Distribution, carbapenem resistance and DTR dynamics of ESKAPEEc pathogens from pediatric bloodstream infections in Sichuan Province, 2017-2025: epidemiological characteristics under COVID-19 pandemic and emerging linezolid MIC creep.

Shanshan Long, Min Zhong, Xin Liu, Kai Zhang, Zhuorui You, Xiangning Huang, Hua Yu

Abstract readMulticenter Study

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Article in Frontiers in cellular and infection microbiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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Shanshan Long *Department of Laboratory Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.

Min Zhong *Department of Laboratory Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.

Xin LiuDepartment of Laboratory Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.

Kai ZhangDepartment of Laboratory Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.

Zhuorui YouSchool of Medicine, University of Electronic Science and Technology of China, Chengdu, China.

Xiangning HuangDepartment of Laboratory Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.

Hua YuDepartment of Laboratory Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Objective: To characterize the distribution and antimicrobial resistance evolution of ESKAPEEc pathogens causing pediatric bloodstream infections in Sichuan Province across the COVID-19 era, and to systematically evaluate the epidemiology of carbapenem resistance (CR), difficult-to-treat resistance (DTR), and MIC drift in vancomycin and linezolid, thereby addressing a long-standing gap in longitudinal pediatric multidrug-resistant surveillance in Southwest China. Methods: A multicenter retrospective study was conducted using pediatric blood culture data from 134 healthcare institutions in Sichuan Province between 2017 and 2025. A total of 20,018 isolates were included and stratified into pre-pandemic, pandemic, and post-pandemic periods. Antimicrobial susceptibility testing and DTR classification were interpreted according to CLSI M100 (35th edition) criteria. Statistical analyses were performed using WHONET 5.6 and SPSS 26.0. Results: A total of 5,236 ESKAPEEc isolates were identified, accounting for 26.2% of all bloodstream isolates. Detection rates increased during the pandemic period and declined thereafter. Carbapenem resistance rates in Conclusions: The COVID-19 pandemic exerted a bidirectional and sustained impact on the pediatric ESKAPEEc landscape and resistance ecology in Sichuan Province. Post-pandemic escalation of carbapenem resistance persists. The persistently high DTR burden in A. baumannii and early MIC drift toward linezolid in MRSA represent two critical regional threats in pediatric infectious disease management. Regional surveillance systems should incorporate DTR metrics alongside CR monitoring and implement age-stratified, precision-based antimicrobial stewardship strategies.

Indexed as

Anti-Bacterial AgentsBacteremiaCarbapenemsCOVID-19LinezolidAcinetobacter baumanniiChildChild, PreschoolChinaDrug Resistance, BacterialDrug Resistance, Multiple, BacterialEscherichia coliFemaleHumansInfantKlebsiella pneumoniaeAnti-Bacterial AgentsCarbapenemsLinezolidVancomycinbloodstream infectioncarbapenem resistanceCOVID-19difficult-to-treat resistance (DTR)ESKAPEEcMIC driftpediatricsSichuan province

Identifiers

PMID42889086

DOI10.3389/fcimb.2026.1914448

PMCPMC13668538

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