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Antibiotics
Special Issues
Current Updates in Antimicrobial Resistance in Pediatric Patients
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Current Updates in Antimicrobial Resistance in Pediatric Patients

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotic Therapy in Infectious Diseases".

Deadline for manuscript submissions: closed (30 November 2023) | Viewed by 11151

Special Issue Editors

Dr. Corina Maria Vasile

E-Mail Website
Guest Editor
Department of Pediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, 33600 Bordeaux, France
Interests: echocardiography; pediatric cardiology, congenital heart disease; congenital cardiopathy in adults; artificial intelligence; automatic measurements
Special Issues, Collections and Topics in MDPI journals
Dr. Alicia Demirjian

E-Mail Website
Guest Editor
Department of Paediatric Infectious Diseases & Immunology, Evelina London Children's Hospital, London, UK
Interests: paediatric infectious diseases; paediatric antimicrobial stewardship; antimicrobial resistance

Special Issue Information

Dear Colleagues,

Antimicrobial resistance (AMR) is currently one of the most important threats to public health worldwide and should be considered a top priority by all public health professionals and institutions.

The prevalence of multidrug-resistant organisms (MDROs) is significantly increasing and is associated with significant morbidity and mortality in affected patients. MDR bacteria are more resistant to treatment and are associated with more severe and prolonged disease, leading to longer hospitalisation, with a 20% increase in the length of stay and deprivation outcomes, increasing mortality by up to 40% for hospital-acquired MDR infections.

Children are known to be the main beneficiaries of antimicrobial drugs compared to any other form of medication, as they are frequent subjects of infections of various aetiologies, from the most common urinary tract infections to the less common meningitis. The most important cause of modern antibiotic resistance is the inappropriate use of antibiotics.

Insufficient knowledge of the pathogens associated with different infections, along with the pharmacokinetic and pharmacodynamic properties of specific classes of antibiotics, underlies bacterial resistance. These characteristics have a significant impact on the drug selection process, on the correct dosage and on the duration of treatment.

In addition, antibiotics are still frequently prescribed for misdiagnosed conditions such as viral infections, especially in ambulatory care.

This Special Issue plans to provide an overview of the most recent advances in the field of antimicrobial resistance in pediatric patients.

Potential topics include, but are not limited to, the following:

  • Antimicrobial resistance;
  • Inappropriate antibiotics use in pediatrics;
  • Public health;
  • Adverse effects of antibiotics;
  • Multidrug-resistant bacteria;
  • Future perspectives for antimicrobial resistance;
  • Role of antimicrobial resistance in pediatric patients.

Dr. Corina Maria Vasile
Dr. Alicia Demirjian
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Related Special Issue

Published Papers (7 papers)

