Antimicrobial resistance in Staphylococcus aureus and Enterococci spp. isolates from bloodstream infections in Australian children, 2013 - 2021

Anita Williams; Geoffrey W Coombs; Jan M Bell; Denise A Daley; Shakeel Mowlaboccus; Penelope Bryant; Anita Campbell; Louise Cooley; Jon Iredell; Adam D Irwin; Alison Kesson; Brendan McMullan; Morgyn S Warner; Phoebe Williams; Christopher C Blyth

doi:10.1093/jpids/piae110

Antimicrobial resistance in Staphylococcus aureus and Enterococci spp. isolates from bloodstream infections in Australian children, 2013 - 2021

J Pediatric Infect Dis Soc. 2024 Oct 28:piae110. doi: 10.1093/jpids/piae110. Online ahead of print.

Authors

Anita Williams¹, Geoffrey W Coombs^{2

3

4}, Jan M Bell⁵, Denise A Daley^{3

4}, Shakeel Mowlaboccus^{2

3

4}, Penelope Bryant^{6

7

8}, Anita Campbell^{1

9

10}, Louise Cooley^{11

12}, Jon Iredell^{13

14

15

16}, Adam D Irwin^{17

18}, Alison Kesson^{14

19}, Brendan McMullan^{20

21}, Morgyn S Warner^{22

23}, Phoebe Williams^{14

21

24}, Christopher C Blyth^{1

9

10

25}

Affiliations

¹ Wesfarmers Centre of Vaccines and Infectious Diseases, The Kids Research Institute Australia, Nedlands, WA.
² Antimicrobial Resistance and Infectious Diseases (AMRID) Research Laboratory, Murdoch University, Murdoch, WA.
³ Department of Microbiology, PathWest Laboratory Medicine WA, Fiona Stanley Hospital, Murdoch, WA.
⁴ Australian Group on Antimicrobial Resistance, Fiona Stanley Hospital, Murdoch, WA.
⁵ Australian Group on Antimicrobial Resistance, Adelaide, SA.
⁶ Infectious Diseases, The Royal Children's Hospital Melbourne, Parkville, VIC.
⁷ Department of Paediatrics, University of Melbourne, Parkville, Victoria.
⁸ Murdoch Children's Research Institute, Parkville, Victoria.
⁹ Department of Infectious Diseases, Perth Children's Hospital, Nedlands, WA.
¹⁰ Division of Paediatrics, School of Medicine, University of Western Australia, Nedlands, WA.
¹¹ Department of Microbiology and Infectious Diseases, Royal Hobart Hospital, Hobart, Tasmania.
¹² School of Medicine, University of Tasmania, Hobart, Tasmania.
¹³ Centre for Infectious Diseases and Microbiology, The Westmead Institute for Medical Research, Westmead, NSW.
¹⁴ Faculty of Medicine and Health, University of Sydney, Sydney, NSW.
¹⁵ Westmead Hospital, Western Sydney Local Health District, Westmead, NSW.
¹⁶ Sydney Institute for Infectious Disease, The University of Sydney, Sydney, NSW.
¹⁷ UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland.
¹⁸ Infection Management and Prevention Service, Queensland Children's Hospital, Brisbane, Queensland.
¹⁹ Department of Infectious Disease & Microbiology, The Children's Hospital at Westmead, Westmead, NSW.
²⁰ School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW.
²¹ Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney Children's Hospitals Network, Randwick, NSW.
²² Microbiology & Infectious Diseases Directorate, SA Pathology, Central Adelaide Local Health Network, Adelaide, SA.
²³ Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA.
²⁴ School of Women and Children's Health, University of New South Wales, Kensington, NSW.
²⁵ Department of Microbiology, PathWest Laboratory Medicine WA, QEII Medical Centre, Nedlands, WA.

PMID: 39468748
DOI: 10.1093/jpids/piae110

Abstract

Background: Rising proportions of antimicrobial resistance (AMR) have been observed in both Staphylococcus aureus and Enterococcus spp. isolates.

Methods: The Australian Group on Antimicrobial Resistance (AGAR) surveillance program captures clinical and microbiological data of isolates detected in blood cultures across Australia. EUCAST 2022 was used for MIC interpretation and the AMR package in R for data analysis.

Results: There were 2,091 BSIs with S. aureus and 534 enterococcal BSI episodes over the nine years. Three-quarters of S. aureus BSI episodes were community-onset (78.3%) whilst more than half of enterococcal BSIs were hospital-onset (56.9%). The median age for S. aureus BSIs was 6 years, whilst >50% enterococcal BSIs were in children <12 months old.Fifteen percent of S. aureus isolates were methicillin-resistant (MRSA). Overall, 85.3% of S. aureus were resistant to penicillin, 12.5% resistant to erythromycin, 10.3% to clindamycin, and 4.7% to ciprofloxacin. Resistance to penicillin decreased over time whilst clindamycin resistance increased.Resistance in Enterococcus spp. was almost entirely observed in E. faecium; only one E. faecalis isolate was ampicillin resistant, and no E. faecalis isolates were vancomycin or teicoplanin resistant. Seventy-three percent of E. faecium were resistant to ampicillin, 25.5% to vancomycin (VREfm) and 8.8% to teicoplanin.

Conclusion: Significant shifts in the epidemiology and resistance profiles of S. aureus and Enterococcus spp. BSIs in Australian children were observed, making clear the importance of age-stratified reporting in antimicrobial resistance data.

Keywords: Antimicrobial resistance; Australia; MRSA; VRE; pediatric.

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