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The Impact of the COVID-19 Pandemic on Pediatric Microbial Resistance Patterns and Abandonment Rates in Western
Dan Dumitru Vulcanescu1,2,3,4, Iulia Cristina Bagiu2,3,4, Tiberiu Liviu Dragomir5
1Doctoral School, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania.
Insights
The COVID-19 pandemic worsened pediatric antimicrobial resistance (AMR) in Romania, with increased resistance observed in abandoned children. This highlights the need for better antimicrobial stewardship and social support.
Area of Science:
- Infectious Diseases
- Public Health
- Microbiology
Background:
- The COVID-19 pandemic in Romania correlated with increased pediatric antimicrobial resistance (AMR), potentially due to broad-spectrum antibiotic overuse.
- This study investigated pediatric AMR trends and phenotypes, examining links with hospital abandonment.
Purpose of the Study:
- To assess pediatric antimicrobial resistance (AMR) trends and phenotypes in Romania.
- To investigate the association between pediatric AMR and hospital abandonment.
Main Methods:
- A retrospective study analyzed AMR patterns in pediatric patients from 2019, 2021, and 2023.
- Key resistance phenotypes like Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant Enterococci (VRE), and Extended-spectrum beta-lactamase (ESBL) producers were assessed.
- Data on pediatric abandonment and its correlation with specific antimicrobial resistance patterns were analyzed.
Main Results:
- Overall antimicrobial resistance remained high, with specific increases in cephalosporin and reserve antibiotic resistance during the pandemic.
- Methicillin-resistant Staphylococcus aureus (MRSA) and Methicillin-resistant Coagulase-negative Staphylococci (MRCoNS) peaked during the pandemic.
- Pediatric abandonment rates increased, showing significantly higher antimicrobial resistance in abandoned children, particularly to fluoroquinolones, aminoglycosides, cephalosporins, and reserve antibiotics.
Conclusions:
- The COVID-19 pandemic significantly influenced pediatric AMR trends in Romania, with notable peaks in specific resistant phenotypes.
- Post-pandemic data suggest a continuing rise in antimicrobial resistance.
- The strong association between resistant infections and pediatric abandonment underscores the critical need for integrated antimicrobial stewardship and social intervention policies.
Abstract:
Background: The COVID-19 pandemic in Romania exacerbated pediatric antimicrobial resistance (AMR). Overuse of broad-spectrum antibiotics may be related to increased multidrug-resistant bacteria. The main aim of this study was to assess pediatric AMR trends and phenotypes, while a secondary objective was to investigate the potential links with hospital abandonment. Methods: This retrospective study from the Children's Emergency Hospital "Louis Țurcanu", Timișoara, focused on AMR patterns in 2019 pre-pandemic, 2021 pandemic, and 2023 post-pandemic. The following phenotypes were assessed: MRSA, MRCoNS, VRE, ESBL, CRO, MDR, XDR, and PDR. Results: There were 3530 total patients and 6885 total samples. There were 69.92% of the total samples resistant to at least one antimicrobial class, (72.69% in 2019, 67.05% in 2021, 69.16% in 2023). Specifically, resistance towards penicillins remained high across the entire period (57.45-60.93%), while the following classes presented elevated resistance in the pandemic: cephalosporins (42.91%), combination therapies (40.95%), reserve antibiotics (38.89%), and cyclines (13.83%). As for resistance phenotypes, MRSA and MRCoNS peaked during the pandemic (36.08% and 81.43%, respectively) while VRE remained relatively constant. Overall ESBL declined in 2023 to 14.45%, while overall CRO peaked during the pandemic (8.81%). Overall MDR fell during the pandemic (64.47%), while overall XDR peaked in 2019 (9.87%). No PDR cases were observed. Pediatric abandonment was an increasing concern, with regional cases rising from 5.42% (2019) to 9.83% (2023). Compared to the general population, increased antimicrobial resistance in abandoned patients was observed for fluoroquinolones (50.00%), Aminogycolsides (60.00%), reserve antibiotics (70.00%), cephalosporins (60.00%), and urinary antibiotics (60.00%). Resistance to cephalosporins (OR = 5.17, p = 0.0304) and reserve antibiotics (OR = 5.64, p = 0.0049) were key predictors of abandonment risk. Conclusions: The COVID-19 pandemic influenced resistance trends, with notable peaks in MRSA, MRCoNS, and CRO. Post-pandemic patterns suggest continued escalation of resistance. The association between resistant infections and pediatric abandonment highlights the need for robust antimicrobial stewardship and social intervention policies.
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