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17 pages, 1080 KiB  
Article
Rapid Detection of Antimicrobial Resistance Genes in Critically Ill Children Using a Custom TaqMan Array Card
by John A. Clark, Martin D. Curran, Theodore Gouliouris, Andrew Conway Morris, Rachel Bousfield, Vilas Navapurkar, Iain R. L. Kean, Esther Daubney, Deborah White, Stephen Baker and Nazima Pathan
Antibiotics 2023, 12(12), 1701; https://doi.org/10.3390/antibiotics12121701 - 05 Dec 2023
Viewed by 1016
Abstract
Bacteria are identified in only 22% of critically ill children with respiratory infections treated with antimicrobial therapy. Once an organism is isolated, antimicrobial susceptibility results (phenotypic testing) can take another day. A rapid diagnostic test identifying antimicrobial resistance (AMR) genes could help clinicians [...] Read more.
Bacteria are identified in only 22% of critically ill children with respiratory infections treated with antimicrobial therapy. Once an organism is isolated, antimicrobial susceptibility results (phenotypic testing) can take another day. A rapid diagnostic test identifying antimicrobial resistance (AMR) genes could help clinicians make earlier, informed antimicrobial decisions. Here we aimed to validate a custom AMR gene TaqMan Array Card (AMR-TAC) for the first time and assess its feasibility as a screening tool in critically ill children. An AMR-TAC was developed using a combination of commercial and bespoke targets capable of detecting 23 AMR genes. This was validated using isolates with known phenotypic resistance. The card was then tested on lower respiratory tract and faecal samples obtained from mechanically ventilated children in a single-centre observational study of respiratory infection. There were 82 children with samples available, with a median age of 1.2 years. Major comorbidity was present in 29 (35%) children. A bacterial respiratory pathogen was identified in 13/82 (16%) of children, of which 4/13 (31%) had phenotypic AMR. One AMR gene was detected in 49/82 (60%), and multiple AMR genes were detected in 14/82 (17%) children. Most AMR gene detections were not associated with the identification of phenotypic AMR. AMR genes are commonly detected in samples collected from mechanically ventilated children with suspected respiratory infections. AMR-TAC may have a role as an adjunct test in selected children in whom there is a high suspicion of antimicrobial treatment failure. Full article
(This article belongs to the Special Issue Current Updates in Antimicrobial Resistance in Pediatric Patients)
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17 pages, 2480 KiB  
Article
Bacterial Species and Antibiotic Resistance—A Retrospective Analysis of Bacterial Cultures in a Pediatric Hospital
by Bianca Prajescu, Liana Gavriliu, Mara Ioana Iesanu, Andreea Ioan, Anca Andreea Boboc, Catalin Boboc and Felicia Galos
Antibiotics 2023, 12(6), 966; https://doi.org/10.3390/antibiotics12060966 - 26 May 2023
Cited by 1 | Viewed by 1323
Abstract
Antimicrobial resistance (AMR) has become a major healthcare concern having a rising incidence, especially in pediatric patients who are more susceptible to infections. The aim of our study was to analyze the bacterial species isolated from patients admitted to our tertiary hospital and [...] Read more.
Antimicrobial resistance (AMR) has become a major healthcare concern having a rising incidence, especially in pediatric patients who are more susceptible to infections. The aim of our study was to analyze the bacterial species isolated from patients admitted to our tertiary hospital and their AMR profiles. We conducted a retrospective observational study by examining the bacterial cultures collected from pediatric patients admitted to our hospital over a period of one year. We identified the most common bacterial species from 1445 clinical isolates and their AMR patterns using standard microbiological techniques. Our analysis revealed that the most frequently isolated bacterial species were Escherichia coli (23.73%), Staphylococcus aureus (15.64%), Klebsiella species (12.04%), and Pseudomonas species (9.96%). Additionally, these species exhibited varying levels of resistance to commonly used antibiotics. Notably, we observed high rates of resistance among Gram-negative bacteria, including extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella species. Among Gram-positive bacteria, we observed a high level of methicillin-resistant Staphylococcus aureus. Our findings highlight the urgent need for effective antibiotic management programs and infection control measures to address the rising incidence of AMR in pediatric hospitals. Further research is needed to identify the mechanisms of resistance in these bacterial species and to develop new strategies for preventing and treating infections caused by antibiotic-resistant bacteria in pediatric patients. Full article
(This article belongs to the Special Issue Current Updates in Antimicrobial Resistance in Pediatric Patients)
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10 pages, 913 KiB  
Article
The Prevalence of Carbapenemase-Producing Microorganisms and Use of Novel Cephalosporins for the Treatment of Severe Infections Caused by Carbapenem-Resistant Gram-Negative Bacteria in a Pediatric Cardiac Intensive Care Unit
