# Clinical and Genetic Characteristics of Enterobacter cloacae and Klebsiella aerogenes in Children

## TL;DR

This study compares the clinical and genetic features of two bacterial infections in children, highlighting differences in age, resistance, and genetic diversity.

## Contribution

The study provides new insights into the distinct clinical and genomic profiles of Enterobacter cloacae and Klebsiella aerogenes in pediatric bloodstream infections.

## Key findings

- K. aerogenes infections were associated with younger age, preterm status, and urosepsis, while ECC was linked to hematologic malignancies.
- Gentamicin resistance and K. aerogenes infection were independently linked to higher 30-day mortality in pediatric patients.
- ECC showed higher prevalence of antimicrobial resistance genes compared to K. aerogenes, with Enterobacter hormaechei being the most common ECC species.

## Abstract

This study investigated the clinical and genomic characteristics of Enterobacter cloacae complex (ECC) and Klebsiella aerogenes bloodstream infections (BSIs) in pediatric patients. A total of 115 BSI episodes (ECC: 86, K. aerogenes: 29) from 110 children hospitalized between 2011 and 2024 were retrospectively analyzed. Whole-genome sequencing was performed on available isolates to determine species, sequence types, and antimicrobial resistance (AMR) genes. Clinical characteristics, antibiotic usage, and outcomes were compared between groups. Patients with K. aerogenes BSI were younger and more likely to be preterm or diagnosed with urosepsis, while ECC infections were more frequently associated with hematologic malignancies. According to a multivariable analysis of the entire cohort (n = 115), K. aerogenes infection (OR [6.26], 95% CI [1.36–28.78]) and gentamicin resistance (OR [10.06], 95% CI [1.88–53.87]) were independently associated with 30-day mortality. Enterobacter hormaechei was the most common ECC species (68.4%) and exhibited the highest prevalence of AMR genes, particularly those conferring resistance to aminoglycosides, β-lactams, and trimethoprim–sulfamethoxazole. In contrast, K. aerogenes harbored few resistance genes. Multi-locus sequence typing analysis revealed high genetic diversity in both ECC and K. aerogenes, without evidence of dominant clonal expansion. Despite similarities in clinical presentation, ECC and K. aerogenes exhibit distinct age distributions, resistance profiles, and genetic diversity in pediatric BSIs. These findings underscore the importance of species-level identification and continued genomic surveillance to inform empirical antibiotic strategies and prevent the spread of resistant strains.