Antimicrobial Resistance in Staphylococcus aureus and Enterococcus spp. Isolates From Bloodstream Infections in Australian Children, 2013-2021

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

doi:10.1093/jpids/piae110

Antimicrobial Resistance in Staphylococcus aureus and Enterococcus spp. Isolates From Bloodstream Infections in Australian Children, 2013-2021

J Pediatric Infect Dis Soc. 2025 Feb 6;14(2):piae110. doi: 10.1093/jpids/piae110.

Authors

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 School of Clinical Medicine, Faculty of Medicine and Health, 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: 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 surveillance program captures clinical and microbiological data of isolates detected in blood cultures across Australia. EUCAST 2022 was used for interpretation and the AMR package in R for data analysis.

Results: There were 2091 bloodstream infections (BSIs) with S. aureus and 534 enterococcal BSI episodes in children <18 years old over 9 years. Three quarters of S. aureus BSI episodes were community-onset (78.3%), while more than half of enterococcal BSIs were hospital-onset (56.9%). The median age for S. aureus BSIs was 6 years, while >50% of enterococcal BSIs were in children <12 months old. Fifteen percent of S. aureus isolates were methicillin-resistant. 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, while clindamycin resistance increased. Resistance in Enterococcus spp. was almost entirely observed in Enterococcus faecium; only 1 Enterococcus 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.

Conclusions: 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 AMR data.

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

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MeSH terms

Adolescent
Anti-Bacterial Agents* / pharmacology
Anti-Bacterial Agents* / therapeutic use
Australia / epidemiology
Bacteremia* / drug therapy
Bacteremia* / epidemiology
Bacteremia* / microbiology
Child
Child, Preschool
Drug Resistance, Bacterial*
Enterococcus* / drug effects
Enterococcus* / isolation & purification
Female
Gram-Positive Bacterial Infections* / drug therapy
Gram-Positive Bacterial Infections* / epidemiology
Gram-Positive Bacterial Infections* / microbiology
Humans
Infant
Infant, Newborn
Male
Microbial Sensitivity Tests
Staphylococcal Infections* / drug therapy
Staphylococcal Infections* / epidemiology
Staphylococcal Infections* / microbiology
Staphylococcus aureus* / drug effects
Staphylococcus aureus* / isolation & purification

Substances

Anti-Bacterial Agents

Abstract

MeSH terms

Substances

Grants and funding