by Costanza Tripiciano, Lorenza Romani, Stefania Mercadante, Laura Cursi, Martina Di Giuseppe, Francesca Ippolita Calo Carducci, Tiziana Fragasso, Luca Di Chiara, Cristiana Garisto, Annamaria Sisto, Leonardo Vallesi, Valentino Costabile, Laura Lancella, Paola Bernaschi and Maia De Luca
Antibiotics 2023, 12(5), 796; https://doi.org/10.3390/antibiotics12050796 - 22 Apr 2023
Cited by 1 | Viewed by 1439
Abstract
Background: The spread of carbapenem-resistant organisms (CROs) is an increasingly serious threat globally, especially in vulnerable populations, such as intensive care unit (ICU) patients. Currently, the antibiotic options for CROs are very limited, particularly in pediatric settings. We describe a cohort of pediatric [...] Read more.
Background: The spread of carbapenem-resistant organisms (CROs) is an increasingly serious threat globally, especially in vulnerable populations, such as intensive care unit (ICU) patients. Currently, the antibiotic options for CROs are very limited, particularly in pediatric settings. We describe a cohort of pediatric patients affected by CRO infections, highlighting the important changes in carbapenemase production in recent years and comparing the treatment with novel cephalosporins (N-CEFs) to Colistin-based regimens (COLI). Methods: All patients admitted to the cardiac ICU of the Bambino Gesù Children’s Hospital in Rome during the 2016–2022 period with an invasive infection caused by a CRO were enrolled. Results: The data were collected from 42 patients. The most frequently detected pathogens were Pseudomonas aeruginosa (64%), Klebsiella pneumoniae (14%) and Enterobacter spp. (14%). Thirty-three percent of the isolated microorganisms were carbapenemase producers, with a majority of VIM (71%), followed by KPC (22%) and OXA-48 (7%). A total of 67% of patients in the N-CEF group and 29% of patients in the comparative group achieved clinical remission (p = 0.04). Conclusion: The increase over the years of MBL-producing pathogens in our hospital is challenging in terms of therapeutic options. According to the present study, N-CEFs are a safe and effective option in pediatric patients affected by CRO infections. Full article
(This article belongs to the Special Issue Current Updates in Antimicrobial Resistance in Pediatric Patients)
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12 pages, 279 KiB  
Article
Antimicrobial Defined Daily Dose in Neonatal Population: Validation in the Clinical Practice
by Cristina Villanueva-Bueno, Elena Montecatine-Alonso, Francisco Jiménez-Parrilla, María González-López, Silvia Manrique-Rodríguez, Francisco Moreno-Ramos, Carme Cañete-Ramírez, Elisenda Dolz, Ana García-Robles, José Manuel Caro-Teller, María Teresa Moral-Pumarega, Elena Bergon-Sendin, María Teresa Gómez-Trevecedo Calvo, Carmen Gallego-Fernández, Concepción Álvarez del Vayo-Benito, Marta Mejías-Trueba, María Victoria Gil-Navarro and Paediatric Antimicrobial Defined Daily Dose Study Group (KiDDDs)
Antibiotics 2023, 12(3), 602; https://doi.org/10.3390/antibiotics12030602 - 17 Mar 2023
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Abstract
Background: Currently, there is no validated method for estimating antimicrobial consumption in the neonatal population, as it exists for adults using Defined Daily Doses (DDD). In neonatology, although there are different methods, each one with advantages and disadvantages, there is no unified criterion [...] Read more.
Background: Currently, there is no validated method for estimating antimicrobial consumption in the neonatal population, as it exists for adults using Defined Daily Doses (DDD). In neonatology, although there are different methods, each one with advantages and disadvantages, there is no unified criterion for use. The aim of this study is to validate the neonatal DDD designed as a new standardised form of antimicrobial consumption over this population. Methods: The validation of the neonatal DDD, Phase II of the research project, was carried out through a descriptive observational study. Periodic cut-offs were performed to collect antimicrobial prescriptions of neonates admitted to the neonatology and intensive care units of nine Spanish hospitals. The data collected included demographic variables (gestational age, postnatal age, weight and sex), antimicrobial dose, frequency and route of administration. The selection of the optimal DDD value takes into account power value, magnitude obtained from the differences in the DDD, statistical significance obtained by the Wilcoxon test and degree of agreement in the stipulated doses. Results: Set of 904 prescriptions were collected and finally 860 were analysed based on the established criteria. The antimicrobials were mostly prescribed in the intensive care unit (63.1%). 32 different antimicrobials were collected, and intravenous administration was the most commonly used route. Neonatal DDD were defined for 11 different antimicrobials. A potency > 80% was obtained in 7 antibiotics. The 57.1% of the selected DDD correspond to phase I and 21.4% from phase II. Conclusion: DDD validation has been achieved for the majority of intravenously administered antimicrobials used in clinical practice in the neonatal population. This will make it possible to have an indicator that will be used globally to estimate the consumption of antimicrobials in this population, thus confirming its usefulness and applicability. Full article
(This article belongs to the Special Issue Current Updates in Antimicrobial Resistance in Pediatric Patients)

