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A global study in JAMA Pediatrics finds antimicrobial resistance in children is rising, undermining life-saving antibiotics for infections like sepsis and pneumonia.
Analysing over 106,000 pediatric isolates from 82 countries, researchers report growing resistance to WHO Watch and Reserve drugs, especially in ICUs, resource-limited regions and among children under two, prompting creation of an AMR in Kids data platform.
Antimicrobial resistance (AMR) is rising among children worldwide, threatening the effectiveness of medicines used to treat serious infections such as sepsis and pneumonia, according to a new study.
The findings, published in JAMA Pediatrics, was conducted by the University of Sydney in collaboration with researchers at the Murdoch Children’s Research Institute (MCRI), the Clinton Health Access Initiative (CHAI) and the Chinese University of Hong Kong.
AMR occurs when bacteria evolve the ability to survive antibiotic treatment, making infections increasingly difficult to manage.
Children are especially vulnerable as they experience high rates of bacterial infections and have fewer antibiotic options than adults. In 2021, approximately 840,000 deaths in children under five years were associated with AMR.
Vulnerable groups, including newborns in intensive care and children undergoing cancer treatment, face particularly high risks. Multidrug-resistant organisms account for up to 10 per cent of bloodstream infections in some healthcare settings, with even higher levels reported for certain pathogen and clinical combinations.
Despite this, research on AMR in children remains fragmented, with existing international data, especially from resource-limited settings, often difficult to compare or inaccessible to clinicians, researchers, and policymakers. This gap undermines effective clinical decision-making and development of evidence-based policies.
To address this gap, the researchers analysed data from the Antimicrobial Testing Leadership and Surveillance (ATLAS) database, which includes pediatric bacterial isolates collected from children aged 0 to 18 in 82 countries from 2004 to 2022. They focused on priority pathogens identified by the World Health Organization (WHO) and assessed resistance trends using the WHO’s Access, Watch, and Reserve (AWaRE) antibiotic classification system.
Antibiotics in the Access group are first-line, narrow-spectrum drugs recommended for most common bacterial infections. The Watch and Reserve categories are for broader-spectrum antibiotics that should be limited to treatment of more serious infections to preserve their effectiveness.
The study analysed 106,581 isolates, nearly three-quarters of which came from hospital wards and intensive care units. The most frequently identified pathogens were Staphylococcus aureus, Klebsiella species and Escherichia coli.
Overall, resistance was highest (36 per cent) to Access antibiotics, while 22 per cent of the isolates were resistant to Watch antibiotics and 13 per cent to Reserve antibiotics.
Although resistance to Access antibiotics declined in most inpatient settings, resistance to Watch and Reserve antibiotics increased. In intensive care units (ICUs), resistance to Watch antibiotics increased from 15 per cent to 33 per cent, and resistance to Reserve antibiotics rose from 9 per cent to 32 per cent. Resistance to Watch and Reserve antibiotics was highest in children aged 0 to 2 years, children with sepsis, and those with respiratory infections.
Resistance to all AWaRE categories was highest in resource-limited regions, including countries in Southeast Asia, Africa and Central America. In Africa and Southeast Asia, resistance to Reserve antibiotics in Klebsiella species rose to 33 per cent and 43 per cent, respectively.
Forecasts suggest these regions could experience further increases in resistance to Watch and Reserve antibiotics by 2035.
To support global action, the researchers developed a new website called AMR in Kids that allows clinicians, researchers and policymakers to explore antibiotic resistance by country, bacteria and antibiotic class. It also provides region and pathogen-specific forecasts to 2035, helping researchers to identify emerging threats, inform treatment decisions and help guide public health planning.
The researchers hope that the platform will support better antibiotic prescribing, identify emerging resistance threats and strengthen public health planning to protect children from increasingly difficult-to-treat infections.
