FROM THE JOURNAL OF PEDIATRIC INFECTIOUS DISEASES
The rate of infection with resistant Pseudomonas aeruginosa among children has risen steadily about 4% per year since 1999, according to a report.
Infections with P aeruginosa in children occur most often associated with pulmonary disease in patients with cystic fibrosis, but healthy children also can experience a variety of P aeruginosa infection types.
In what they described as the first study to assess time trends in resistant P. aeruginosa in the pediatric population, researchers analyzed information in a database of antimicrobial susceptibility testing. The database covers microbiology laboratories serving approximately 300 U.S. hospitals, and its contents are “geographically representative and representative of hospital size and patient population,” said Latania K. Logan, MD , a pediatric infectious specialist at Rush University Medical Center, Chicago, and her associates.
They focused on 77,349 P. aeruginosa isolates that were tested for resistance for all five antibiotic classes: cephalosporins, beta-lactam and beta-lactamase inhibitors, carbapenems, fluoroquinolones, and aminoglycosides. The investigators were specifically interested in multidrug- and carbapenem-resistant P. aeruginosa. They described the organism as “arguably the most resistance-prone health care–related pathogen.”
The study samples were obtained from the respiratory tract, urinary tract, ear, sinuses, wounds, skin, and connective tissues of children aged 1-17 years who were treated in 1999-2012; 2012 was the last year for which this information was collected in this database. Patients were treated in ambulatory, inpatient, ICU, and long-term-care settings. The study excluded children with cystic fibrosis and children under 1 year of age, so as to improve the applicability of the results to the general pediatric population.
The proportion of multidrug-resistant P. aeruginosa samples rose from 15% to 26% during the 13-year study period, and the proportion of carbapenem-resistant P. aeruginosa samples rose from 9% to 20%. This represents an average annual increase of approximately 4% for both types of resistance, Dr. Logan and her associates said ( J Ped Infect Dis. 2016 Nov 16. doi: 10.1093/jpids/piw064 ).
These increases were consistent across all but one age group and all but one treatment setting, the exception being inpatients aged 13-17 years. The prevalence of resistant P. aeruginosa was highest among adolescents in ambulatory, ICU, or long-term-care settings; their rates were three times higher than those in children aged 1 year and two times higher than those in children aged 5 years. It is possible that this pattern reflects “an increasing number of older children with a medically complex condition who have frequent exposure to the health care environment,” the investigators noted.
“The results of our study highlight the need for bacterial surveillance, strategies for implementing effective infection prevention, and antimicrobial stewardship programs.” In addition, all health care facilities should consider using rapid molecular diagnostic platforms to guide antibiotic treatment decisions, “to reduce the burden of the persistent and continually evolving global threat of extensively drug-resistant organisms,” Dr. Logan and her associates added.
This study was supported by the National Institute of Allergy and Infectious Diseases; the Global Antibiotic Resistance Partnership, funded by the Bill and Melinda Gates Foundation; and the Health Grand Challenges Program at Princeton University. Dr. Logan and her associates reported having no relevant financial disclosures.
