ArticleBMC infectious diseases2025
Changes in microbiological characteristics of bloodstream infections before and after the COVID-19 pandemic in a tertiary teaching hospital in Iran.
Article in BMC infectious diseases, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Abstract
backgroundThe COVID-19 pandemic has significantly impacted healthcare systems, leading to increased antibiotic misuse and multidrug-resistant (MDR) infections. This study assessed microorganisms and antibiotic-resistance patterns in bloodstream infections at a tertiary teaching hospital in Shiraz, Iran.
methodsThis retrospective cohort study analyzed blood culture results from the Professor Alborzi Clinical Microbiology Research Center (2017–2023), comparing two periods: pre-pandemic (Period 1) (2017–2020) and pandemic/post-pandemic (Period 2) (2020–2023).
resultsAmong 5,970 pathogenic strains, Gram-negative bacteria predominated (81.2% Period 1, 77.3% Period 2), maintaining a 1:5 ratio with Gram-positive bacteria. Stenotrophomonas maltophilia was the most common pathogen (23%) but declined significantly from 30 to 11% post-2020. In contrast, Escherichia coli (8–14%), Klebsiella spp. (6–13%), and Enterobacter spp. (6–13%) increased significantly. Staphylococcus aureus (7–12%) and Enterococcus spp. (6–8%) showed non-significant increases, while Pseudomonas spp. (10–6%) and streptococcus viridans (5–2%) declined without statistical significance. Acinetobacter spp. remained stable at 6%. Time-series analysis revealed pandemic-induced shifts: Enterobacter spp. reversed its pre-pandemic rise post-COVID (p < 0.001), while Stenotrophomonas maltophilia exhibited a declining trend in Period 1 and an increasing one in Period 2 (p = 0.016). No significant trend changes were observed for the remaining examined bacterial species. Among Gram-negative fermenters, carbapenems and amikacin remained the most effective antibiotics. While Acinetobacter spp. demonstrated elevated resistance to all tested antibiotics, including carbapenems, other Gram- negative non-fermenter bacteria displayed mixed resistance patterns, with increases, decreases, and stable resistance levels observed when comparing data from two periods. Methicillin-resistant S. aureus (MRSA) rates doubled (24% to 50%, p < 0.0001), with increased resistance to ciprofloxacin. High 54 rates of vancomycin-resistant Enterococci (VRE, 62%) were observed, with a 55 non-significant upward change (67%).
conclusionsThe study highlights shifts in pathogen epidemiology and antibiotic resistance during the pandemic, emphasizing the need for continuous surveillance and targeted antibiotic stewardship programs.
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