The impact of COVID-19 pandemic on bloodstream infections in pediatrics and alteration in antimicrobial resistance phenotypes, 2020-2022

Background: Alteration in the etiology of bloodstream infection (BSI) and antimicrobial resistance (AMR) following the COVID-19 pandemic is not well known in children. This study aimed to investigate these changes during 2 years in Tehran, Iran. Methods Children under 18 years old with suspected bacteremia/fungemia who had positive BACTEC blood cultures were included. Characterization of the isolates, antimicrobial susceptibility testing, and detection of multidrug-resistant (MDR) phenotypes were done based on standard protocols. Statistical analysis was done to measure the correlation of COVID-19 infection with BSI and AMR. Results Out of 13,345 COVID-19 tests and 4,194 BACTEC blood culture requests, bacteremia/fungemia were confirmed in 10.34% of the patients who requested both tests simultaneously. The COVID-19 infection was confirmed in 25.3% of the patients with bacteremia/fungemia. The infection with Gram-negative bacteria, Gram-positive bacteria (GPB), and fungi was detected in 59.3%, 32.3%, and 8.31% of the cases, respectively. Pseudomonas spp. (21.3%), Klebsiella spp. (20.2%), CN S (15.8%), Acinetobacter spp. (9.6%), S. aureus (8%), and Enterococcus spp. (5%) were among the common isolates. In the case of BSI with GPB, a significant difference was measured among different hospital wards ( p -value= 0.01). Moreover, a negative correlation was shown between the CN S bacteremia and COVID-19 infection ( p -value= 0.029). Candida spp. and non- Candida yeasts were detected in 6.7% and 13.4% of the cases, respectively. Results of antibiotic susceptibility testing showed the highest frequency of resistance to azithromycin and oxacillin among CN S , azithromycin, tetracycline, and oxacillin among S. aureus , and tetracycline and trimethoprim/sulfamethoxazole among Enterococcus . Methicillin-resistance phenotype in the S. aureus (MR SA ) and coagulase-negative Staphylococcus spp. (MR-CNS) was detected in 40% and 61.5% of the strains, respectively and the Enterococci were resistant to vancomycin in 33.3% of the isolates. Conclusion A decline in the trend of BSI by GPB and an increase in AMR was shown in children during the COVID-19 pandemic. The rise in antibiotic resistance could be described by the overuse of antibiotics in COVID-19 patients, while the difference in types of medical interventions may explain the difference in the etiology of BSI among the hospital wards.