Genomic determinants of Bacillus cereus and outcomes of infection in preterm neonates: a multicentre retrospective study
Abstract
Objectives: Bacillus cereus sensu lato (s.l.) or B. cereus group increasingly causes severe infections in preterm neonates. However, species-level identification and virulence characterization remain limited. This study aimed to identify B. cereus group species responsible for invasive infections in preterm neonates and to correlate genomic virulence profiles with clinical outcomes. We conducted a retrospective, multicentre study across 13 French hospitals (2010-2021), including 40 B. cereus group isolates from blood or cerebrospinal fluid of preterm neonates with invasive infections. Clinical data were extracted from patient records. Whole-genome sequencing (WGS) (Illumina and Oxford Nanopore) with hybrid assemblies enabled species identification using digital DNA-DNA hybridization and average nucleotide identity. Virulence genes were screened against a curated database of 65 virulence genes, and associations with clinical outcomes were analysed. Results: Forty isolates were analysed, 42.5% (17 of 40) of patients developed septic shock, and 37.5% (15 of 40), died, usually after rapid clinical deterioration. WGS identified seven species, predominantly Bacillus paranthracis (47.5%, 19 of 40) and B. cereus sensu stricto (20%, 8 of 40). Virulence gene content varied by species. The presence of hblCDAB (60%, 9 of 15), nprB (46.5%, 7 of 15), asbABCDEF (80%, 12 of 15), and essC-cereus/esxA (66.7%, 10 of 15) genes correlated with mortality (p 0.00015, 0.002, 0.0027, and 0.02, respectively). B. cereus sensu stricto carried more virulence determinants and was associated with higher mortality than B. paranthracis and other species, at day 7 (p 0.05) and at day 28 (p 0.0065). The cesH gene (60%, 15 of 25) is significantly associated with survival (p 0.007), particularly with B. paranthacis, the predominant species in our cohort. Conclusions: Invasive B. cereus group infections in preterm neonates are associated with high mortality, particularly in cases due to B. cereus sensu stricto. WGS enables precise species identification and virulence profiling, which are essential insights for diagnostic refinement, outbreak control, and risk stratification in neonatal intensive care settings.
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BibTeX
@article{chevalier2026genomic,
title = {{Genomic determinants of Bacillus cereus and outcomes of infection in preterm neonates: a multicentre retrospective study}},
author = {Alicia Chevalier and Mariem Ben Khedher and Antoine Tran and Matilde Coin and Mélanie Pousse and Asmaa Tazi and Sergio Eleni Dit Trolli and Philippe Lanotte and Christelle Follet and Maxime Pichon and Damien Dubois and Léa Herbulot and Anais Potron and Saïd Aberrane and André Birgy and Béatrice Boutillier and Alix Pantel and Massimo Di Maio and Grégory Dubourg and Pierre Boyer and Stéphane Corvec and Guillaume Groshenry and Mathilde Bonis and Margot Saissi and Armel Gallet and Laurent Boyer and Olivier Croce and Romain Lotte and Raymond Ruimy},
journal = {Clinical Microbiology and Infection},
year = {2026},
month = oct,
doi = {10.1016/j.cmi.2026.01.023},
url = {https://inserm.hal.science/inserm-05502113v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Genomic determinants of Bacillus cereus and outcomes of infection in preterm neonates: a multicentre retrospective study
AU - Alicia Chevalier
AU - Mariem Ben Khedher
AU - Antoine Tran
AU - Matilde Coin
AU - Mélanie Pousse
AU - Asmaa Tazi
AU - Sergio Eleni Dit Trolli
AU - Philippe Lanotte
AU - Christelle Follet
AU - Maxime Pichon
AU - Damien Dubois
AU - Léa Herbulot
AU - Anais Potron
AU - Saïd Aberrane
AU - André Birgy
AU - Béatrice Boutillier
AU - Alix Pantel
AU - Massimo Di Maio
AU - Grégory Dubourg
AU - Pierre Boyer
AU - Stéphane Corvec
AU - Guillaume Groshenry
AU - Mathilde Bonis
AU - Margot Saissi
AU - Armel Gallet
AU - Laurent Boyer
AU - Olivier Croce
AU - Romain Lotte
AU - Raymond Ruimy
PY - 2026
DA - 2026/10/20
JO - Clinical Microbiology and Infection
DO - 10.1016/j.cmi.2026.01.023
UR - https://inserm.hal.science/inserm-05502113v1
AB - Objectives: Bacillus cereus sensu lato (s.l.) or B. cereus group increasingly causes severe infections in preterm neonates. However, species-level identification and virulence characterization remain limited. This study aimed to identify B. cereus group species responsible for invasive infections in preterm neonates and to correlate genomic virulence profiles with clinical outcomes. We conducted a retrospective, multicentre study across 13 French hospitals (2010-2021), including 40 B. cereus group isolates from blood or cerebrospinal fluid of preterm neonates with invasive infections. Clinical data were extracted from patient records. Whole-genome sequencing (WGS) (Illumina and Oxford Nanopore) with hybrid assemblies enabled species identification using digital DNA-DNA hybridization and average nucleotide identity. Virulence genes were screened against a curated database of 65 virulence genes, and associations with clinical outcomes were analysed. Results: Forty isolates were analysed, 42.5% (17 of 40) of patients developed septic shock, and 37.5% (15 of 40), died, usually after rapid clinical deterioration. WGS identified seven species, predominantly Bacillus paranthracis (47.5%, 19 of 40) and B. cereus sensu stricto (20%, 8 of 40). Virulence gene content varied by species. The presence of hblCDAB (60%, 9 of 15), nprB (46.5%, 7 of 15), asbABCDEF (80%, 12 of 15), and essC-cereus/esxA (66.7%, 10 of 15) genes correlated with mortality (p 0.00015, 0.002, 0.0027, and 0.02, respectively). B. cereus sensu stricto carried more virulence determinants and was associated with higher mortality than B. paranthracis and other species, at day 7 (p 0.05) and at day 28 (p 0.0065). The cesH gene (60%, 15 of 25) is significantly associated with survival (p 0.007), particularly with B. paranthacis, the predominant species in our cohort. Conclusions: Invasive B. cereus group infections in preterm neonates are associated with high mortality, particularly in cases due to B. cereus sensu stricto. WGS enables precise species identification and virulence profiling, which are essential insights for diagnostic refinement, outbreak control, and risk stratification in neonatal intensive care settings.
SN - 1198-743X
SN - 1469-0691
ER -