Most news on the dangers of antibiotic-resistant infections focus on adults. But children are very much at risk too. In fact, a recent study found that U.S. children have experienced a 700 percent surge in infections caused by particular bacteria that’s both resistant to multiple antibiotics and responsible for growing numbers of serious bacterial infections in kids.
“These organisms are scary, they’re hard to treat and respond to few antibiotics…and it’s the type of antibiotic resistance that’s capable of spreading itself to adjacent bacteria even if those bacteria haven’t been exposed to antibiotics,” study co-author Sharon Meropol, an assistant professor of pediatrics, epidemiology and biostatistics at Case Western Reserve University School of Medicine, told me. “Because of previous surveillance, we weren’t surprised to find this type of increase. But, of course, we wish it wasn’t true.”
The study, published in the March issue of the Journal of the Pediatric Infectious Diseases Society, focused on a family of bacteria known as Enterobacteriaceae, which includes both harmless agents as well as pathogens such as E. coli, salmonella and shigella. Federal public health officials have been warning of rising incidence of multidrug resistant gram-negative Enterobacteriaceae (MDR-GNE) infections, which are becoming particularly common in less developed nations where antibiotics can be purchased over the counter. In addition, children face a higher risk of MDR-GNE complications because the number of broad-spectrum antibiotics approved for pediatric use is already limited.
So, with little existing data on incidence of MDR-GNE among U.S. kids, Meropol and colleagues set out to measure its prevalence and related outcomes. Their study now stands as one of the most comprehensive analyses of multidrug-resistant infections in children.
“This has become one of the most prevalent and invasive infections in young children now, especially since we’ve been so successful in preventing other infections through immunizations,” said Meropol, who also serves as associate medical director for research and evaluation at the Center for Child Health and Policy at Rainbow Babies & Children’s Hospital in Cleveland. “But there hadn’t really been a description of the recent extent of the problem.”
To conduct the study, Meropol and colleagues examined data from the Pediatric Health Information System, which houses data from 48 children’s hospitals around the country. The study's dataset ultimately included more than 94,000 patients with Enterobacteriacaea infections between Jan. 1, 2007, and March 31, 2015. The average age of patients was just 4 years old. Researchers found that while the number of Enterobacteriacaea infections were relatively stable during the study period, the proportion that were multidrug resistant rose from 0.2 percent to 1.5 percent. That doesn’t seem like a lot on the surface, but it’s actually a 700 percent increase in less than 10 years, Meropol noted. The rate rose even faster for patients in intensive care units.
Researchers also found that 76 percent of the pediatric patients with MDR-GNE had the infection upon admission to the hospital. That’s important because multidrug-resistant infections are often acquired inside health care settings. And so the fact that so many of these patients were infected prior to hospital admission means the drug-resistant bacteria may be in wider circulation in the community, Meropol told me.
As for outcomes, the study found that the average hospital stay for children with MDR-GNE was 21.4 days, versus 17.3 days for patients without MDR-GNE. That means MDR-GNE patients had a more than 23 percent increased length of the stay in the hospital. That’s important to note, Meropol said, because the risk of health complications can increase the longer a person stays in a hospital. The study also found a higher risk of death among children with the resistant infection, but the difference was not statistically significant.
Overall, older children, children with existing health conditions and children living in the American West were most likely to contract MDR-GNE. Study co-authors Meropol, Allison Haupt and Sara Debanne concluded:
The march of escalating antibiotic resistance seems inexorable, however thoughtful and thorough efforts to reverse this trend can be successful. Considering global skyrocketing incidence of MDR-GNE, we must be vigilant, and do everything possible to curtail, and even reverse this process.
But is it possible to reverse growing antibiotic resistance? Meropol tells me “maybe,” adding that while she’s not sure we can reverse resistance, we can certainly slow it down and prevent infections from happening in the first place. Much of the positive progress on this front is being accomplished through immunizations as well as improved hygiene and patient safety protocols in health care settings. For example, on the immunization front, Meropol noted that one of the most invasive pediatric infections used to be antibiotic-resistant pneumococcus. But with the 2010 licensure of a new pneumococcal vaccine, incidence of invasive resistance has declined by over 60 percent, she reported.
Of course, one of the most important actions against antibiotic resistance is changing how the life-saving medicines are prescribed and used, Meropol told me. That includes how antibiotics are prescribed in the doctor’s office as well as the prophylactic use of antibiotics in agricultural animals. (Agricultural antibiotic use is particularly problematic. According to Pew Charitable Trusts, in 2011, 29.9 million pounds of antibiotics were sold for U.S. meat and poultry production versus 7.7 million pounds to treat sick people. That means antibiotics are ending up in our environment, in our food and in our water, “creating selection pressure for increased antibiotic resistance,” Meropol noted. Learn more about how antibiotics on the farm affect human health here.)
Meropol noted that developing new antibiotics, especially ones for children, is also critical.
“Because of the evidence that we’re using antibiotics unnecessarily, reducing that use is the low-hanging fruit in slowing down the drive toward antibiotic resistance,” she said. “Developing new antibiotics is much harder and requires enormous resources…reducing unnecessary antibiotic use is something we can do now.”
Without global action on antibiotic resistance, she said the U.S. risks catching up to other nations where the rates of antibiotic-resistant infections are many times higher. She also warned that if anti-vaccine sentiment begins to gain more traction and immunization coverage wanes, antibiotic-resistant organisms will quickly take advantage of the opening.
“Antibiotic resistance,” Meropol said, “is a global health crisis.”
For a full copy of the children’s health study, visit the Journal of the Pediatric Infectious Diseases Society. For more on antibiotic resistance, visit CDC.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years.