Dramatic rise in antibiotic-resistant infections in Bangladeshi kids

• A study has found high levels of antibiotic-resistant bacterial infections in children under 5 years with pneumonia in Bangladesh.
• Around 18% of bacteria isolated from children with pneumonia were resistant to all routinely used antibiotics.
• The researchers attribute their findings to unsafe drinking water, poor sanitation, and the widespread availability of over-the-counter (OTC) antibiotics.
• They warn that these resistant strains are likely to spread worldwide in the coming years.

The World Health Organization (WHO) reports that a growing number of infections, including pneumonia, tuberculosis, and salmonellosis, are getting harder to treat as antibiotics become less effective.

It warns that without urgent action to tackle antibiotic resistance, the world faces a “post-antibiotic era in which common infections and minor injuries can once again kill.”

In the latest evidence of this worrying trend, research at a hospital in Dhaka, Bangladesh, has found resistance to all routinely used antibiotics in around 18% of all bacterial isolates from children with pneumonia.

The study found that children with a multidrug-resistant bloodborne bacterial infection were 17 times as likely to die as those without a bacterial infection.

The research, which was a collaboration between scientists in Bangladesh and the United States, appears in Open Forum Infectious Diseases.

Co-author Jason Harris, MD, MPH, chief of the division of Pediatric Global Health at Massachusetts General Hospital for Children in Boston, said there has been a dramatic increase in antibiotic-resistant infections at the hospital in Dhaka.

He is particularly concerned that people acquire these resistant infections in the community rather than in the hospital.

“In the U.S. I see a lot on antibiotic resistance in patients who have been in the hospital for weeks or months with chronic illness, but the fact that these are kids coming in from the community with these severe resistant infections is very worrying,” he told Medical News Today.

He said the widespread availability of OTC antibiotics, lack of access to safe drinking water, and inadequate sanitation are fuelling the spread of antibiotic-resistant “superbugs” across South and East Asia.

He added that while the problem was much worse in Bangladesh, he was already seeing some community-acquired cases of resistance in the U.S.

“If we don’t do anything to address it now, these bacteria will continue to spread, and they will inevitably be the new normal everywhere,” he warned.

Pneumonia in young children

Pneumonia accounts for 12% of all deaths in children under 5 years in Bangladesh.

For the new study, researchers analyzed the records of 4,007 children under 5 years admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh between 2014 and 2017 with pneumonia.

Of these, 1,814 had a blood culture to test for the presence of a bacterial infection, of which 108 (6%) were positive.

Gram-negative bacteria accounted for 77% of these positive cultures, including Pseudomonas, Escherichia coli, and Salmonella enterica. The authors report that this is an unusually high proportion for bacterial pneumonia.

Out of the 108 positive cultures, 20 (18%) were resistant to all routinely used antibiotics (ampicillin, gentamicin, ciprofloxacin, and ceftriaxone).

Children with confirmed bacteremia, a bacterial infection of the blood, were 5 times as likely to die as those with a negative blood culture.

In cases where bacteria were resistant to all routinely used antibiotics, 17 times as many children died as those without a blood infection.

“Taken together, these findings suggest that the emerging pandemic of antibiotic-resistant bacterial infection is already taking a toll on young children in Dhaka, Bangladesh,” the authors conclude.

They write that they are unaware of any previous studies demonstrating a clear increased risk of death associated with antibiotic resistance in childhood pneumonia.

“We need better diagnostic tests and better availability of appropriate medicines for kids who might otherwise die from their infections,” Dr. Harris told MNT.

He criticized the use of antibiotics to treat colds, which are viral infections, and mild diarrheal illness, which fuels the spread of antibiotic resistance in the community.

He also warned that travelers carry superbugs across the world:

“We’ve seen from COVID-19 and [COVID-19] variants how we live in a global community. Like COVID, superbugs already have and continue to spread around the world because antibiotic resistance gives these bacteria a competitive advantage.”

Limitations of the study

“These findings echo those of other studies of antibiotic resistance patterns, South and South East Asia being a region of particularly high prevalence,” said Nick Brown, a pediatrician and epidemiologist, and editor in chief of Archives of Disease in Childhood, who has lived and worked in the region.

However, he cautioned that the number of positive cultures from which resistance was inferred was low.

He told MNT that late presentation at the hospital with advanced illness might have contributed to the findings.

The paper also reports several limitations of the study.

In particular, it notes that the cause of infection in the 6% of children with positive blood cultures is unlikely to reflect the causes in the wider group who did not get this test or who had a negative result.

Finally, the authors say they were unable to account for previous antibiotic use among the children. They say this is a significant factor because antibiotics are widely available without a prescription in Bangladesh.

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