The prevalence of an uncommon but drug-resistant type of Gram-negative superbug in children is on the rise, with researchers discovering an alarming upward trend in infections in the US, including within the community setting.

A study led by Latania Logan, of Rush University Medical Center in Chicago, looked at resistance patterns in around 370,000 clinical isolates from paediatric patients, collected from across the US between 1999 and 2011.

The researchers found that the prevalence of a resistant type of Gram-negative bacteria called Enterobacteriaceae - which produces an enzyme called extended-spectrum beta-lactamase (ESBL) that is able to thwart many strong antibiotics - had risen from 0.28% to 0.92%.

They also found that resistance to third-generation cephalosporins, an important class of antibiotics used to treat many infections, and another indicator of ESBL prevalence, jumped from 1.4% to 3.0%.

ESBLs were identified in children across the country of all ages, but slightly more than half with this resistance were in the one-five years old category, and, worryingly, 74.4% of these bacteria were resistant to multiple classes of antibiotics.

Community spread

Also of note, “these antibiotic-resistant bacteria have traditionally been found in health care settings but are increasingly being found in the community, in people who have not had a significant history of health care exposure,” Logan said.

While overall the rate of these infections in children is still low, ESBL-producing bacteria can spread rapidly and have been linked to longer hospital stays, higher health care costs, and increased mortality, the study authors warn.

Their emergence should prompt a shift in treatment approach - physicians should now obtain cultures for all suspected bacterial infections to help determine which antibiotics are best, Logan noted, adding: “some infections in children that have typically been treated with oral antibiotics in the past may now require hospitalisation, treatment with intravenous drugs, or both, as there may not be an oral option available.”

Going forward, Logan said more research is needed to define risk factors for these infections in children, their prevalence in different settings, and their molecular epidemiology, and additional drug development, with younger patients in mind, is also crucial, given that “the overwhelming majority of current research for new pharmaceuticals against antibiotic-resistant organisms are in adults".