Global antimicrobial resistance in children has surged significantly over the last two decades, rendering standard treatments less effective and increasingly threatening second-line and last-resort medications. Researchers analyzing more than 106,000 bacterial infection samples across 82 countries warn that infections will continue to escalate without urgent intervention.
Global Surge in Pediatric Infection Resistance
Antimicrobial resistance rates among pediatric patients have climbed across every world region between 2004 and 2022. An international research team evaluated more than 106,000 bacterial infection samples collected from children aged up to 18 across 82 countries and regions, utilizing data from the Antimicrobial Testing Leadership and Surveillance database analyzed over a multi-year period. The findings were published in JAMA Pediatrics, also referred to as the Journal of the American Medical Association Paediatrics.
The analysis revealed that more than a third of the bacterial isolates were resistant to at least one first-line antibiotic, while roughly one in five showed resistance to second-line drugs. Children are particularly vulnerable because they experience high rates of bacterial infections while possessing fewer treatment options than adults. An estimated 840,000 deaths in children under five worldwide were associated with antimicrobial resistance in 2021.
“There’s really no area of the world that isn’t seeing an increase, and it’s going to continue to increase unless we turn it around.”
Penelope Bryant, PhD, MBBCh, corresponding author and research clinician at Murdoch Children’s Research Institute in Australia
Vulnerable Settings and Last-Resort Drug Pressures
Resistance levels vary widely by clinical setting and geographic region. Nearly three-quarters of the analyzed samples originated from hospital wards at 47 percent and intensive care units at 27 percent. The most frequently identified pathogens included Staphylococcus aureus at 19 percent, Klebsiella species at 11 percent, and Escherichia coli at 10 percent.
Overall resistance was highest at 36 percent to Access-group antibiotics, which are first-line, narrow-spectrum drugs recommended for common bacterial infections under the World Health Organization AWaRE classification system. Meanwhile, 22 percent of isolates resisted Watch-group antibiotics, and 13 percent resisted Reserve-group drugs meant to be held in reserve for severe infections.
While resistance to first-line Access drugs declined in most inpatient settings, it rose sharply for broader-spectrum options. In intensive care units, resistance to Watch-group antibiotics increased from 15 percent to 33 percent, while resistance to Reserve-group drugs jumped from 9 percent to 32 percent.
Regional Disparities and Driving Pathogens
Resource-limited regions face the highest burdens of resistance across all AWaRE categories. Countries in Southeast Asia, Africa, and Central America recorded the most elevated figures. In Africa and Southeast Asia, reserve-drug resistance in Klebsiella species reached 33 percent and 43 percent, respectively.
Two types of Gram-negative bacteria, Acinetobacter baumannii and Klebsiella, drove global resistance, with the latter recording the fastest growth, particularly in Southeast Asia, Eastern Europe, and the Western Pacific. High infection burdens, poor sanitation, and unfettered antibiotic access fueled these numbers. In many low-income nations, antibiotics remain available over the counter in pharmacies or open markets without regulation.
New Digital Tracking Tools and Future Projections
To combat the growing data gap surrounding pediatric antimicrobial resistance, researchers collaborated across Australia, China, and the United States. Institutions involved in the collaborative effort included Australia’s University of Sydney, Murdoch Children’s Research Institute, Brown University, and the Clinton Health Access Initiative.
The team launched an online platform named AMR in Kids to track antibiotic resistance by country, bacteria, and antibiotic class, featuring forecasting models extending to 2035. The platform aims to improve clinical prescribing practices and public awareness.
Study authors emphasized that high-income nations will not remain isolated from these trends due to global travel and interconnected borders. Researchers called for the development of child-friendly antibiotics, clearer dosing guidelines, and expanded research funding to safely reduce antibiotic use before resistant pathogens spread further.
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