Antibiotic-resistant bacteria on rise among US children

Dr Logan

Infections caused by a specific type of antibiotic-resistant bacteria are on the rise in US children, according to study published in the Journal of the Pediatric Infectious Diseases Society. While still rare, the bacteria are increasingly found in children of all ages, especially those aged 1 to 5 years old, raising concerns about dwindling treatment options.

“Enterobacteriaceae [gram-negative bacteria] infections resistant to extended-spectrum β-lactam antibiotics-the mainstay of therapy-are an emerging problem in children,” said Latania K. Logan, MD, lead author of the study and an assistant professor of pediatrics and pediatric infectious disease specialist at Rush University Medical Center.

Dr Logan and colleagues analyzed resistance patterns in approximately 370,000 bacterial cultures from pediatric patients. They obtained regional and national data from the Surveillance Network Database–USA. The network includes close to 300 clinical laboratories that service 1 or more patient care facilities. The analysis considered all isolates from pediatric patients (aged 1 to 17 years) collected in outpatient (ambulatory), inpatient non-intensive care unit (ICU), ICU, and long-term care settings between Jan. 1, 1999 and Dec. 31, 2011, and identified as Klebsiella pneumoniae, Escherichia coli, and Proteus mirabilis.

Although uncommon, extended-spectrum beta-lactamase (ESBL) producing bacteria are increasingly being found in children of all ages, however predominate in younger children (50.5% of ESBL bacteria were in the 1-to-5-year-old age group), and these bacteria are resistant to multiple (>3) classes of antibiotics (74.4% in this study) leaving few treatment options, Dr Logan explained. 

“We then looked at susceptibility results to characterize the ESBL and third-generation cephalosporin-resistant phenotypes using the Clinical and Laboratory Standards Institute standards,” Dr Logan said. “Individual susceptibility results were stratified by isolate source, patient location, age, sex, and year. The site-level breakdown was collapsed into regions based on the location of the laboratory and aggregated over biannual intervals in order to smooth trends.”

In Dr Logan’s study, although previous medical histories of subjects are unknown, 51.3% of children presented in the outpatient or ambulatory setting.

“Some infections in children that have typically been treated with oral antibiotics in the past may now require hospitalization and/or treatment with intravenous drugs as there may not be an oral option available,” she said.

The overwhelming majority of current research for new pharmaceuticals against antibiotic-resistant organisms are in adults, Dr Logan explained. “New drug options will need to be available for young children. Physicians should obtain cultures for suspected bacterial infections so that laboratories can determine which antibiotics are best to treat infections.  For ESBL infections, there may not be an oral antibiotic option available.”

ESBLs are able to rapidly spread and are a serious threat worldwide, Dr Logan explained. “These antibiotic-resistant bacteria have traditionally been found in healthcare settings but are increasingly being found in the community, in people who have not had a significant history of healthcare exposure.”

Although the overall rate of these infections in children is still low, ESBL-producing bacteria can spread rapidly and have been linked to longer hospital stays, higher healthcare costs, and increased mortality, according to the study. In a 2013 report, the Centers for Disease Control and Prevention called ESBLs a “serious concern” and a significant threat to public health.