Antimicrobial Resistance in Children With Bloodstream Infections: A Population-Based Study in Stockholm, Sweden

We retrospectively evaluated trends in antimicrobial resistance (AMR) in paediatric bloodstream infections and assessed changes in antimicrobial prescription patterns over a 20-year period.

We analysed positive blood cultures from children admitted with suspected serious infection between 1998 and 2018. Data on comorbidities, hospital unit, intensive care admission, community- or hospital-acquired isolates, and mortality were collected. Resistance results were compared with national surveillance data.

Among 1977 isolates, crude AMR was 9.2%, increasing in Gram-positive (τ = 0.61, p < 0.001) and Gram-negative bacteria (τ = 0.54, p < 0.01). ESBL-producing Enterobacterales increased from 1.5% to 14.1% (p < 0.001); 64.7% were multidrug-resistant. Most children with ESBL-producing Enterobacterales (82.4%) or methicillin-resistant Staphylococcus aureus (75%) had been hospitalized within the previous 6 months or had household members with travel to or origin from high-AMR countries. Overall antimicrobial use remained stable, although prescriptions of third-generation cephalosporins, piperacillin-tazobactam, and carbapenems increased. AMR rates remained lower than in many countries and were comparable to Swedish adult data.

AMR increased despite stable antimicrobial use. Empirical coverage for resistant pathogens should be considered in children with recent hospitalization, travel to, or household origin from regions with high AMR prevalence.