Global emerging resistance in pediatric infections with TB, HIV, and gram-negative pathogens

ABSTRACT

Infants, children and adolescents are at risk of life-threatening, antimicrobial-resistant infections. Global burdens of drug-resistant TB, HIV and gram-negative pathogens have a particular impact on paediatric age groups, necessitating a paediatric-focused agenda to address emerging resistance. Dedicated approaches are needed to find, successfully treat and prevent resistant infections in paediatric populations worldwide. Challenges include the diagnosis and identification of resistant infections, limited access to novel antimicrobials or to paediatric-friendly formulations, limited access to research and clinical trials and implementation challenges related to prevention and successful completion of treatment. In this review, the particular complexities of emerging resistance in TB, HIV and gram-negative pathogens in children, with attention to both clinical and public health challenges, are highlighted. Key principles of a paediatric-focused agenda to address antimicrobial resistance are outlined. They include quality of care, increasing equitable access to key diagnostics, expanding antimicrobial stewardship and infection prevention across global settings, and health system strengthening. Increased access to research studies, including clinical trials, is needed. Further study and implementation of care models and strategies for child- or adolescent-centred management of infections such as HIV and TB can critically improve outcome and avoid development of resistance. As the current global pandemic of a novel coronavirus, SARS-CoV-2, threatens to disrupt health systems and services for vulnerable populations, this is a critical time to mitigate against a potential surge in the incidence of resistant infections.

KEYWORDS:

• Drug resistance
• antimicrobial resistance
• HIV
• tuberculosis
• gram-negative bacteria
• paediatrics
• adolescents

Disclosure statement

The authors have no conflicts of interest to disclose.

Additional information

Funding

This work was supported by the Eunice Kennedy Shriver National Institute on Child Health and Human Development at the National Institutes of Health under Grant K23 HD095778.

Notes on contributors

Leslie A. Enane

Leslie A. Enane is an Assistant Professor of Paediatrics in the Ryan White Center for Pediatric Infectious Disease and Global Health at the Indiana University School of Medicine, and the Medical Director of Pediatric HIV Care at Riley Hospital for Children. She conducts research in interventions to improve adolescent HIV and TB treatment outcomes in international settings.

John C. Christenson

John C. Christenson is a Professor of Clinical Pediatrics in the Ryan White Center for Pediatric Infectious Disease and Global Health at the Indiana University School of Medicine, the Medical Director of Infection Prevention and of Travel and Geographic Medicine at Riley Hospital for Children, and the Statewide Director of Pediatric Clerkship. He is an international expert in pediatric infectious disease with particular expertise in geographic medicine and emerging infections.