{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T18:05:38Z","timestamp":1775844338041,"version":"3.50.1"},"reference-count":62,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"2","license":[{"start":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T00:00:00Z","timestamp":1770163200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,4]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>Antimicrobial resistance poses a growing threat to pediatric care, yet data on its clinical and economic burden in low-resource settings remain limited. The impact of antibiotic-resistant infections on mortality, hospital stay, and treatment costs was assessed among children admitted to a national referral hospital in Kenya in the present study. A retrospective review of medical records for pediatric patients (0\u201312 years) hospitalized with bacterial infections between January 2017 and December 2021 was conducted. Diagnoses included gastroenteritis, pneumonia, sepsis, urinary tract infections, meningitis, and others. Data on treatment, laboratory testing, outcomes, hospital stays, and costs were abstracted. Statistical analyses included Kaplan\u2013Meier survival curves, Cox regression, and mixed-effects negative binomial and generalized linear models. Among 1,608 patients, 63% were infants, and 38% were referrals. Gastroenteritis (46%) and pneumonia (28%) were the most common diagnoses. Antibiotic-resistant infections occurred in 27% of participants and were associated with higher mortality (26% versus 9% in susceptible participants) and an attributable risk of 17%; the population attributable fraction was 65%. After adjustment, resistance was associated with increased mortality (HR 1.44), longer hospital stays (60% increase), and higher treatment costs (33% increase). Antimicrobial resistance significantly increases mortality, hospital stays, and healthcare costs in pediatric patients. Strengthening diagnostics, antimicrobial stewardship, and policy interventions is critical to address this threat.<\/jats:p>","DOI":"10.4269\/ajtmh.25-0440","type":"journal-article","created":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T15:32:44Z","timestamp":1764689564000},"page":"216-223","source":"Crossref","is-referenced-by-count":0,"title":["Burden of Antibiotic Resistance in Hospitalized Children in Kenya: Associations with Mortality, Hospital Stay, and Treatment Costs"],"prefix":"10.4269","volume":"114","author":[{"given":"Veronicah","family":"Chuchu","sequence":"first","affiliation":[{"name":"Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya;"},{"name":"Washington State University Global Health Kenya, Nairobi, Kenya;"},{"name":"Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya;"},{"name":"FIND, Geneva, Switzerland;"},{"name":"Commonwealth Pharmacists Association, London, United Kingdom;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stanley","family":"Sayianka","sequence":"additional","affiliation":[{"name":"Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ita","family":"Teresa","sequence":"additional","affiliation":[{"name":"Washington State University Global Health Kenya, Nairobi, Kenya;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irene","family":"Inwani","sequence":"additional","affiliation":[{"name":"Kenyatta National Hospital, Nairobi, Kenya;"},{"name":"Department of Paediatrics, University of Nairobi, Nairobi, Kenya;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julius","family":"Oyugi","sequence":"additional","affiliation":[{"name":"University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"SM","family":"Thumbi","sequence":"additional","affiliation":[{"name":"Washington State University Global Health Kenya, Nairobi, Kenya;"},{"name":"Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya;"},{"name":"University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya;"},{"name":"Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, United Kingdom;"},{"name":"Paul G. Allen School for Global Health, Washington State University, Pullman, Washington"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sylvia","family":"Omulo","sequence":"additional","affiliation":[{"name":"Washington State University Global Health Kenya, Nairobi, Kenya;"},{"name":"University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya;"},{"name":"Paul G. Allen School for Global Health, Washington State University, Pullman, Washington"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","article-title":"Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report.","year":"2020"},{"key":"b2","series-title":"Infect Drug Resist","first-page":"3903","article-title":"Antimicrobial resistance: Implications and costs","volume":"12","author":"Dadgostar","year":"2019"},{"key":"b3","article-title":"Drug-Resistant Infections: A Threat to Our Economic Future, Vol. 2, World Bank Report.","year":"2017"},{"key":"b4","article-title":"Tackling Drug-Resistant Infections Globally: Final Report and Recommendations \u2013 The Review on Antimicrobial Resistance.","author":"O\u2019Neill","year":"2016"},{"key":"b5","article-title":"Antimicrobial