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10 pages, 266 KiB  
Case Report
Off-Label Use of Ceftazidime/Avibactam for the Treatment of Pan-Drug-Resistant Klebsiella pneumoniae in a Neonate: Case Report and Literature Review
by Iliya Mangarov, Ralitsa Georgieva, Valentina Petkova and Irina Nikolova
Antibiotics 2023, 12(8), 1302; https://doi.org/10.3390/antibiotics12081302 - 09 Aug 2023
Cited by 1 | Viewed by 1366
Abstract
Background: Klebsiella pneumoniae is among the most common Gram-negative bacteria isolated to neonatal intensive care units (NICU) and one of the leading causes of morbidity and mortality. The ceftazidime/avibactam (CAZ-AVI) combination is approved for infections caused by aerobic Gram-negative organisms. It is licensed [...] Read more.
Background: Klebsiella pneumoniae is among the most common Gram-negative bacteria isolated to neonatal intensive care units (NICU) and one of the leading causes of morbidity and mortality. The ceftazidime/avibactam (CAZ-AVI) combination is approved for infections caused by aerobic Gram-negative organisms. It is licensed for use in infants over 3 months old. There are no safety and efficacy data regarding the administration of CAZ-AVI to infants younger than 3 months, except for a few case reports. Case presentation: This report describes a severely intoxicated 24-day-old, full-term, male neonate transferred to NICU level III from a secondary maternity hospital due to the deterioration of his general condition. On day four of admission, blood culture revealed the pan-drug-resistant (PDR) K. pneumoniae ss. pneumoniae, susceptible only to CAZ-AVI, which thus represented the only treatment option. Off-label CAZ-AVI was administered intravenously as a salvage therapy. Conclusions: In healthcare settings, treating resistant K. pneumoniae presents serious challenges, especially in NICU patients. The off-label treatment with CAZ-AVI for 17 days was safe and effective in this one-month-old patient. A year later, the patient was healthy with normal cognitive development. Full article
(This article belongs to the Special Issue Current Updates in Antimicrobial Resistance in Pediatric Patients)
11 pages, 4043 KiB  
Case Report
Neonatal Brain Abscess with Serratia marcescens after Intrauterine Infection: A Case Report
by Mihaela Bizubac, Francisca Balaci-Miroiu, Cristina Filip, Corina Maria Vasile, Carmen Herișeanu, Veronica Marcu, Sergiu Stoica and Catalin Cîrstoveanu
Antibiotics 2023, 12(4), 722; https://doi.org/10.3390/antibiotics12040722 - 07 Apr 2023
Cited by 1 | Viewed by 1684
Abstract
Brain abscesses are a possible complication of bacterial sepsis or central nervous system infection but are uncommon in the neonatal period. Gram-negative organisms often cause them, but Serratia marcescens is an unusual cause of sepsis and meningitis in this age group. This pathogen [...] Read more.
Brain abscesses are a possible complication of bacterial sepsis or central nervous system infection but are uncommon in the neonatal period. Gram-negative organisms often cause them, but Serratia marcescens is an unusual cause of sepsis and meningitis in this age group. This pathogen is opportunistic and frequently responsible for nosocomial infections. Despite the existing antibiotics and modern radiological tools, mortality and morbidity remain significant in this group of patients. We report an unusual unilocular brain abscess in a preterm neonate caused by Serratia marcescens. The infection had an intrauterine onset. The pregnancy was achieved through assisted human reproduction techniques. It was a high-risk pregnancy, with pregnancy-induced hypertension, imminent abortion, and required prolonged hospitalization of the pregnant woman with multiple vaginal examinations. The infant was treated with multiple antibiotic cures and percutaneous drainage of the brain abscess associated with local antibiotic treatment. Despite treatment, evolution was unfavorable, complicated by fungal sepsis (Candida parapsilosis) and multiple organ dysfunction syndrome. Full article
(This article belongs to the Special Issue Current Updates in Antimicrobial Resistance in Pediatric Patients)
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9 pages, 3504 KiB  
Case Report
Gemella sanguinis Infective Endocarditis—Challenging Management of an 8-Year-Old with Duchenne Dystrophy and Undiagnosed Congenital Heart Disease: A Case Report
by Cristina Filip, Corina Maria Vasile, Georgiana Nicolae, Irina Margarint, Loredana Popa, Mihaela Bizubac, Gabriela Ganea, Mihaela Rusu, Bruno Murzi, Mihaela Balgradean and Catalin Cirstoveanu
Antibiotics 2023, 12(4), 706; https://doi.org/10.3390/antibiotics12040706 - 04 Apr 2023
Viewed by 1711
Abstract
Congenital heart disease (CHD) remains a predisposing cardiac condition for infective endocarditis (IE). Case report: We present the case of 8-year-old boy with no known pre-existing cardiac disease diagnosed with infective endocarditis (IE) with Gemella sanguinis. After admission, he underwent transthoracic echocardiography (TTE), [...] Read more.
Congenital heart disease (CHD) remains a predisposing cardiac condition for infective endocarditis (IE). Case report: We present the case of 8-year-old boy with no known pre-existing cardiac disease diagnosed with infective endocarditis (IE) with Gemella sanguinis. After admission, he underwent transthoracic echocardiography (TTE), which revealed the presence of Shone syndrome with a bicuspid valve, mitral parachute valve and severe aortic coarctation. He developed a paravalvular aortic abscess with severe aortic regurgitation and left ventricle (LV) systolic dysfunction for which he required a complex surgical intervention after six weeks of antibiotic treatment, consisting of Ross operation and coarctectomy, with a complicated postoperative course, cardiac arrest and ECMO support for five days. The evolution was slow and favorable, with no significant residual valvular lesions. However, persistent LV systolic dysfunction and increased muscle enzymes required further investigation to establish a genetic diagnosis of Duchenne disease. As Gemella is not considered a frequent pathogen of IE, no current guidelines refer specifically to it. Additionally, the predisposing cardiac condition of our patient is not currently classified as “high-risk” for IE; this is not considered an indication for IE prophylaxis in the current guidelines. Conclusion: This case illustrates the importance of accurate bacteriological diagnosis in infective endocarditis and poses concerns regarding the necessity of IE prophylaxis in “moderate risk” cardiac conditions such as congenital valvular heart disease, especially aortic valve malformations. Full article
(This article belongs to the Special Issue Current Updates in Antimicrobial Resistance in Pediatric Patients)
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