibiotic resistance trends among children over the past two decades and modeled what could happen by 2035. The study predicts “steep increases” in resistance to some important antibiotics among bacteria such as Acinetobacter baumannii and Klebsiella.
Antibiotic resistance was linked to approximately 840,000 deaths among children younger than 5 in 2021, according to global estimates. If drug-resistant infections continue to increase, the health burden for young children could grow further.
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“These forecasts describe warning scenarios, not inevitable outcomes,” said study co-author Dr. Yanhong Jessika Hu, a clinical epidemiologist and public health researcher at Murdoch Children’s Research Institute in Australia. The projections assume that current antibiotic resistance trends continue without major changes, Hu told Live Science in an email.
Effective public health measures, improved access to medical care and responsible antibiotic use could change that trajectory, she added.
Antibiotic resistance increased across every region
Antibiotic resistance is often described as a “silent pandemic” because it spreads gradually and attracts less attention than sudden viral outbreaks. Although antimicrobial resistance has become a growing global health concern, researchers say data focused specifically on children remain limited.
“It’s perceived as being a lesser problem in children,” said study co-author Dr. Penelope Bryant, a clinician-researcher at MCRI, Royal Children’s Hospital Melbourne and the University of Melbourne. “It’s not a theoretical problem; it’s real, and it’s happening.”
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Many surveillance programs combine adult and pediatric data, which can hide important trends in children, Hu explained. “Adult findings cannot simply be applied to children because children have different infection patterns, antibiotic exposure and treatment options,” she said.
Studies that focus only on children also differ in the age groups and healthcare settings they examine, making comparisons difficult. This lack of detailed pediatric data can complicate efforts to update treatment guidelines and public health policies. Children also have fewer antibiotic treatment options than adults, making it especially important to preserve the medicines that remain effective.
Antibiotic resistance was highest in intensive care units, among children younger than 3 with severe infections and in resource-limited healthcare settings.
(Image credit: Jacob Wackerhausen via Getty Images)
To investigate pediatric antibiotic resistance, the researchers analyzed the Antimicrobial Testing Leadership and Surveillance database. The database contains clinical samples from children and teenagers ages 0 to 18 across 82 countries. Samples were collected from 2004 through 2022 in hospital wards, intensive care units and outpatient clinics in both high-income and low-income countries.
The study examined more than 106,000 bacterial samples and measured resistance to antibiotics classified under the World Health Organization’s Access, Watch, Reserve, or AWaRe, system. Access antibiotics are generally recommended as first-choice treatments. Watch antibiotics have broader effects and should be used selectively, while Reserve antibiotics are last-resort medicines for infections that do not respond to other treatments.
“Resistance increased across all regions, showing that this is not only a problem in lower-income countries,” Hu said. The highest resistance levels and some of the fastest increases, however, occurred in lower-resource settings.
Rising resistance is a wake-up call
The researchers also analyzed eight bacteria classified by the WHO as “critical” or “high” priority because drug resistance makes them particularly difficult and costly to treat. In 2004, resistance levels among these bacteria were similar in high-income and low-income countries. By 2022, the trends had diverged.
Resistance to Access antibiotics declined overall. In high-resource countries, the proportion of samples resistant to at least one Access antibiotic fell from 48% to 29%. In low-income countries, however, resistance increased slightly, from 44% to 47%.
The improvement in some higher-income countries may be linked to major investments in controlling MRSA, Bryant said. MRSA, or methicillin-resistant Staphylococcus aureus, can cause skin infections and potentially fatal complications such as sepsis.
In low-income countries, the problem is amplified by poor sanitation and unregulated access to antibiotics.
Dr. Penelope Bryant, clinician-researcher at MCRI, Royal Children’s Hospital Melbourne, and the University of Melbourne
The researchers’ models suggest that resistance to Access antibiotics may stabilize or decline in most regions by 2035. Resistance to Watch antibiotics, however, increased from 2004 to 2022 and is expected to continue rising. Among the eight critical and high-priority bacteria, Watch antibiotic resistance increased from 14% to 24% in high-income countries and from 16% to 48% in low-income countries.
Resistance to Reserve antibiotics also grew, rising from 9% to 25% in high-income countries and from 4% to 37% in low-income countries.
The model projects particularly steep increases in resistance to Watch antibiotics, while Reserve resistance is expected to rise more gradually over the next decade. Although low-income regions are likely to experience the greatest increases, high-income countries will not be unaffected.
Poor sanitation and the over-the-counter availability of antibiotics can worsen the problem, Bryant said. When antibiotics are used unnecessarily or incorrectly, bacteria face increased pressure to evolve drug resistance.
The study provides an important overview of antibiotic resistance in children, but the researchers noted several limitations. The samples came from selected medical centers and may not represent entire countries. In addition, countries contributed different numbers and types of samples. “The results should therefore not be interpreted as precise national prevalence estimates,” Hu cautioned.
Even with those limitations, the study is one of the largest analyses to focus specifically on children. “It gives us an idea that things are getting worse,” Bryant said.
The researchers have made their findings available through AMR in Kids. Future research will aim to measure drug-resistant infections in children more representatively and model which interventions could reduce pediatric antimicrobial resistance.
“I’m hopeful that this is a little bit of a sort of wake-up call around children, that it really isn’t a problem just in adults,” Bryant said.
This article is for informational purposes only and is not meant to offer medical advice.
Source: www.livescience.com