Antibiotic-Resistant Pneumonia Quickly Killing Bangladeshi Children

By Ronnie Cohen

July 23, 2021

(Reuters Health) - Seven years ago, Dr. Mohammod Jobayer Chisti noticed a disturbing trend among young children he treated with standard antibiotics for pneumonia at the International Centre for Diarrhoeal Disease Research.

Within 48 hours of arriving at the hospital in Dhaka, Bangladesh, the children were dying. They were dying before Chisti could even determine what caused their pneumonia.

Only after their deaths would he receive a blood-culture report showing that the children had been infected with gram-negative bacteria, organisms with a double membrane that cannot be penetrated by the antibiotics that the World Health Organization recommends to treat pneumonia. (https://bit.ly/2UrVaC7)

In an effort to understand and reverse the trend, Chisti and a team of researchers examined the pathogens associated with bacteremia collected from 1,814 children under the age of 5 who were admitted to the hospital's intensive-care unit with X-ray confirmed pneumonia from 2014 through 2017.

The results "shocked" the study's co-author, Dr. Jason B. Harris of Massachusetts General Hospital in Boston, he said in a phone interview.

The usual staph and strep infections Dr. Harris commonly sees in children with pneumonia in Boston were relatively rare in the Bangladeshi children. Gram-negative pathogens accounted for 77% of positive cultures, Drs. Chisti and Harris and colleagues report in Open Forum Infectious Diseases.

"A big part of it has to do with the lack of safe water and sanitation," compounded by unregulated, rampant sales of antibiotics, Harris told Reuters Health. "The conditions are a perfect storm for antibiotic resistance."

In the United States, the antibiotic-resistant infections that are killing the Bangladeshi children only appear in patients who've been hospitalized for long periods of time, he said.

"If the COVID pandemic is like a tidal wave spreading across the globe, then the pandemic of antibiotic-resistant bacteria is a rising flood," Harris said. "It may seem like a far-off threat, but it is spreading, and children in Bangladesh are the ones who are already under water."

More than 4,000 young children were hospitalized with pneumonia in the Dhaka hospital from 2014 through 2017, and 186 died. Of 108 children from whom investigators obtained positive blood cultures, 31 died.

Children with infections resistant to both first-line antibiotics, ampicillin and gentamicin, were 10 times more likely to die than those without bacterial infections, the study found. Children with infections resistant to all first- and second-line therapies were 17 times more likely to die.

The study confirms that antimicrobial resistance kills children as well as adults, said Dr. Rick Malley, a pediatric infectious disease specialist at Boston Children's Hospital.

The organisms that caused pneumonia in the children in Bangladesh are not only different than doctors might have expected, they are antibiotic resistant and deadly, Malley, who was not involved in the study, noted in a phone interview..

He and Harris both suggested an ideal solution would be the development of vaccines that target the pneumonia-causing infections.

Drug-resistant infections kill an estimated 700,000 people a year. As a result of the rising toll, the World Health Organization classifies antibiotic resistance as one of the greatest threats to global health. (https://bit.ly/3i9XipZ)

Pneumonia accounts for 12% of all deaths in children under 5 in Bangladesh, prior research shows.

Chisti suspects that young children are more likely to die from pneumonia stemming from antibiotic-resistant infections than other age groups because they are more likely to suffer from malnutrition and diarrhea, he said in an email. Also, older children might have higher levels of immunity to the deadly pathogens, he said.

Aggravating the problem of antibiotic-resistant infections is the unregulated, over-the-counter dispensing of antibiotics in Bangladesh, Chisti said. Unqualified providers dispense antibiotics without indication, including as preventatives and for viruses, a 2020 BMC Health Services Research study found. (https://bit.ly/3BucB5l)

It estimated that unqualified providers dispensed 63% of antibiotic prescriptions, and nearly half of all primary healthcare consultations resulted in antibiotic prescriptions.

Providers described antibiotics as powerful medicines that quickly work against almost all diseases, the previous study found.

Similar patterns have been reported in India. (https://bit.ly/3x15YUK)

Chisti called on the World Health Organization to set guidelines to prohibit over-the-counter dispensing of antibiotics and to allow only qualified physicians to sell them.

"I hope the message gets around that this needs to be regulated," Harris said. "We have to treat this as a global problem. That means strengthening healthcare systems, improving water and sanitation, giving antibiotics to kids who need them and not to those who don't."

SOURCE: https://bit.ly/3iiQ56P Open Forum Infectious Diseases, online July 15, 2021.

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