Childhood Antimicrobial Resistance With Global Forecasts

Area of Science:

• Global health
• Infectious diseases
• Microbiology

Background:

• Antimicrobial resistance (AMR) poses a significant threat to treating severe childhood infections.
• Multiregional data on pediatric AMR trends are limited, hindering effective global strategies.
• The World Health Organization (WHO) categorizes antibiotics into Access, Watch, and Reserve (AWaRe) groups to guide their use.

Purpose of the Study:

• To assess geographic and temporal trends in pediatric antimicrobial resistance (AMR).
• To analyze AMR patterns for WHO priority pathogens using the AWaRe antibiotic classification.
• To project future AMR trends and inform global public health interventions.

Main Methods:

• A multiregional surveillance study analyzed 106,581 pediatric bacterial isolates from the ATLAS database (2004-2022).
• Data from 82 countries were analyzed for resistance to AWaRe-categorized antibiotics in WHO priority pathogens.
• Spatiotemporal models were used to evaluate trends, estimate resistance trajectories, and forecast to 2035.

Main Results:

• Pediatric AMR increased globally from 2004-2022, with higher levels and faster growth in resource-limited settings.
• Resistance was highest for Access antibiotics (36%), followed by Watch (22%) and Reserve (13%) groups.
• Rapid increases in Watch and Reserve antibiotic resistance were observed in intensive care units, particularly in young children and those with sepsis or respiratory infections. *Acinetobacter baumannii* showed high resistance, while *Klebsiella* species exhibited the fastest increase, especially to carbapenems.

Conclusions:

• Pediatric AMR is increasing across all regions, driven by Gram-negative pathogens causing sepsis and pneumonia.
• These escalating resistance trends jeopardize the effectiveness of empiric therapy for severe childhood infections.
• Urgent interventions are needed, especially in settings with limited alternative treatment options, to combat rising AMR.