Antibiotic Resistance in Children Rose Globally From 2004 to 2022

Global antibiotic resistance in children rose across every region between 2004 and 2022, threatening last-line treatments for severe infections like sepsis and pneumonia. Published in JAMA Pediatrics, a comprehensive international analysis examined more than 106,000 bacterial samples from 82 countries and warned that critical pathogens could become resistant by 2035.

A massive global monitoring effort tracking bacterial infections in pediatric patients has revealed a troubling upward trajectory in antimicrobial resistance. The study, which evaluated more than 106,000 bacterial isolates collected from children aged zero to 18 across 82 countries between 2004 and 2022, demonstrates that resistance increased universally across all geographic regions.

Babies, children in intensive care units, and patients in resource-limited settings face the highest burden. Researchers warn that these trends threaten to erode the efficacy of foundational first-line drugs and imperil second-line and last-resort treatments.

Global Data Gap and the Launch of the AMR in Kids Platform

Historically, antimicrobial resistance surveillance systems relied almost exclusively on adult data, obscuring the distinct clinical realities of treating minors. Adult pathogen profiles, infection patterns, and treatment options do not translate directly to pediatric medicine, according to study authors.

To address this critical blind spot, the research team—representing institutions including the Murdoch Children’s Research Institute, the University of Sydney, the Clinton Health Access Initiative, and The Chinese University of Hong Kong—launched a public tracking tool named AMR in Kids. The platform allows clinicians, researchers, and policymakers to query resistance data by country, bacterial strain, and antibiotic class while providing region- and pathogen-specific forecasts extending to 2035.

Making antibiotic resistance in children visible, through AMR in Kids, is the first step towards changing its trajectory. By understanding where resistance is emerging and how it’s changing, we can better protect children now and preserve the effectiveness of antibiotics into the future.

Gram-Negative Superbugs and AWaRe Classifications

The analysis focused on priority pathogens identified by the World Health Organization and evaluated resistance trends using the WHO’s Access, Watch, and Reserve classification system. Access drugs serve as first-line treatments for common bacterial infections, whereas Watch and Reserve options are broader-spectrum agents restricted to severe infections to prevent overuse.

A close up of a latex gloved hand holding a petri dish speckled with dots — Photo: Livescience

The study found that Gram-negative bacteria, particularly Acinetobacter baumannii and Klebsiella species, drove the global rise in resistance. Acinetobacter baumannii—frequently responsible for hospital-acquired bloodstream infections and pneumonia—exhibited the highest overall resistance levels. Meanwhile, Klebsiella species recorded the fastest increase, particularly across Southeast Asia, Eastern Europe, and the Western Pacific.

In hospital intensive care units, resistance metrics for restricted classes climbed sharply. Watch-level resistance jumped from 15% to 33%, and Reserve-level resistance rose from 9% to 32% over the study period. Among children suffering from sepsis, Watch-level resistance rose from 15% to 30%, while Reserve-level resistance climbed from 3% to 26%.

Projections to 2035 and Regional Disparities

Forecasting models built into the monitoring platform suggest that if historical patterns continue unchecked, formidable pathogens will exhibit widespread resistance to last-resort medications within the decade. Specifically, resistance to carbapenem antibiotics is projected to reach 82 per cent for Acinetobacter baumannii and 35 per cent for Klebsiella strains by 2035.

Antibiotic Resistance in Children Rose Globally From 2004 to 2022 — Photo: News Medical

Stewardship, Diagnostics, and Policy Interventions

Mitigating the threat requires coordinated global and local interventions. In low- and middle-income countries, experts emphasize the necessity of addressing unregulated antibiotic use and improving sanitation alongside expanding access to diagnostic testing and standard first-line therapies.

In high-income nations, antimicrobial stewardship must encompass primary care, hospitals, veterinary medicine, and agricultural practices. Clinicians are urged to collect microbiological samples before initiating empirical treatment, consult local resistance profiles, and de-escalate or discontinue regimens promptly based on laboratory findings.

Collaborative international initiatives are already underway, including efforts by Australia’s Department of Foreign Affairs and Trade bringing together the World Health Organization and regional academic experts to develop targeted solutions in the Western Pacific.