WASHINGTON, D.C. Infections caused by a type of antibiotic-resistant bacteria are increasing among children in the U.S., according to a new study co-authored by CDDEP researchers and published in the Journal of the Pediatric Infectious Diseases Society. The rising rate of infections, which are particularly prevalent among children between 1 and 5 years old, is raising concerns about dwindling treatment options.
Using national data collected between 1999 and 2011 by The Surveillance Network-USA, which includes close to 300 laboratories serving hospitals and outpatient clinics, researchers analyzed resistance patterns in approximately 370,000 clinical isolates from pediatric patients. Specifically, they determined the prevalence of Enterobacteriaceae, a resistant Gram-negative bacteria that produces the enzyme extended-spectrum beta-lactamase (ESBL), which confers resistance to many strong antibiotics. Another indicator of ESBL prevalence, susceptibility to third-generation cephalosporins an important class of antibiotics used to treat many infections was also measured.
The prevalence of ESBL-producing bacteria increased from 0.28 percent to 0.92 percent between 1999 and 2011, while resistance to third-generation cephalosporins increased from 1.4 percent to 3.0 percent. ESBLs were found in children of all ages, but slightly more than half of the isolates with this resistance were from those 1-5 years old. Nearly three-quarters (74.4 percent) of these bacteria were resistant to multiple classes of antibiotics.
These antibiotic-resistant bacteria have traditionally been found in health care settings but are increasingly being found in the community, in people who have not had a significant history of health care exposure, Dr. Latania K. Logan, who led the study, said. In our study, though previous medical histories of the subjects were unknown, 51.3 percent of the children presented in the outpatient or ambulatory setting.
The rise in ESBL infections is disconcerting because they require treatment with last-resort antibiotics such as carbapenems. This in turn promotes resistance to those drugs, leaving us with few proven alternatives, said CDDEP Director Dr. Ramanan Laxminarayan. The situation is further complicated for pediatric patients, who can tolerate a limited number of drugs.
While the overall rate of these infections in children remains low, ESBL-producing bacteria can spread rapidly and have been linked to longer hospital stays, higher health care costs, and increased mortality, the study authors noted. In a 2013 report, the Centers for Disease Control and Prevention (CDC) called ESBLs a serious concern .
To counter the significant threat that ESBLs and other antibiotic-resistant pathogens pose to public health, the CDC has recommended a number of policies for improving antibiotic stewardship. These include the promotion and enforcement of better prescribing habits among doctors, closer monitoring of antibiotic resistance patterns and public education initiatives on antibiotic use and resistance.
More research is needed to define risk factors for these infections in children, their prevalence in different settings, and their molecular epidemiology, Dr. Logan said. A companion study by several of the same researchers, also now available online in the Journal of the Pediatric Infectious Diseases Society, suggests that children with neurologic conditions are at higher risk for infections caused by ESBL-producing bacteria.
Additionally, further research and development efforts will be necessary to produce new antibiotics that will be effective against the growing number of resistant bacteria. The overwhelming majority of current research for new pharmaceuticals against antibiotic-resistant organisms are in adults, Dr. Logan said. New drug options will need to be available for young children.
CDDEP Media Contact:
+1 (202) 328-5152
Infectious Diseases Society Media Contact:
Terri Christene Phillips, MSA
+1 (703) 299-9865
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