Australian Group on Antimicrobial Resistance (AGAR) surveillance outcome programs – bloodstream infections and antimicrobial resistance patterns in Australian children and adolescents, January 2022 – December 2023

Authors

  • Ms Anita Williams Wesfarmers Centre of Vaccines and Infectious Diseases, The Kids Research Institute Australia, Nedlands, WA; UWA Centre for Child Health Research, School of Medicine, University of Western Australia, Nedlands, WA
  • Geoffrey W Coombs School of Medical, Molecular and Forensic Sciences, Murdoch University, Murdoch, WA; Department of Microbiology, PathWest Laboratory Medicine WA, Fiona Stanley Hospital, Murdoch, WA; Australian Group on Antimicrobial Resistance, Fiona Stanley Hospital, Murdoch, WA
  • Jan M Bell Australian Group on Antimicrobial Resistance, Adelaide, SA
  • Denise A Daley Department of Microbiology, PathWest Laboratory Medicine WA, Fiona Stanley Hospital, Murdoch, WA; Australian Group on Antimicrobial Resistance, Fiona Stanley Hospital, Murdoch, WA
  • Shakeel Mowlaboccus School of Medical, Molecular and Forensic Sciences, Murdoch University, Murdoch, WA; Australian Group on Antimicrobial Resistance, Fiona Stanley Hospital, Murdoch, WA
  • Penelope A Bryant Infectious Diseases, The Royal Children's Hospital Melbourne, Parkville, Victoria; Department of Paediatrics, University of Melbourne, Parkville, Victoria
  • Anita J Campbell Wesfarmers Centre of Vaccines and Infectious Diseases, The Kids Research Institute Australia, Nedlands, WA; Department of Infectious Diseases, Perth Children's Hospital, Nedlands, WA; Division of Paediatrics, School of Medicine, University of Western Australia, Nedlands, WA
  • Louise Cooley Department of Microbiology and Infectious Diseases, Royal Hobart Hospital, Hobart, Tasmania; School of Medicine, University of Tasmania, Hobart, Tasmania
  • Annaleise R Howard-Jones Department of Infectious Diseases & Microbiology, The Children's Hospital at Westmead, Westmead, NSW; Sydney Institute for Infectious Diseases (SydneyID), The University of Sydney, Camperdown, NSW
  • Jon Iredell Sydney Institute for Infectious Diseases (SydneyID), The University of Sydney, Camperdown, NSW; Westmead Hospital, Western Sydney Local Health District, Westmead, NSW
  • Adam D Irwin UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland; Infection Management and Prevention Service, Queensland Children’s Hospital, Brisbane, Queensland
  • Brendan McMullan School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW; Department of Immunology and Infectious Diseases, Sydney Children’s Hospital, Sydney Children’s Hospitals Network, Randwick, NSW
  • Morgyn S Warner Microbiology & Infectious Diseases Directorate, SA Pathology, Central Adelaide Local Health Network, Adelaide, SA; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA
  • Phoebe CM Williams Sydney Institute for Infectious Diseases (SydneyID), The University of Sydney, Camperdown, NSW; School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Kensington, NSW; Department of Immunology and Infectious Diseases, Sydney Children’s Hospital, Sydney Children’s Hospitals Network, Randwick, NSW; School of Women and Children’s Health, University of New South Wales, Kensington, NSW
  • Christopher C Blyth Wesfarmers Centre of Vaccines and Infectious Diseases, The Kids Research Institute Australia, Nedlands, WA; Department of Infectious Diseases, Perth Children's Hospital, Nedlands, WA; Division of Paediatrics, School of Medicine, University of Western Australia, Nedlands, WA

DOI:

https://doi.org/10.33321/cdi.2025.49.052

Keywords:

Australian Group on Antimicrobial Resistance (AGAR), antimicrobial resistance surveillance, paediatrics, bacteraemia, Enterobacterales, Staphylococcus aureus, Enterococcus

Abstract

Between January 2022 and December 2023, there were 1,827 bloodstream infection (BSI) isolates in 1,745 children and adolescents reported to the Australian Group on Antimicrobial Resistance (AGAR) surveillance outcome programs, with 40% of episodes in children aged < 12 months. Two-thirds of BSIs were community-onset.

Of 1,034 gram-negative isolates, 932 (90%) were Enterobacterales. Gram-negative BSI episodes were more commonly community-onset and in children < 12 months of age. Of Enterobacterales isolates, 17.9% were ciprofloxacin resistant; 14.0% were ceftriaxone and/or ceftazidime resistant; 9.5% were gentamicin and/or tobramycin resistant; and 8.9% were piperacillin-tazobactam resistant. Increasing ciprofloxacin resistance was noted, primarily due to the increase in Salmonella Typhi BSI. Overall, 13% of Enterobacterales were extended spectrum β-lactamase producers, and 18.5% were multi-drug resistant (MDR).

Of 601 Staphylococcus aureus isolates, 13.6% were methicillin-resistant (MRSA), and 5.5% were MDR. Overall, 14.4% of S. aureus isolates were erythromycin resistant; 10.3% were clindamycin resistant; and 5.0% were ciprofloxacin resistant. Erythromycin, clindamycin, and ciprofloxacin resistance in MRSA were significantly higher than in methicillin-sensitive isolates. No co-trimoxazole resistant S. aureus was isolated.

There were 192 enterococcal isolates reported; 70.8% were E. faecalis and 17.2% were E faecium. All ampicillin-resistant, vancomycin-resistant, and MDR enterococci were E. faecium.

The 2022–2023 AGAR Kids Biennial Report shows relative stability in the antimicrobial resistance landscape within the Australian paediatric population, with few significant differences detected when compared to the 2020–2021 report. Small increases in the proportion of resistant Enterobacterales and Enterococcus spp. isolates highlight the importance of ongoing surveillance to inform stewardship and infection prevention interventions.

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Published

18/11/25

How to Cite

Williams, Anita, Geoffrey Coombs, Jan Bell, Denise Daley, Shakeel Mowlaboccus, Penelope Bryant, Anita Campbell, et al. 2025. “Australian Group on Antimicrobial Resistance (AGAR) Surveillance Outcome Programs – Bloodstream Infections and Antimicrobial Resistance Patterns in Australian Children and Adolescents, January 2022 – December 2023”. Communicable Diseases Intelligence 49 (November). https://doi.org/10.33321/cdi.2025.49.052.

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Vol. 49 (2025)

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Annual report

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