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Pandemic of antibiotic resistance is under way, drug-resistant pneumonia killing children in Bangladesh

"If COVID-19 was a tsunami, then emerging antibiotic resistance is like a rising flood water" - says Jason Harris from the Massachusetts General Hospital for Children. Read to know the factors that are promoting antibiotic resistance.

Antibiotics are medicines used to prevent and treat bacterial infections. But when bacteria become antibiotic-resistant, it becomes harder to treat the infections they cause, resulting in higher medical costs, prolonged hospital stays, and increased mortality. Although antibiotic resistance occurs naturally, misuse of antibiotics in humans and animals is accelerating the process, according to the World Health Organsation (WHO). The UN health agency describes antibiotic resistance as the biggest threats to global health, food security, and development today. It has cautioned that a growing number of infections such as pneumonia, tuberculosis, gonorrhoea, and salmonellosis are becoming harder to treat as the antibiotics used to treat them become less effective.

A new study published in the journal Open Forum Infectious Diseases has also warned of an emerging pandemic of fatal antibiotic resistance that could spread around the globe. It highlighted an unusual pattern of deadly bacteria with resistance to all standard antibiotic therapy in children with pneumonia in Bangladesh.

The study was coauthored by researchers from Massachusetts General Hospital (MGH) with colleagues at the International Centre for Diarrhoeal Disease Research, Bangladesh (abbreviated as icddr,b). It was led by Mohammod Jobayer Chisti, MD, PhD, a senior scientist in icddr,b's Nutrition and Clinical Services Division.

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Kids dying of antibiotic-resistant bacterial infectionsin Bangladesh

Pneumonia is an infection of the lungs that causes fluid and pus to fill air sacs, producing cough, fever, trouble breathing, and other symptoms. Without effective treatment, the infection can be fatal. In fact, pneumonia is the most common cause of death in young children, according to the WHO. In small children, pneumonia can be caused by viruses, but certain types of bacteria like Staphylococcus ("staph"), Streptococcus ("strep"), and Haemophilus influenzae are common sources of infection, too. These bacterial causes of pneumonia usually respond well to antibiotic therapy. There are also vaccines for the latter two, which have saved countless lives worldwide.

However, researchers at icddr,b are witnessing an increasing number of young children with pneumonia who are highly resistant to treatment with standard antibiotics. Dozens of kids died of pneumonia between 2014 and 2017, despite receiving the World Health Organization's recommended antibiotics and enhanced respiratory support at the hospital affiliated with icddr,b, said Chisti.

Gram-negative bacteria responsible for 77% of pneumonia in Bangladesh

Chisti and his team examined health records of more than 4,000 children under age five with pneumonia admitted to their hospital between 2014 and 2017, and found a very different pattern of bacterial infections occurring. The usual staph and strep infections that commonly cause pneumonia were relatively rare, instead gram-negative bacteria were responsible for 77 percent of the infections, including Pseudomonas, E. coli, Salmonella and Klebsiella.

Unfortunately, the gram-negative bacteria found in these kids are notorious for being antibiotic resistant, noted Jason Harris, MD, MPH, co-first author of the study and chief of the division of Pediatric Global Health at the Massachusetts General Hospital for Children.

According to their study, some 40 percent of these gram-negative bacterial infections resisted treatment with first- and second-line antibiotics that are routinely used to treat pneumonia. Concerningly, children who had antibiotic-resistant bacterial infections were 17 times more likely than others without bacterial infections to die, the authors said.

These results are clear evidence that longstanding concerns that antibiotic resistance will become a deadly menace are no longer theoretical -- the problem has taken root, Harris added.

The researchers underscored an urgent need to address factors that are promoting antibiotic resistance such as misuse of antibiotics, inadequate lab testing for diagnosis of bacterial infections, lack of access to clean water and adequate sanitation before the problem spreads around the world.

"If COVID-19 was a tsunami, then emerging antibiotic resistance is like a rising flood water," said Harris in the article published in Science Daily.

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