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A European survey on anaerobes from paediatric blood cultures: a comparative analysis with adults
Matteo Boattini1,2, Arianna Aceti3,4, Paulo Bastos5
1Department of Public Health and Paediatrics, University of Torino, Turin, Italy. matteo.boattini@unito.it.
Insights
This study analyzed anaerobic bloodstream infections in European children, finding distinct resistance patterns compared to adults. Understanding these differences is crucial for effective pediatric antimicrobial therapy.
Area of Science:
- Clinical Microbiology
- Infectious Diseases
- Pediatric Infectious Diseases
Background:
- Anaerobic bacteria are common causes of infection in children, yet European data on bloodstream infections are limited.
- Previous studies have not extensively compared anaerobic epidemiology and antimicrobial resistance between pediatric and adult populations.
- Accurate antimicrobial susceptibility data is vital for guiding treatment decisions in pediatric anaerobic infections.
Purpose of the Study:
- To investigate the epidemiology and antimicrobial resistance profiles of anaerobic bacteria causing bloodstream infections in European children.
- To compare the findings in pediatric patients with those observed in adult patients within the same European healthcare settings.
- To identify age-specific patterns in anaerobic bloodstream infections to inform targeted therapeutic strategies.
Main Methods:
- A multicenter retrospective observational study was conducted across 44 European hospitals from 2020 to 2023.
- Analysis included all anaerobic bacteria isolated from blood cultures, with a specific focus on pediatric cases (n=186).
- Epidemiological data and antimicrobial resistance profiles were compared between pediatric and adult patient groups using SHAP values for pattern distinction.
Main Results:
- Cutibacterium acnes, Schaalia odontolytica, Actinomyces oris, and Bacteroides fragilis were the most prevalent anaerobic species in pediatric patients.
- Gram-positive bacilli in children showed higher resistance to meropenem, metronidazole, and vancomycin compared to adults.
- Gram-negative bacilli and Bacteroides species in pediatric patients exhibited varying resistance patterns, with notable susceptibility to carbapenems and metronidazole, respectively.
Conclusions:
- Significant differences exist in anaerobic bloodstream infection epidemiology and antimicrobial resistance between pediatric and adult patients in Europe.
- Pediatric Gram-positive anaerobes demonstrate distinct resistance profiles, particularly higher rates for meropenem and metronidazole.
- Age-stratified antimicrobial susceptibility surveillance data for anaerobes is essential for optimizing treatment guidelines in pediatric populations.
Abstract:
Infections caused by anaerobes are common in children. However, limited data are available on bloodstream infections caused by these bacteria in Europe. A multicentre retrospective observational study was conducted over a 4-year period (2020-2023) across 44 European hospitals to analyze all anaerobes isolated from blood cultures. The study examined the epidemiology and antimicrobial resistance profiles of anaerobes identified in paediatric patients, comparing the findings with those observed in adults. Among the 14,527 total anaerobic isolates, 186 (1.3%) were detected from paediatric patients. These were predominantly Gram-positive (70%) and Gram-negative (22%) bacilli. The most prevalent species in paediatric patients were Cutibacterium acnes (24.7%), Schaalia odontolytica (9.7%), Actinomyces oris (8.1%), and Bacteroides fragilis (7.5%). Relative feature importance based on the mean SHAP (SHapley Additive exPlanations) values distinguished paediatric patients and adults based on their antibiotic resistance patterns with high accuracy. Compared to those from adult patients, Gram-positive bacilli detected in paediatric samples displayed higher resistance rates for meropenem (15% vs. 9%), metronidazole (52% vs. 24%), and vancomycin (27% vs. 6%), and lower resistance to benzylpenicillin (11% vs. 17%), amoxicillin/clavulanate (9% vs. 17%), and clindamycin (30% vs. 36%). Gram-negative bacilli in paediatric samples displayed lower resistance to benzylpenicillin (18% vs. 29%), piperacillin/tazobactam (26% vs. 33%), and clindamycin (20% vs. 27%), and they were highly susceptible to imipenem, meropenem, and metronidazole as those detected in adult patients. Bacteroides species detected in paediatric and adult patients displayed high resistance to piperacillin/tazobactam (33% vs. 39%) and clindamycin (38% vs. 29%), while they were highly susceptible to metronidazole. Compared to those from adult samples, Cutibacterium acnes in paediatric patients displayed lower resistance to benzylpenicillin (none vs. 15%) and clindamycin (17% vs. 29%). The comparison of species and susceptibility profiles of anaerobes detected in paediatric and adult patients highlighted the importance of reporting antimicrobial susceptibility surveillance data by age group.
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