Temporal tendencies and interactions of viral and bacterial respiratory pathogens in children presenting with acute respiratory infection following SARS-CoV-2 pandemic

The aim of this study was to investigate the temporal trends and interactions between infectious agents and to determine the risk factors associated with acute respiratory tract infection (ARI) in children aged 1-15 years admitted to the Pediatric Emergency Department of Manisa Celal Bayar University Hospital following the SARS-CoV-2 pandemic. To determine the bacterial and viral agents, samples were taken from 314 patients attending our hospital with symptoms suggestive of ARI, between 06/01/2021 and 05/31/2022. Viral and bacterial agents were identified by multiplex PCR and automated identification systems, respectively. Demographics of the participants and possible risk factors for ARI were recorded in the questionnaires. In the study, viral agents were detected in 77.3% of children, and the most common infectious agent was RV/EV (36.3%), followed by Influenza viruses (11.2%), and SARS-CoV-2 (10.5% ). While RV/EV positivity was found to be higher in children with moderate and below average (p<0.001) hand hygiene, influenza positivity was found higher in those attending school/preschool institutions (p<0.001) and whose mothers worked full-time (p<0.001). RSV positivity was associated with maternal smoking (p=0.013) and home crowding (p=0.014). Bacterial colonization was found in 33 (11.6%) of 284 children swabbed for both bacterial and viral agents. The most common agents were S. aureus (60.6%) and P. aeruginosa (15.2%). Having siblings (p=0.008) and maternal smoking (p=0.012) were associated with the detection of bacterial agents. In this study, performed following the pandemic, the most detected agents and seasonal characteristics were found to be similar to the pre-pandemic period. Knowing the regional etiology and risk factors will contribute to taking the necessary local control and protective measures. Keywords: acute respiratory tract infections, etiology, risk factors