ABSTRACT

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.

摘要

婴儿，儿童和青少年处于危及生命的耐药菌感染风险中。耐药结核病，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，因此有必要以儿科为重点的议程来应对新出现的耐药性。需要专门的方法来发现，成功治疗和预防全球儿科人群的耐药性感染。挑战包括耐药性感染的诊断和鉴定，获得新型抗微生物药或儿科友好型制剂的途径有限，获得研究和临床试验的途径有限以及与预防和成功完成治疗相关的实施挑战。在这篇评论中，儿童结核病，艾滋病毒和革兰氏阴性病原体新出现的耐药性的特殊复杂性，强调了对临床和公共卫生挑战的关注。概述了以儿科为重点的议程中解决抗菌素耐药性的关键原则。其中包括护理质量，增加对关键诊断手段的公平获取，在全球范围内扩展抗菌素管理和预防感染以及加强卫生系统。需要增加对包括临床试验在内的研究的访问。进一步研究和实施以儿童或青少年为中心的感染（例如艾滋病毒和结核病）管理模式和策略，可以极大地改善治疗效果并避免耐药性的发展。由于目前全球流行的新型冠状病毒SARS-CoV-2威胁着破坏卫生系统和为脆弱人群提供的服务，