Evaluation of changes in antimicrobial susceptibility in bacteria infecting children and their mothers in pediatric, neonatal-intensive care unit, and gynecology/obstetrics wards of a quaternary referral hospital during the COVID-19 pandemic

Abstract

The World Health Organization released a statement warning of increased risk for the incidence of multidrug resistant microorganisms and the absence of new drugs to control such infections soon. Since the beginning of the COVID-19 pandemic, the prescription of antimicrobial agents has increased and may have accelerated the emergence of multidrug resistant (MDR) bacteria. This study aimed to evaluate maternal and pediatric infections within a hospital from January 2019 to December 2021. An observational retrospective cohort study was performed at a quaternary referral hospital in a metropolitan area of Niteroi city, Rio de Janeiro state, Brazil. A total of 196 patients’ medical records were analyzed. The data from 90 (45.9%) patients were collected before the SARS-CoV-2 pandemic, 29 (14.8%) from the 2020 pandemic period, and 77 (39.3%) from the 2021 pandemic period. A total of 256 microorganisms were identified during this period. Out of those, 101 (39.5%) were isolated in 2019, 51 (19.9%) in 2020, and 104 (40.6%) in 2021. Antimicrobial susceptibility tests were performed on 196 (76.6%) clinical isolates. The exact binomial test showed that the distribution of Gram-negative bacteria was predominant. The most common microorganism was Escherichia coli (23%; n = 45), followed by Staphylococcus aureus (17.9%, n = 35), Klebsiella pneumoniae (12.8%, n = 25), Enterococcus faecalis (7.7%, n = 15), Staphylococcus epidermidis (6.6%, n = 13) and Pseudomonas aeruginosa (5.6%, n = 11). Staphylococcus aureus was the predominant species among resistant bacteria. Among the antimicrobial agents tested, the following were resistant, presented on a descending scale: penicillin (72.7%, p = 0.001, Binomial test), oxacillin (68.3%, p = 0.006, Binomial test), ampicillin (64.3%, p = 0.003, Binomial test), and ampicillin/sulbactam (54.9%, p = 0.57, Binomial test). Infections with S. aureus were 3.1 times greater in pediatrics and maternal units than in other hospital wards. Despite the global reduction in the incidence of MRSA, we observed an increase in MDR S. aureus in this study. No changes were observed in the frequency of resistance profiles of the clinical isolates after the establishment of the global SARS-CoV-2 pandemic. More comprehensive studies are needed to understand the impact of the global SARS-CoV-2 pandemic on the resistance levels of bacteria associated with neonate and pediatric patients.

Surveillance of Multidrug-Resistant Pathogens in Neonatal Intensive Care Units of Palermo, Italy, during SARS-CoV-2 Pandemic

“…Since the beginning of the COVID-19 pandemic, the prescription of antimicrobial drugs has increased and may have accelerated the emergence of MDR bacteria. Ineffective empiric antibiotic therapy is associated with an increased risk of morbidity and mortality, especially because it is linked to the circulation of MDROs [ 23 ], which recent studies have recognized as the major risk factor responsible for the diffusion of nosocomial infections in newborns [ 24 ]. Moreover, despite a consistent lack of scientific literature on the topic, it is well ascertained that the COVID-19 pandemic has provoked a deep change in MDROs’ circulation within NICUs during this period [ 25 ].…”

“…To foster our main hypothesis that the pandemic period profoundly affected MDROs’ resistance spectrum, Witt et al [ 35 ] showed a statistical association between COVID-19 diagnosis and drug-resistant bacteria, such as an increase in resistance to third-generation antibiotics among Klebsiella , Enterobacteriaceae , and Pseudomonas aeruginosa bloodstream infections in 2020 compared to 2019. In a recent observational retrospective cohort study conducted in a pediatric quaternary referral hospital in Brazil, carbapenem-resistant Klebsiella pneumoniae (KPC) infections associated with COVID-19 were predominant [ 24 ]. Furthermore, it was highlighted that carbapenem-resistant Acinetobacter baumannii (CRAB) was one of the most common pathogens associated with MDRO outbreaks during the COVID-19 pandemic in NICUs—as they can survive and persist for a prolonged time on surfaces—as seen in the results found for CARBA-R MDR-GNB carriage in the NICU C of our study [ 25 ].…”

“…The carriage of ESBL-producing MDR-GNB—a risk factor for developing ESBL infections in pediatric cardiac surgery patients [ 36 ]—diminished in NICU C during the pandemic period. Despite data limitations, another pathogen associated with MDRO outbreaks during the COVID-19 pandemic in NICUs was Staphylococcus aureus [ 24 , 37 ]. As for upper tract MDROs, our study showed a significant reduction in MSSA carriage.…”

Antimicrobial Stewardship: A Correct Management to Reduce Sepsis in NICU Settings

“…Examples of MDROs in NICU settings include methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), Klebsiella pneumoniae expressing extended-spectrum β-lactamases (ESBLs), and Gram-negative bacilli resistant to third-generation and fourth-generation cephalosporins and/or carbapenem groups [ 18 , 23 ]. Recent studies have shown an increase in nosocomial infections in newborns associated with MDROs, even if the literature data are lacking in this slice of the population [ 24 ].…”

COVID-19 infection and risk analysis: a short introduction

“…Also, in 36 the survival and direct medical costs of patients admitted in private hospitals with COVID-19 during the first wave were evaluated. Related risks during COVID pandemic can be found in 37 where, knowing that the prescription of antimicrobial agents has increased and may have accelerated the emergence of multidrug resistant bacteria, the authors describe a study that aimed to evaluate maternal and pediatric infections within a hospital from January 2019 to December 2021. Also, in 38 a dose-response relation was deduced for coronaviruses from coronavirus disease 2019; it was presented a meta-analysis result and its application for infection risk assessment of aerosol transmission was described.…”