Trends in antibiotic resistance for the priority bacterial pathogens in children and adults

In a recent study published in JAC-Antimicrobial Resistance, researchers assessed the variation in antibiotic resistance (AR) patterns in adults and children.

Background

The emergence of AR bacteria has endangered the efficiency of antibiotics and raised global concern for public health. Monitoring emerging AR patterns facilitates the providers to accurately generate antibiotic therapies and prevent the transmission of existing AR.

Until recently, trends in drug-resistant infections among children have been comparatively uncharacterized. Isolated samples from children have displayed distinct selective pressure because of their immature immune systems and a different set of antibiotics or overall exposure to antimicrobials.

Assessing the emerging patterns of AR for priority pathogens among adults and children would help inform antibiotic stewardship programs (ASPs) focused on the pediatric care setting.       

About the study

In the present study, researchers compared the trends in AR for the priority bacterial pathogens among adults and children along with children who are treated in pediatric and blended facilities.

The team obtained study information from the Cerner Health Facts (HF) database comprising the daily extraction of electronic health record (EHR) data from participating organizations. HF included data related to patient demographics, microbiology results, medication orders, diagnoses, clinical procedures, and other laboratory tests.

The researchers performed a retrospective study involving encounters with 22 priority bacteria along with microbiology susceptibility test results for the clinically relevant and Food and Drug Administration (FDA)-recommended antibiotics. S. aureus isolates were categorized as methicillin-resistant Staphylococcus aureus (MRSA) or methicillin-susceptible Staphylococcus aureus (MSSA).

Facilities, where the average patient age was below 18 years, were recognized as likely pediatric facilities, while facilities that treated children and adults were termed blended facilities.

The data group was divided into four categories: (1) Group 1 comprising encounters of isolates obtained from children ages less than 18 years, (2) Group 2 comprising encounters of isolates obtained from adults, (3) Group 3 comprising isolates from children being treated in pediatric facilities, and (4) Group 4 comprising isolates from children being treated in blended facilities. The team assessed the resistant percentage associated with each pathogen-antibiotic combination individually and with respect to the four groups. 

Results

The study results showed that the HF microbiology susceptibility data from the 2018 version included 125 million susceptibility test results assessed from 1,047 pathogens and 23,362 pathogen-antibiotic pairs. Isolate samples were noted from 550 body source locations. Among these, 63% included isolates from the urinary tract.

Taking into account the 22 priority organisms, a total of 19 million encounters were included in the study group. This cohort included 1.5 million isolates obtained from 1 million study patients from 166 facilities. Almost 84,101 patients aged below 18 years were identified and categorized under group 1, while the rest were a part of group 2. Group 1 comprised encounters observed in 160 facilities along with 10 pediatric facilities, which were divided into groups 3 and 4.

Among the pathogens with the highest total resistance level, Streptococcus Group B displayed the highest resistance to clindamycin. Furthermore, the overall variation in the number of resistant isolates was considerably higher among adults than in children. Some isolates obtained from children from blended facilities reported a higher number of penicillin-resistant S. pneumoniae. Yet, children treated in pediatric facilities revealed a higher number of resistant isolates compared to blended facilities.

The team noted that the predominant pathogen-antibiotic combination was ciprofloxacin-resistant Shigella sp., which rose from 1.6% in 2012 to 8% in 2017, while ceftazidime-resistant A. baumanii reduced to 24% from 34%. Among isolates obtained from adults, H. influenzae resistant to cefuroxime rose from 1.4% to 8%, while ceftazidime-resistant A. baumanii declined to 25.3% from 36.1%.

Among isolates obtained from children, clindamycin-resistant MRSA boosted to 24.2% from 15.5%, whereas nitrofurantoin-resistant E. aerogenes reduced to 13.3% from 37.1%. Isolates of ertapenem-resistant E. cloacae from children rose remarkably in comparison to adults. On the other hand, ampicillin/sulbactam-resistant Klebsiella oxytoca elevated in adults but declined in children.     

Pediatric facilities reported that ertapenem-resistant E. cloacae rose to 27.1% from 0%, while gentamicin-resistant Proteus mirabilis diminished to 0.8% from 8%. Furthermore, blended facilities noted that cefazolin-resistant P. mirabilis raised to 11% from 4% and nitrofurantoin-resistant E. cloacae lowered to 14% from 25%.

Among children, imipenem-resistant P. aeruginosa isolates diminished in blended facilities despite rising in pediatric facilities. On the other hand, ampicillin/sulbactam-resistant K. oxytoca isolates grew in blended facilities but lessened in pediatric facilities.      

Conclusion

The study findings revealed the deviation in AR for 22 high-priority infections based on patient age group, care setting for pediatric patients, and time. The team observed a higher incidence of AR among isolates derived from the same pathogen among children versus adults and children treated at pediatric facilities than those treated in blended facilities.

This study reported the prevalence and trends of AR among common Gram-negative and Gram-positive bacteria, adjusting for patient age and care context. By providing summaries of intricate patterns, the present visualization techniques may guide data-driven ASPs at the local, regional, as well as national levels.