Resistance: Tackling a Crisis for the Health and Wealth of Nations.","author":"O\u2019Neill","year":"2014"},{"key":"b6","series-title":"BMC Med","first-page":"78","article-title":"Measuring and mapping the global burden of antimicrobial resistance","volume":"16","author":"Hay","year":"2018"},{"key":"b7","article-title":"Antimicrobial Resistance in G7 Countries and Beyond: Economic Issues, Policies and Options for Action.","author":"Cecchini","year":"2015"},{"key":"b8","series-title":"Lancet","first-page":"629","article-title":"Global burden of acterial antimicrobial resistance in 2019: A systematic analysis","volume":"399","year":"2022"},{"key":"b9","series-title":"J Glob Health","first-page":"010306","article-title":"Global disease burden due to antibiotic resistance \u2013 State of the evidence","volume":"6","author":"Woolhouse","year":"2016"},{"key":"b10","article-title":"Towards Specific Commitments and Action in the Response to Antimicrobial Resistance: Recommendations for Consideration by UN Member States in the Outcome Document of the High-Level Meeting on AMR in September 2024 Global Leaders Group on AMR Report.","year":"2024"},{"key":"b11","article-title":"Global Action Plan on Antimicrobial Resistance.","year":"2016"},{"key":"b12","article-title":"All for Health, Health for All WHO Investment Case Deep Dive: Antimicrobial Resistance.","year":"2024"},{"key":"b13","article-title":"National Policy on Prevention and Containment of Antimicrobial Resistance.","year":"2017"},{"key":"b14","series-title":"Front Public Heal","first-page":"1411962","article-title":"Progress made in digitalizing antimicrobial resistance surveillance in a One Health approach in Kenya","volume":"12","author":"Chuchu","year":"2024"},{"key":"b15","article-title":"High Prevalence of Antibiotic Resistance in Kenya.","year":"2017"},{"key":"b16","series-title":"Antimicrob Resist Infect Control","first-page":"18","article-title":"Carriage of antimicrobial-resistant bacteria in a high-density informal settlement in Kenya is associated with environmental risk-factors","volume":"10","author":"Omulo","year":"2021"},{"key":"b17","article-title":"Estimating the Economic Costs of Antimicrobial Resistance.","author":"Taylor","year":"2014"},{"key":"b18","article-title":"Diagnostic Stewardship: A Guide to Implementation in Antimicrobial Resistance Surveillance Sites.","year":"2016"},{"key":"b19","series-title":"PLoS One","first-page":"e0270048","article-title":"Point-prevalence survey of antibiotic use at three public referral hospitals in Kenya","volume":"17","author":"Omulo","year":"2022"},{"key":"b20","series-title":"Indian J Psychol Med","first-page":"121","article-title":"How to calculate sample size for different study designs in medical research?","volume":"35","author":"Charan","year":"2013"},{"key":"b21","series-title":"Front Cell Infect Microbiol","first-page":"892126","article-title":"Genomic transmission analysis of multidrug-resistant Gram-negative bacteria within a newborn unit of a Kenyan tertiary hospital: A four-month prospective colonization study","volume":"12","author":"Villinger","year":"2022"},{"key":"b22","author":"Chuchu","year":"2025"},{"key":"b23","series-title":"Chest","first-page":"S39","article-title":"A practical overview and reporting strategies for statistical analysis of survival studies","volume":"158","author":"Dey","year":"2020"},{"key":"b24","series-title":"PLoS One","first-page":"e0189621","article-title":"Clinical and economic impact of antibiotic resistance in developing countries: A systematic review and meta-analysis","volume":"12","author":"Founou","year":"2017"},{"key":"b25","series-title":"Lancet","first-page":"3027","article-title":"Global, regional, and national causes of under-5 mortality in 2000\u201315: An updated systematic analysis with implications for the Sustainable Development Goals","volume":"388","author":"Liu","year":"2016"},{"key":"b26","article-title":"Global Report on the Epidemiology and Burden of Sepsis: Current Evidence, Identifying Gaps and Future 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Chemother","first-page":"109","article-title":"Attributable hospital cost and length of stay associated with health care-associated infections caused by antibiotic-resistant gram-negative bacteria","volume":"54","author":"Mauldin","year":"2010"},{"key":"b1","article-title":"Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report.","year":"2020"},{"key":"b2","series-title":"Infect Drug Resist","first-page":"3903","article-title":"Antimicrobial resistance: Implications and costs","volume":"12","author":"Dadgostar","year":"2019"},{"key":"b3","article-title":"Drug-Resistant Infections: A Threat to Our Economic Future, Vol. 2, World Bank Report.","year":"2017"},{"key":"b4","article-title":"Tackling Drug-Resistant Infections Globally: Final Report and Recommendations \u2013 The Review on Antimicrobial Resistance.","author":"O\u2019Neill","year":"2016"},{"key":"b5","article-title":"Antimicrobial Resistance: Tackling a Crisis for the Health and Wealth of 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