Antimicrobial Susceptibility among Gram-Negative Isolates in Pediatric Patients in Europe from 2013-2018 Compared to 2004-2012: Results from the ATLAS Surveillance Study.

AIMS:Data on antimicrobial resistance (AMR) in the paediatric patient population are scarce. This study assessed the AMR rates and phenotype distribution of Gram-negative isolates in paediatric patients in Europe from 2004-2012 and 2013-2018. METHODS:Isolates that were collected were stratified by age groups (< 1, 1-5, 6-12, and 13-17 years) and regions (North-Western, Eastern and Southern Europe). Minimal inhibitory concentrations (broth microdilution) were interpreted according to European Committee on Antimicrobial Susceptibility Testing guidelines. Resistance rates and phenotype prevalence were identified for Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Haemophilus influenzae. RESULTS:In the overall paediatric patient population (0-17 years), extended-spectrum beta-lactamase (ESBL) production significantly decreased (from 20.7% to 15.4%, P < 0.0001) in Escherichia coli, whereas it increased for Klebsiella pneumoniae (from 35.0% to 39.2%, P = 0.015). Carbapenem resistance was highest for Acinetobacter baumannii (32.3%) compared with Klebsiella pneumoniae (4.7%) and Pseudomonas aeruginosa (12.4%) in 2013-2018, and rates were significantly increased relative to 2004-2012. There was no change in resistance to beta-lactam antimicrobials for Haemophilus influenzae. The lowest resistance rates for most organism groups were observed in North-Western Europe. CONCLUSIONS:The results revealed a significant increase in Klebsiella pneumoniae isolates with an ESBL and carbapenem-resistance phenotype as well as in carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa from 2004-2012 to 2013-2018. Conversely, a decrease in ESBL E. coli was observed. Continued surveillance and awareness of resistance in these bacteria causing serious infections is crucial for improving treatment quality in paediatric patients.