Antibiotic-resistant infections that usually occur only in hospital settings are spreading in communities, increasing hospital stays—and danger—for young children.
In a study published in the Journal of the Pediatric infectious Diseases Society, researchers from the School of Medicine at Case Western Reserve University (CWRU) in Ohio studied hospital admissions data between 2007 and 2015, for children under 18 years of age. The results raise concern about the rate of spread of antibiotic-resistant bacteria in local communities, instead of just healthcare facilities.
This large study evaluated data on 94,000 admissions from 48 children's hospitals in the US. Scientists looked specifically for occurrence of Enterobacteriaceae-related infections, which are usually found only in healthcare settings, or in patients with a history of exposure to healthcare-related microbes.
Enterobacteriaceae are a large family of pathogens, that include bacteria including Escherichia coli (E. coli) and Klebsiella. This family of bacteria are well known for the ability to become resistant to antibiotics such as cephalosporins and penicillins.
Because bacteria can transfer genetic material to other bacteria, antibiotic resistance spreads. For younger children, infection with multi-drug resistant bacteria can lead to long hospital stays, and sometimes fatal illness.
Evaluation of patient data found that 75% of the multi-drug resistant bacteria identified in young patients in this study were already present by the time children were admitted to hospital.
This startling find suggests multi-drug resistant bacteria are becoming common in children outside of healthcare settings—a very troubling concern. High risk groups for almost any type of infection include the very young, who do not have well-developed immune systems, older adults, whose aging immune systems do not protect as well, and people whose immune systems are compromised by a chronic health problem.
In a press release, study author Dr. Sharon B. Meropol, an assistant professor in pediatrics at CWRU, noted, "There is a clear and alarming upswing throughout this country of antibiotic resistant Enterobacteriaceae infections in kids and teens. This makes it harder to effectively treat our patients' infections."
Typically, studies of resistant Enterobacteriaceae infections find they most likely result from medical devices or from in-patient hospital care. This research sounds the alarm that community-based infections in children have risen from 0.2% in 2007 to 1.5% in 2015, signaling that infection with multi-drug resistant bacteria is becoming more prevalent outside a hospital setting than within.
The children most impacted are those with existing health concerns, and surprisingly, those living in the western US. "This suggests that the resistant bacteria are now more common in many communities," remarked Meropol, on her results.
As could be expected, children with multi-drug resistant infections often have longer hospital stays. This study found that young people suffering these infections were in the hospital 20% longer than others without resistant infections.
Researchers report that 1,882 patients died before they were discharged, and 2,048 were discharged to hospice care or died shortly thereafter. The study notes that children with a multi-drug resistant infection had a "higher crude risk of death before discharge."
While this study was limited to a certain family of pathogens, the research raises credible concern for parents, caregivers, and public health officials over the increasing occurrence of dangerous infections circulating in our neighborhoods, schools, and local communities.
Overall, study authors determined that the number of multi-drug resistant infections caused by Enterobacteriaceae-related pathogens in children rose more than 700% between 2007 and 2015. While healthcare protocols can address hospital-acquired infections, we do not currently have guidelines for reducing risk of these bacteria in our homes and communities.
"The development of new antibacterial drugs, especially ones appropriate for children, remains essentially stagnant," Meropol said in the press release. "We need to stop over-using antibiotics in animals and humans and develop new ones if we want to stop a bad problem from getting worse."