Antimicrobial Resistance in Enterobacterales, Acinetobacter spp. and Pseudomonas aeruginosa Isolates From Bloodstream Infections in Australian Children, 2013-2021

Anita Williams¹, Geoffrey W Coombs^{2

3

4}, Jan M Bell⁵, Denise A Daley^{3

4}, Shakeel Mowlaboccus^{2

3

4}, Penelope A Bryant^{6

7

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

PMID: 39460715
DOI: 10.1093/jpids/piae111

Antimicrobial Resistance in Enterobacterales, Acinetobacter spp. and Pseudomonas aeruginosa Isolates From Bloodstream Infections in Australian Children, 2013-2021

Anita Williams et al. J Pediatric Infect Dis Soc. 2024.

. 2024 Dec 30;13(12):617-625.

doi: 10.1093/jpids/piae111.

Authors

Affiliations

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

PMID: 39460715
DOI: 10.1093/jpids/piae111

Abstract

Background: Gram-negative bloodstream infections are associated with significant morbidity and mortality in children. Increasing antimicrobial resistance (AMR) is reported globally, yet efforts to track pediatric AMR at a national level over time are lacking.

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: Over a 9-year period, there were 3145 bloodstream infections with 3266 gram-negative isolates reported in hospitalized children aged <18 years; 21.0% were from neonates. The median length of stay was 9 days, and 30-day all-cause mortality was 5.2%. A greater odds of death was observed in those with a multi-drug resistant organism (aOR: 2.1, 95% CI: 1.3, 3.3, p: 0.001). Escherichia coli (44.5%) and Klebsiella pneumoniae complex (12.6%) were the two most frequently reported organisms. Overall resistance in Enterobacterales to gentamicin/tobramycin was 11.6%, to ceftazidime/ceftriaxone was 12.9%, and 13.2% to ciprofloxacin. Resistance increased over time. Of the 201 Pseudomonas aeruginosa isolates reported, 19.7% were resistant to piperacillin-tazobactam, 13.1% resistant to cefepime/ceftazidime, and 9.8% to ciprofloxacin. Of 108 Acinetobacter spp. isolates, one was resistant to meropenem, and two were resistant to ciprofloxacin. Resistance did not increase over time.

Conclusions: AMR in gram-negative organisms causing bloodstream infections in Australian children is increasing, which should be considered when updating guidelines and empiric treatment regimens. Ongoing pediatric-specific national surveillance with pediatric reporting must remain a priority to strengthen antimicrobial stewardship and infection control programs.

Keywords: Antimicrobial Resistance; Australia; Enterobacterales; bacteremia; gram negative; pediatric.

© The Author(s) 2024. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.

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Antimicrobial Resistance in Enterobacterales, Acinetobacter spp. and Pseudomonas aeruginosa Isolates From Bloodstream Infections in Australian Children, 2013-2021

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Antimicrobial Resistance in Enterobacterales, Acinetobacter spp. and Pseudomonas aeruginosa Isolates From Bloodstream Infections in Australian Children, 2013-2021

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Abstract

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Medical

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