Department of Pediatrics Indiana University School of Medicine, Ryan White Center for Pediatric Infectious Disease and Global Health, Indianapolis, IN, USA.
Paediatr Int Child Health. 2021 Feb;41(1):65-75. doi: 10.1080/20469047.2020.1853350. Epub 2020 Dec 11.
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.
婴儿、儿童和青少年面临危及生命的、耐药的感染风险。耐药结核、艾滋病毒和革兰氏阴性病原体的全球负担对儿科年龄组有特殊影响，需要制定以儿科为重点的议程来应对新出现的耐药问题。需要采取专门的方法在全球儿科人群中发现、成功治疗和预防耐药感染。挑战包括耐药感染的诊断和鉴定、新型抗菌药物或适合儿科的制剂获取有限、获取研究和临床试验的机会有限，以及与预防和成功完成治疗相关的实施挑战。在这篇综述中，突出强调了儿童中结核病、艾滋病毒和革兰氏阴性病原体中新出现的耐药问题的特殊复杂性，同时关注临床和公共卫生挑战。概述了以儿科为重点的解决抗菌素耐药问题议程的关键原则。其中包括提供高质量的护理、增加获得关键诊断的公平性、在全球范围内扩大抗菌药物管理和感染预防、以及加强卫生系统。需要增加对研究的投入，包括临床试验。进一步研究和实施针对儿童为中心的艾滋病毒和结核病等感染的护理模式和策略，可以显著改善治疗效果，避免耐药性的产生。由于目前新型冠状病毒 SARS-CoV-2 的全球大流行有可能破坏脆弱人群的卫生系统和服务，现在是减轻耐药感染发病率潜在激增的关键时期。
