Global Geographic Patterns and Trends of WHO Priority Pathogens and AWaRe Antibiotic Resistance among Children: An Epidemiological Surveillance Study

Abstract

Background: Antimicrobial resistance (AMR) poses a pressing global health challenge, particularly impacting children. Despite the severity, research on pediatric AMR remains limited, resulting in gaps in understanding unique challenges and trends. To address this void, we propose harnessing Vivli platform surveillance data to uncover geographical patterns and trends in pediatric AMR across 18 years (2004-2021).

Methods: Utilizing Vivli platform data from 83 countries and 858,233 isolates (including 101,661 children's isolates), we employed WHO AWaRe antibiotics and priority pathogens lists. Descriptive statistics provided absolute frequencies and percentages. Resistance rates were computed based on WHO GLASS 2 surveillance methods, with Cochran-Armitage test 3 for trend used to examine resistance rate shifts over time.

Findings: Findings encompassed 101,661 children's isolates, revealing trends such as increasing carbapenem resistance in Acinetobacter baumannii, emerging cephalosporin resistance in Klebsiella pneumoniae, Enterobacter cloacae, and Escherichia coli. Haemophilus influenzae exhibited steady Access antibiotic resistance, while global Staphylococcus aureus resistance decreased. Resistant rates were more pronounced in Low-Middle-Income Countries (LMICs), though LMIC data collection was limited. Notably, carbapenem-resistant genes were predominant among Klebsiella pneumoniae and Pseudomonas aeruginosa, while cephalosporin-resistant genes were prevalent in Klebsiella pneumoniae and Escherichia coli. These genetic resistances were concentrated in gram-negative pathogens. Our predictive model underscored an impending surge, projecting over 50% increase in Watch antibiotic resistance for Klebsiella pneumoniae, Acinetobacter baumannii, and Enterobacter cloacae, and over 25% surge in Reserve antibiotics resistance for Serratia marcescens within the next decade if no action occurs.

Interpretation: This study contributes significantly to paediatric antibiotic resistance knowledge, unveiling concerning trends across priority pathogens and regions. Urgent interventions are warranted to combat Access and Watch antibiotic resistance in Acinetobacter baumannii, and Watch and Reserve resistance in Klebsiella pneumoniae, Enterobacter cloacae, Escherichia coli, and Serratia marcescens.

Note:

Funding Information: No specific funding for this study.

Conflict of Interests: No conflict of interests to be declared.

Keywords: Antimicrobial resistance, children, surveillance, Global