Trends in antimicrobial resistance in Enterobacterales isolated from

Antimicrobial Resistance Poses Persistent Threat to Pediatric Health

Antimicrobial resistance (AMR) remains a significant global public health concern, especially when it comes to infections caused by bacteria in the Enterobacterales order. These Gram-negative pathogens, which include common culprits like Escherichia coli, Klebsiella spp., Salmonella spp., and Enterobacter spp., are a leading cause of infections in children.

To better understand the scope of this challenge, researchers analyzed data from the China Antimicrobial Surveillance Network (CHINET) on Enterobacterales isolates collected from pediatric patients between 2015 and 2021. The findings, published in the journal One Health Advances, shed light on concerning trends in antimicrobial resistance among these key uropathogens and bloodstream infection-causing agents.

Key Takeaways:

• Enterobacterales accounted for 50.1% of all Gram-negative organisms isolated from children during the 7-year study period.
• The most commonly isolated Enterobacterales were E. coli, Klebsiella spp., Salmonella spp., and Enterobacter spp.
• Concerning rates of extended-spectrum beta-lactamase (ESBL) production were observed, with 48.8%-57.6% of E. coli, 49.3%-66.7% of K. pneumoniae, and 23.1%-33.8% of P. mirabilis isolates exhibiting this resistance mechanism.
• Carbapenem resistance was also alarmingly high, affecting 5.7%-9.5% of all Enterobacterales isolates, with Klebsiella spp. showing the highest rates at 14.1%-22.6%.
• While resistance to ciprofloxacin and levofloxacin remained problematic, the Enterobacterales strains showed high susceptibility to amikacin, polymyxin B, and tigecycline.

IT Fix is dedicated to providing practical IT solutions and staying on top of the latest technology trends. This in-depth look at antimicrobial resistance patterns in pediatric Enterobacterales infections offers crucial insights for healthcare providers and IT professionals alike, as they work to combat this growing threat to patient safety and public health.

The Scope of Enterobacterales Infections in Children

The CHINET surveillance data analyzed in this study spanned 51 hospitals across 29 provinces in China, covering more than 50% of the country’s population. Over the 7-year period, the researchers collected and analyzed a staggering 81,681 Enterobacterales isolates from pediatric patients.

These Gram-negative bacteria were the predominant group, accounting for half of all Gram-negative organisms identified. The most frequently isolated Enterobacterales species were:

• Escherichia coli (42.0% of isolates)
• Klebsiella spp. (23.0%)
• Salmonella spp. (10.7%)
• Enterobacter spp. (8.0%)

The primary sources of these Enterobacterales isolates were urine (29.3%) and the respiratory tract (27.7%), underscoring their role in common pediatric infections like urinary tract infections (UTIs) and pneumonia.

When examining the age distribution of Enterobacterales infections, the researchers found the highest rates in infants (35.1%-43.5%), followed by neonates (11.4%-21.5%) and preschoolers (13.5%-17.7%). School-age children had the lowest proportion of Enterobacterales infections at 5.9%-8.0%.

Alarming Resistance Trends in Enterobacterales

The most concerning finding from this study was the high and increasing prevalence of antimicrobial resistance among the Enterobacterales isolates. Particularly worrisome were the rates of ESBL production and carbapenem resistance.

ESBL-Producing Enterobacterales

ESBL-producing strains are able to hydrolyze and confer resistance to extended-spectrum cephalosporins, a critically important class of antibiotics. The researchers found that:

• 48.8%-57.6% of E. coli isolates were ESBL-producers
• 49.3%-66.7% of K. pneumoniae isolates were ESBL-producers
• 23.1%-33.8% of P. mirabilis isolates were ESBL-producers

Disturbingly, the proportions of ESBL-producing E. coli and K. pneumoniae showed a clear upward trend over the 7-year period, indicating a worsening situation.

Carbapenem Resistance

Carbapenems are often considered the last line of defense against severe Enterobacterales infections. However, the study revealed concerning levels of carbapenem resistance:

• 5.7%-9.5% of all Enterobacterales isolates were carbapenem-resistant
• Carbapenem-resistant Klebsiella spp. accounted for 14.1%-22.6% of isolates
• Carbapenem-resistant Enterobacter spp. and E. coli were 7.1%-15.7% and 2.0%-3.4%, respectively

Worryingly, the prevalence of carbapenem-resistant Klebsiella spp. and E. coli increased over time, while carbapenem-resistant Enterobacter spp. showed an upward trend.

Susceptibility Patterns Offer Some Hope

While the rise of ESBL production and carbapenem resistance in Enterobacterales is extremely concerning, the study did find some promising susceptibility patterns that could inform treatment strategies.

Key Susceptibility Findings:

• E. coli isolates showed decreasing resistance to most antibiotics tested, except for ciprofloxacin and levofloxacin
• Klebsiella spp. also exhibited decreasing resistance to most agents, with the exception of ciprofloxacin, levofloxacin, and trimethoprim-sulfamethoxazole
• Enterobacter spp. displayed increasing resistance to most antibiotics, except for amikacin and gentamicin
• Salmonella spp. maintained high susceptibility to ceftriaxone, with resistance rates below 30%

Notably, the Enterobacterales isolates demonstrated high susceptibility to amikacin, polymyxin B, and tigecycline, suggesting these agents could be valuable options for treating resistant infections.

Implications and the Path Forward

This comprehensive analysis of antimicrobial resistance trends in pediatric Enterobacterales infections highlights the critical need for continued surveillance and antibiotic stewardship efforts. As resistance to first-line and even last-resort treatments continues to rise, clinicians must be vigilant in monitoring local susceptibility patterns and adjusting empiric therapy accordingly.

To effectively combat this growing threat, the researchers emphasize the importance of the following strategies:

1. Strengthen Antimicrobial Resistance Monitoring: Maintaining long-term surveillance programs like CHINET is crucial for tracking evolving resistance patterns and guiding empiric treatment decisions.

2. Enhance Antibiotic Stewardship: Robust antibiotic stewardship programs in healthcare settings are essential for promoting the judicious use of antimicrobials and limiting the further spread of resistance.

3. Improve Infection Prevention and Control: Enhancing infection control measures, such as hand hygiene, environmental cleaning, and appropriate device management, can help reduce the transmission of resistant pathogens in both inpatient and outpatient settings.

4. Invest in Novel Antimicrobial Development: As resistance continues to outpace the development of new antibiotics, increased investment and innovation in antimicrobial research and development are critical for replenishing the dwindling treatment arsenal.

By implementing a multi-faceted approach to address antimicrobial resistance, healthcare providers and policymakers can work to safeguard the health and well-being of children worldwide. The insights from this comprehensive CHINET study serve as a crucial call to action in the fight against this persistent and evolving public health challenge.