{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T15:52:03Z","timestamp":1791215523702,"version":"4.1.0"},"reference-count":40,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Pediatr"],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:sec id=\"ab-poi260040-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Antimicrobial resistance (AMR) threatens effective treatment of severe childhood infections, but multiregional data about pediatric AMR remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-poi260040-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess geographic and temporal AMR trends among children for World Health Organization (WHO) priority pathogens using the WHO Access, Watch, and Reserve (AWaRe) antibiotic classification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-poi260040-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This multiregional surveillance study analyzed pediatric bacterial isolates from the Antimicrobial Testing Leadership and Surveillance (ATLAS) database between January 2004 and December 2022. The analysis included 106\u202f581 isolates from 106\u202f581 children aged 0 to 18 years in 82 countries. Data were analyzed from February 2024 to April 2026.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-poi260040-7\">\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>Resistance to AWaRe-categorized antibiotics in WHO priority bacterial pathogens.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-poi260040-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Temporal trends in resistance were evaluated using linear and nonlinear models, by geographic region, age, setting, and infection. Spatiotemporal generalized additive models were applied to estimate resistance trajectories and forecast to 2035.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-poi260040-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 106\u202f581 children included in this study, 47% were aged 0 to 2 years, 35% were aged 3 to 12 years, and 18% were aged 13 to 18 years; 58\u202f620 (55%) were male. From 2004 to 2022, pediatric AMR increased in all regions, with consistently higher resistance levels and faster growth in resource-limited settings. Resistance to any Access-group antibiotic was highest overall at a mean of 36% (range, 2%-66%), with resistance to Watch-group antibiotics at a mean of 22% (range, 1%-47%) and Reserve-group antibiotics at a mean of 13% (range, 0%-30%). Resistance to antibiotics in the Watch and Reserve groups increased most rapidly in intensive care units, wherein Watch-group antibiotic resistance increased from 15% (517\/3564) to 33% (2910\/8748) (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001), especially in those aged 0 to 2 years (12% [325\/2649] to 32% [1257\/3959];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001) and those with sepsis (15% [298\/2030] to 30% [1409\/4705];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001) and respiratory infections [12% [657\/5324] to 29% [3311\/11507];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001).\n                      <jats:italic toggle=\"yes\">Acinetobacter baumannii<\/jats:italic>\n                      had the highest overall resistance (more than 55% in every AWaRe category), while\n                      <jats:italic toggle=\"yes\">Klebsiella<\/jats:italic>\n                      species increased fastest, particularly to third- or fourth-generation cephalosporins and carbapenems in Southeast Asia, Eastern Europe, and the Western Pacific. Projections suggested stabilization of resistance to Access antibiotics but continued increases in resistance to antibiotics in the Watch and Reserve groups, especially in Gram-negative pathogens. By 2035, carbapenem resistance was projected to be 35% (95% uncertainty interval [UI], 29%-40%) in\n                      <jats:italic toggle=\"yes\">Klebsiella<\/jats:italic>\n                      species and 82% (95% UI, 77%-85%) in\n                      <jats:italic toggle=\"yes\">A baumannii<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-poi260040-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>Pediatric AMR increased in all regions across the study period, driven primarily by escalating resistance among Gram-negative pathogens responsible for sepsis and pneumonia. These trends threaten the effectiveness of empiric therapy for severe childhood infections, particularly in settings with limited alternative treatment options.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamapediatrics.2026.2808","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T15:30:39Z","timestamp":1784561439000},"page":"1125","source":"Crossref","is-referenced-by-count":2,"title":["Childhood Antimicrobial Resistance With Global Forecasts"],"prefix":"10.1001","volume":"180","author":[{"given":"Yanhong Jessika","family":"Hu","sequence":"first","affiliation":[{"name":"School of Public Health, The University of Sydney, Camperdown, Sydney, New South Wales, Australia"},{"name":"Murdoch Children\u2019s Research Institute, The Royal Children\u2019s Hospital, Parkville, Victoria, Australia"},{"name":"Sydney Infectious Diseases Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, 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