VIENNA, Austria – A grim new study reveals the devastating global impact of antibiotic resistance, with at least three million children worldwide succumbing to infections caused by drug-resistant bacteria in 2022 alone. The alarming findings, presented at the European Congress of Clinical Microbiology and Infectious Diseases (ESCMID) in Vienna, underscore the critical threat posed by the overuse and misuse of antibiotics.

Antibiotic resistance occurs when bacteria evolve and become impervious to the drugs designed to kill them, allowing them to survive and multiply even in the presence of medication. This phenomenon is exacerbated by the inappropriate and excessive use of antibiotics, a practice this research strongly suggests is rampant.

The research team, led by Professor Joseph Howard of Brown University's Warren Alpert Medical School, analyzed global data and estimated the staggering number of pediatric deaths directly attributable to antibiotic-resistant infections in the specified year.

The World Health Organization (WHO) categorizes 39 essential antibiotics into three groups: Access, Watch, and Reserve (AWaRe). The Access group includes first-line antibiotics with a lower resistance risk, widely used for treating common infections. The Watch group encompasses antibiotics with a higher potential for resistance and are recommended for specific, limited uses. The Reserve group represents last-resort antibiotics, intended for treating severe infections caused by multidrug-resistant organisms when all other options have failed. Critically, Reserve antibiotics should not be used as first-line treatments. Multidrug-resistant organisms (MDROs) are bacteria resistant to multiple classes of antibiotics.

The study's findings paint a stark picture of regional disparities. Southeast Asia recorded the highest number of antibiotic resistance-related child deaths in 2022, with an estimated 752,000 fatalities, followed by Africa with 659,000 deaths. A concerning trend in these regions is the increased consumption of Watch and Reserve antibiotics. Between 2019 and 2021, the use of Watch antibiotics surged by 160% in Southeast Asia and 126% in Africa. Over the same period, Reserve antibiotic usage climbed by 45% and a staggering 125% in these regions, respectively. This dramatic increase strongly indicates a significant rise in antibiotic misuse. The research further suggests that approximately two million of the three million child deaths linked to antibiotic resistance in 2022 were associated with the use of Watch and Reserve category antibiotics.

"The increased use of Watch and Reserve antibiotics poses a serious long-term risk," warned the research team. "As their use escalates, the risk of resistance intensifies, and treatment options become increasingly limited. If resistance develops even to Watch and Reserve antibiotics, there will be very few, if any, alternatives left to treat multidrug-resistant infections."

Low- and middle-income countries (LMICs) face a particularly uphill battle against antibiotic resistance due to a confluence of factors beyond antibiotic misuse. These include overcrowded hospitals, poor sanitation and hygiene practices, weak infection prevention and control measures, a lack of adequate diagnostic tools, misdiagnosis, and the absence of robust national surveillance programs. The research team emphasized the urgent need for "global guidelines and controlled interventions specifically targeting children, who are particularly vulnerable to antibiotic resistance."

The problem is not confined to developing nations. South Korea also grapples with significant antibiotic resistance challenges. Data released by the Korea Disease Control and Prevention Agency (KDCA) in the previous month revealed that South Korea's antibiotic consumption rate in 2019 ranked third highest among Organization for Economic Cooperation and Development (OECD) countries. Further highlighting the issue, a 2019 Health Insurance Review and Assessment Service (HIRA) report indicated that 26.1% of antibiotic prescriptions across 75 hospitals in South Korea were deemed inappropriate.

Alarmingly, South Korea is also witnessing a rise in deaths associated with resistance to carbapenem antibiotics, a class considered the last line of defense against highly resistant bacteria. Fatalities linked to carbapenem resistance surged from 203 in 2019 to 663 in 2023, representing a more than threefold increase. While the South Korean government has been implementing the "National Action Plan for Antimicrobial Resistance" since 2016, the aging population and increased antibiotic use and resistance rates in long-term care hospitals are contributing to the rising death toll. Experts advocate for broader surveillance and management efforts, extending beyond hospital settings to include antibiotic use in agriculture, livestock, and fisheries.

The findings of this study serve as a stark reminder of the urgent need for global collaborative action to combat antibiotic resistance. This includes promoting responsible antibiotic use in human and animal health, strengthening infection prevention and control measures, improving access to diagnostics, and developing new antibiotics and alternative therapies. Failure to address this growing crisis will undoubtedly lead to further preventable deaths and undermine decades of progress in public health.

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