Surveillance of bloodstream infections in pediatric patients for 11 years: what was the COVID-19 impact?

BACKGROUND

Bloodstream infections (BSIs) are associated with high morbidity and mortality. Although frequently studied in adults, data on pediatric patients remain limited. This study evaluated the epidemiology of BSIs in children from 2013 to 2023, associating antibacterial consumption with bacterial resistance, including comparisons between pre- and post-COVID-19 periods in a Brazilian teaching hospital.

METHODS

This retrospective cross-sectional study analyzed 15.369 blood cultures (BC) collected from patients under 18 years old between January 2013 and December 2023. All positive BC were included. Blood samples were incubated using the BACTEC™ system. Species identification and antibacterial susceptibility testing were performed via the BD-Phoenix™ system. A PCR-based assay was used to detect carbapenemase-encoding genes in Gram-negative bacilli (GNB). Data analysis was performed using Microsoft® Excel®.

RESULTS

A total of 266 isolates were recovered from 224 pediatric patients. Of these, 138 (51.9%) were Gram-positive cocci (GPC), 105 (39.5%) were GNB and 21 (7.9%) were Fungi. Infants (< 1 year) represented the majority of cases (143/224; 63.8%) with GPC predominating (59.6%), especially S. epidermidis (46/166; 28%). GPCs were also predominant in adolescents (13 to < 18 years; 50%). GNBs were more frequent in the 1-6 and 7-12-year groups, with Klebsiella pneumoniae being the most common (13.6% and 5.6%, respectively), including one blaNDM-positive isolate identified during the pandemic. Fungal species were detected only after 2015, with Candida genus representing over 95% of the cases. The most common fungi were Candida parapsilosis (47.6%), followed by Candida tropicalis (19.0%) and Candida albicans (19.0%), while other species such as C. lusitaneae, C. rugosa and Kodamaea ohmeri represented 14.4% of isolates. Most fungal isolates (47.6%) were from patients aged < 1 year and admitted in the pediatric-intensive care unit. Antimicrobial susceptibility tests revealed increased MICs90 values in 2022-2023, particularly for meropenem and ceftriaxone coinciding with increased consumption of these antimicrobials during this period.

CONCLUSIONS

While the COVID-19 pandemic did not alter the overall bacterial trends in pediatric BSIs, it was associated with the emergence of fungal infections and rising MICs-even in the absence of increasing resistance rates. These findings reinforce the importance for continuous AMR surveillance in pediatric populations.