Bloodstream infections in patients admitted to our clinic during the COVID 19 pandemic

In a study aiming to investigate the occurrence of bloodstream infections (BSIs) in hospitalized patients during the COVID-19 pandemic, our pediatric department and pediatric intensive care unit (PICU) examined 177 patients diagnosed with BSI between April 1, 2018, and May 31, 2022. Of the patients, 129 (72.9%) were in the pre-pandemic period (PPP) and 48 (27.1%) were in the pandemic period (PP). The most common reasons for hospitalization during both periods were lower respiratory tract infections and gastroenteritis. The most common comorbid conditions were cerebral palsy (CP), immunodeficiency, and epilepsy. Risk factors included ventriculoperitoneal shunt catheters, central venous catheters, and mechanical ventilation. Healthcare-associated bloodstream infections (HABSI) were detected in 48 patients during PPP and 15 patients during PP. The most common pathogens in HABSI were CNS, followed by Streptococcus species, Pseudomonas aeruginosa, Klebsiella pneumoniae, Candida Albicans, and E.coli. Significant differences were observed in absolute lymphocyte count (ALC) between gram-negative bacteria (GNB) and gram-positive bacteria (GPB), and between GNB and fungi. Significant differences in C-reactive protein levels were also observed between GNB and GPB groups. The top three pathogens encountered during PPP were Coagulase-negative staphylococci (CNS) (67.4%), Streptococcus species (14.7%), and Escherichia coli (3.1%). During PP, CNS (77.1%), Staphylococcus aureus (6.3%), and Streptococcus species (4.2%) were the most common pathogens. Isolated pathogens were categorized into five groups: streptococci, staphylococci, enterobacteria, enterococci, and non-fermentative gram-negatives. There was no statistically significant difference in antibiotic resistance rates among streptococci between PPP and PP. However, oxacillin resistance in staphylococci was 75.3% during PPP and 57.5% during PP. There was no significant difference in resistance rates among enterobacteria and enterococci between the two periods. Vancomycin resistance decreased in enterococci during the pandemic period. Resistance to amikacin was not observed in non-fermentative gram-negatives during either period. When there is suspicion of BSI, empirical treatment should consider the focus and epidemiological data of the infection before initiating antibiotic therapy, as the distribution and resistance profile of microorganisms may vary by country and region. Effective and appropriate antibiotic therapy should be promptly initiated based on the most frequently isolated pathogens and their antibiotic susceptibilities. Key Words: Antibiotic resistance, bloodstream infection (BSI), pandemic