Rising Antimicrobial Resistance in Children Threatens Life-Saving Antibiotics Globally, Landmark Study Finds
Key Insights
A global analysis of over 106,000 pediatric infection samples across 82 countries found antibiotic resistance increased in every region between 2004 and 2022.
Gram-negative bacteria Acinetobacter baumannii (search) and Klebsiella (search) are driving resistance, with carbapenem (search) resistance projected to reach 82% and 35% respectively by 2035.
Babies, children in intensive care, and those in low-resource countries are most affected, with resistance rising fastest to WHO-classified 'Watch' and 'Reserve' antibiotics.
A world-first global monitoring platform has revealed that antimicrobial resistance (AMR) in children is rising across every region of the world and will continue to worsen over the next decade, threatening the effectiveness of life-saving antibiotics. The findings, published in JAMA Pediatrics, analyzed more than 106,000 infection samples from children aged up to 18 years across 82 countries, spanning nearly two decades from 2004 to 2022.
The research was led by Murdoch Children's Research Institute (MCRI) in collaboration with the University of Sydney, the Clinton Health Access Initiative (CHAI), and The Chinese University of Hong Kong. Babies and children in intensive care, as well as those in countries with fewer healthcare resources, were found to be the most affected.
Gram-Negative Superbugs Driving the Crisis
The increase in resistance is being driven largely by Gram-negative bacteria responsible for severe infections such as sepsis and pneumonia. Two pathogens in particular emerged as the most concerning: Acinetobacter baumannii (search), which commonly causes hospital-acquired bloodstream infections and pneumonia, showed the highest overall resistance; Klebsiella (search), a common cause of urinary tract infections and liver abscesses, recorded the fastest increase in resistance, particularly in Southeast Asia, Eastern Europe, and the Western Pacific.
Forecast modeling by the newly launched AMR in Kids platform suggests that by 2035, resistance to last-line carbapenem (search) antibiotics is projected to rise substantially, reaching 82% for Acinetobacter baumannii (search) and 35% for Klebsiella (search).
"Rising resistance to first- and now second-line drugs is the clinical reality for children," said MCRI Associate Professor Penelope Bryant. "Making antibiotic resistance in children visible, through AMR in Kids, is the first step towards changing its trajectory."
The AMR in Kids Platform: A New Surveillance Tool
The AMR in Kids website, created by the study team, allows clinicians, researchers, and policymakers to explore antibiotic resistance by country, bacteria, and antibiotic class. It also provides region- and pathogen-specific forecasts to 2035, helping researchers identify emerging threats, inform treatment decisions, and guide public health planning.
MCRI and University of Sydney Dr. Yanhong Jessika Hu explained that by combining almost two decades of global data with forecasting, the platform could identify where resistance was likely to emerge before it becomes an even greater clinical challenge. "Antimicrobial resistance is one of the biggest threats to children's health globally, but until now we haven't had a clear picture of how it's changing specifically in children," Dr. Hu said.
Disproportionate Impact on Vulnerable Populations
The study found that resistance rose most sharply to critical 'Watch' and 'Reserve' antibiotics, which the World Health Organization (WHO) classifies to limit overuse and help preserve their effectiveness when first-line treatments fail. While first-line access antibiotic resistance is declining or stabilizing in high-income regions, lower-resource settings are seeing a sharp rise in resistance to these critical backup drugs.
In 2021, approximately 840,000 deaths in children under five years were associated with antimicrobial resistance. CHAI Senior Clinical Director Associate Professor Joseph Harwell emphasized the urgency: "Better data is essential, but children can't wait for perfect data. We need to use the best available evidence to guide action now."
A Patient's Perspective
Harry Booth, 13, who was born with kidney failure and received a kidney transplant from his father at age four, has taken antibiotics for much of his life. His mother Eileen said doctors found that the bacteria causing his infections were resistant to several commonly used antibiotics. "Antibiotic resistance is quite alarming, especially for someone like Harry who gets a lot of infections because he's reliant on immunosuppressants," she said. "It means there are a lot of things that are off the table for him in terms of treatment."
Calls for Targeted Global Action
Associate Professor Bryant stressed that children have been overlooked in global antibiotic resistance surveillance, resulting in a lack of child-friendly antibiotic formulations and clear dosing guidelines. She called for differentiated strategies based on country income levels.
"In low-income countries we need to address unregulated antibiotic use and poor sanitation," Bryant said. "These countries need better access to diagnostic techniques and first-line antibiotics." In high-income countries, she noted, antibiotic overuse must be tackled across farming, veterinary, primary care, and hospital settings, while infection control remains critical.
Paediatrician and incoming president of the Australasian Society for Infectious Diseases, Professor Chris Blyth, described the study as "really important work," adding: "I'm frequently seeing children with difficult-to-treat infections that are resistant to first and second-line agents, where I'm having to reach for agents that are more difficult to get, more difficult to give, more expensive, and potentially more toxic."
Researchers from The Royal Children's Hospital, Brown University, and the University of Melbourne also contributed to the study.