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Contemporary Treatment of Resistant Gram-Negative Infections in Pediatric Patients

Samantha A Basco1, Jennifer E Girotto2

  • 1University of Connecticut, Storrs CT and Connecticut Children's, Hartford, CT, USA.

Infectious Disease Clinics of North America
|February 16, 2022
PubMed

Insights

Rising Gram-negative resistance in children necessitates understanding resistance mechanisms like beta-lactamases. Optimizing antibiotic dosing by considering pediatric pharmacokinetics is crucial for effective treatment.

Area of Science:

  • Microbiology and Infectious Diseases
  • Pediatric Pharmacology
  • Antimicrobial Resistance

Background:

  • Increasing prevalence of Gram-negative bacterial resistance in pediatric serious infections.
  • Common resistance mechanisms include beta-lactamases (AmpC, ESBLs, carbapenemases), efflux pumps, and porins.
  • Pseudomonas infections present unique resistance challenges.

Purpose of the Study:

  • To highlight the importance of understanding Gram-negative resistance mechanisms in children.
  • To emphasize the role of antibiotic dose adjustments in overcoming resistance.
  • To underscore the necessity of considering pediatric pharmacokinetic variations in antibiotic dosing.

Main Methods:

  • Review of current literature on Gram-negative resistance mechanisms in pediatric infections.
  • Analysis of antibiotic resistance patterns and their impact on treatment efficacy.
  • Discussion of pharmacokinetic principles relevant to pediatric antibiotic dosing.

Main Results:

  • Beta-lactamases (AmpC, ESBLs, carbapenemases) are key resistance mechanisms.
  • Efflux pumps and porins are significant in Pseudomonas resistance.
  • Antibiotic dose adjustments can be effective against certain resistance mechanisms.

Conclusions:

  • Effective treatment of pediatric Gram-negative infections requires addressing resistance mechanisms.
  • Pediatric pharmacokinetic considerations are vital for achieving adequate antibiotic concentrations.
  • Dosing strategies must account for these factors for both older and newer antimicrobial agents.
Keywords:
Antimicrobial stewardshipPharmacotherapyResistance

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