Antibiotic resistance is a growing threat to public health, and experts have been warning about it for so long, they've begun to ask whether they will be ignored until it's too late. Now clinicians and scientists are sounding the alarm about rising numbers of cases of antibiotic resistant pneumonia in children in Bangladesh; they've written that a pandemic is underway, and it has the potential to spread to other places and maybe around the world. The findings have been reported in Open Forum Infectious Diseases.
A senior scientist at the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) noticed that more and more kids were being admitted to the icddr,b-affiliated hospital with pneumonia that was resistant to standard antibiotics. "At our hospital, dozens of kids died of pneumonia between 2014 and 2017, despite receiving the World Health Organization's recommended antibiotics and enhanced respiratory support," said study leader Mohammod Jobayer Chisti, M.D., Ph.D. of icddr,b's Nutrition and Clinical Services Division.
Pneumonia is a disease of the lungs that leads to trouble breathing, cough, and fever. It's also the primary cause of death in kids worldwide. Pneumonia can be caused by about 30 different microbial pathogens, including viruses, fungi, and two different types of bacteria. In the US, bacterial strains including Streptococcus pneumoniae, Staphylococcus, and Mycoplasma pneumoniae commonly cause pneumonia. These cases can usually be treated successfully with antibiotics.
In this study, Chisti's team assessed health data from over 4,000 children under the age of five who were admitted to the hospital between 2014 and 2017 with pneumonia. The pattern of infection was different than expected; these kids were not usually infected with Staph or Strep; in 77 percent of cases, the patients carried Escherichia coli, Klebsiella, Pseudomonas, and Salmonella strains instead. These pathogens tend to be resistant to standard antibiotics.
"That's totally different than what I'm used to in my practice in Boston," said co-first study author Jason Harris, M.D., M.P.H., chief of the division of Pediatric Global Health at the Massachusetts General Hospital for Children. He noted that unfortunately, "the gram-negative bacteria we saw in these kids are notorious for being antibiotic resistant."
Antibiotic resistance is no longer an abstract threat, noted Harris. "These kids are already dying early because of antibiotic-resistant bacteria, from what would be a routine infection in other parts of the world," said Harris. "And this was at one hospital in Bangladesh. Extrapolate these findings across a country of 163 million people, and then to a larger region where antibiotic resistance is emerging, and the overall numbers are probably huge."
There are still ways for us to reduce the threat posed by antibiotic resistance. In Bangladesh, antibiotics can be bought without a prescription. The unfettered use of antimicrobials is thought to contribute to the evolution of antibiotic resistance, as is a lack of good sanitation, another problem for the nation. The country also needs assistance treating these infections when they happen.
We have start tackling the problem now. "If COVID-19 was a tsunami, then emerging antibiotic resistance is like a rising flood water. And it's kids in Bangladesh who are already going under," said Harris.