Antibiotic-Resistant Infections Rise in Kids

Wednesday, November 16, 2016

Study highlights need for better tracking, new drug treatments

Highly drug-resistant infections are on the rise among children in the United States, reports a study published in the Nov. 17 issue of the Journal of the Pediatric Infectious Diseases Society.

Researchers found increasing rates of antibiotic resistance among samples of Pseudomonas aeruginosa, an important type of bacteria, collected from pediatric patients nationwide over the last decade. The findings add to a body of evidence that aggressive strategies are greatly needed to track, prevent and treat these concerning infections in children.

“Infections with P. aeruginosa can be very serious,” says principal study author Latania K. Logan, MD, associate professor of pediatrics and chief of pediatric infectious diseases at Rush University Medical Center. “In children, these infections can result in prolonged illness, require longer hospital stays, and, ultimately, increase the risk of death.”

Pseudomonas aeruginosa is a common bacterium found in the environment (soil, water and plants) that can cause a dangerous and sometimes fatal infection in adults and children with weaker immune systems or in patients who are hospitalized. An infection rarely occurs in otherwise healthy individuals, but when it does occur, it is generally mild.

‘Resistant infections are increasingly becoming more complex’

In the study, researchers analyzed information from a network of clinical microbiology laboratories serving approximately 300 hospitals across the country. The analysis focused on data obtained by testing P. aeruginosa isolates for their susceptibility to several different types of antibiotics. The samples were collected from patients between the ages of 1 and 17 who were in outpatient, inpatient, intensive care unit and long-term care settings from 1999 to 2012.

The rate of P. aeruginosa isolates that were resistant to at least three classes of antibiotics increased from 15.4 percent in 1999 to 26 percent in 2012. The number of bacterial strains resistant to carbapenems, a class of antibiotics considered one of the treatments of last resort for highly resistant infections, more than doubled from 9.4 percent in 1999 to 20 percent in 2012.

Drug resistance was more common in pediatric patients in intensive care units, among those 13-17 years old, and in several states in the Midwest and surrounding states, including Iowa, Kansas, Minnesota, Missouri, Nebraska, and the Dakotas.

“While antibiotic resistance in P. aeruginosa is not new, we found that resistant infections are increasingly becoming more complex and difficult to treat,” Logan says.

Findings highlight need for effective infection prevention strategies

According to the study authors, the latest findings highlight the need for better tracking of antibiotic-resistant infections and for effective strategies to prevent these infections in children, in addition to antibiotic stewardship programs to address inappropriate antibiotic prescribing. Health care facilities should also consider using rapid molecular diagnostics to guide antibiotic treatment decisions.

“Highly drug-resistant P. aeruginosa infections leave health care providers with limited — or sometimes no — antibiotic choices available, and these antibiotics are less safe and more toxic in children,” saysstudy author Sumanth Gandra, MD, MPH, of the Center for Disease Dynamics, Economics & Policy, a public health research organization in Washington, D.C.

An estimated 51,000 health care-associated P. aeruginosa infections occur in adults and children in the U.S. each year, according to the Centers for Disease Control and Prevention. More than 6,000 (13 percent) of these infections are resistant to multiple classes of antibiotics, leading to about 400 deaths annually. Few pediatric studies have assessed antibiotic resistance trends of P. aeruginosa, and there have been no previous national studies of P. aeruginosa resistance trends in children, despite rising rates of antibiotic resistance nationally overall.

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