Pediatric ASP Toolkit

Download CDC Antibiotic Resistance Threats Report

CDC estimates that in the United States (U.S.), more than 2 million people are infected every year with antibiotic-resistant infections, with at least 23,000 dying as a result. These are likely conservative estimates.

Urgent Threats

• Carbapenem-resistant Acinetobacter
• Candida auris
• Clostridium difficile
• Carbapenem-resistant Enterobacteriaceae (CRE)
• Drug-resistant Neisseria gonorrhoeae

Serious Threats

• Drug-resistant Campylobacter
• Fluconazole-resistant Candida
• Extended Spectrum β-lactamase Producing Enterobacteriaceae (ESBLs)
• Vancomycin-resistant Enterococci (VRE)
• Multidrug-resistant Pseudomonas aeruginosa
• Drug-resistant non-typhoidal Salmonella
• Drug-resistant Salmonella typhi
• Drug-resistant Shigella
• Methicillin-resistant Staphylococcus aureus (MRSA)
• Drug-resistant Streptococcus pneumoniae
• Drug-resistant Mycobacterium tuberculosis

Concerning Threats

• Erythromycin-resistant Group A Streptococcus
• Clindamycin-resistant Group B Streptococcus

Watch List

• Azole-resistant Aspergillus fumigatus
• Drug-resistant Mycoplasma genitalium
• Drug-resistant Bordetella pertussis

Staphylococcus aureus

• A pooled pediatric antibiogram representing 200 pediatric healthcare institutions across the United States from 2005 and 2011 demonstrated that 50% of all Staphylococcus aureus isolates were methicillin-resistant and 21% of S. aureus isolates were resistant to clindamycin.(Tamma PD, Robinson GL, Gerber JS, Newland JG, DeLisle CM, Zaoutis TE, Milstone AM. Pediatric Antibiotic susceptibility trends across the United States. Infect Control Hosp Epidemiol. 2013 Dec;34(12):1244-51.)
• Retrospective cohort study using the Pediatric Health Information Systems (PHIS) administrative database of children from 39 pediatric hospitals demonstrated a 36% decrease in hospitalizations from 26.3 to 16.8 infections per 1,000 admissions 2009 to 2016. MRSA rates decreased by 52% and MSSA decreased by 17%. (Spaulding AB, Thurm C, et al. Epidemiology of Staphylococcus aureus infections in patients admitted to freestanding pediatric hospitals, 2009-2016. Infect Control Hosp Epidemiol. 2018 Dec;39(12):1487-1490.)

Enterococcus faecium

• In the pooled pediatric antibiogram described above, among Enterococcus faecium isolates, the prevalence of resistance to ampicillin was 75%, to vancomycin was 55%, and to linezolid was 8%.(Tamma PD, Robinson GL, Gerber JS, Newland JG, DeLisle CM, Zaoutis TE, Milstone AM. Pediatric Antibiotic susceptibility trends across the United States. Infect Control Hosp Epidemiol. 2013 Dec;34(12):1244-51.)

ESBL-Producing Enterobacteriaceae in Children

• National data from The Surveillance Network Database demonstrated an increase in prevalence of third generation cephalosporin-resistant and ESBL-producing Enterobacteriaceae, from 1.39% and 0.28% in 1999–2001 to 3% and 0.92% in 2010–2011 respectively. (Logan LK, Braykov NP, Weinstein RA, Laxminarayan R; CDC Epicenters Prevention Program. Extended-Spectrum β-Lactamase-Producing and Third-Generation Cephalosporin-Resistant Enterobacteriaceae in Children: Trends in the United States, 1999-2011. J Pediatric Infect Dis Soc. 2014 Dec;3(4):320-8.)

Carbapenem-resistant Enterobacteriaceae

• Logan et al analyzed 316,253 isolates from children and identified 0.08% as carbapenem-resistant Enterobacteriaceae (CRE). CRE infection rate increases were highest for Enterobacter species, blood culture isolates, and isolates from intensive care units, increasing from 0% in 1999–2000 to 5.2%, 4.5%, and 3.2%, respectively, in 2011–2012. (Logan LK, Renschler JP, Gandra S, Weinstein RA, Laxminarayan R; Centers for Disease Control; Prevention Epicenters Program. Carbapenem-Resistant Enterobacteriaceae in Children, United States, 1999-2012. Emerg Infect Dis. 2015 Nov;21(11):2014-21.)

Antibiotic Resistance: Tackling a Crisis for the Health and Wealth of Nations

• Commissioned by the UK Prime Minister, economist Jim O’Neill conducted an independent analysis of the global problem of antimicrobial resistance (AMR) and proposed concrete actions.
• The report estimates that unless effective action is taken, drug-resistant strains of tuberculosis, malaria, HIV, MRSA, E. coli and Klebsiella pneumoniae could claim 10 million lives each year by 2050. This would cost of 100 trillion USD from loss of economic output over the next 35 years.