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Background <p>The 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.</p> Methods <p>This retrospective cohort study analyzed blood culture results from the <i>Professor Alborzi Clinical Microbiology Research Center</i> (2017–2023), comparing two periods: pre-pandemic (Period 1) (2017–2020) and pandemic/post-pandemic (Period 2) (2020–2023).</p> Results <p>Among 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. <i>Stenotrophomonas maltophilia</i> was the most common pathogen (23%) but declined significantly from 30 to 11% post-2020. In contrast, <i>Escherichia coli</i> (8–14%), <i>Klebsiella</i> spp. (6–13%), and <i>Enterobacter</i> spp. (6–13%) increased significantly. <i>Staphylococcus aureus</i> (7–12%) and <i>Enterococcus</i> spp. (6–8%) showed non-significant increases, while <i>Pseudomonas</i> spp. (10–6%) and <i>streptococcus viridans</i> (5–2%) declined without statistical significance. <i>Acinetobacter</i> spp. remained stable at 6%.</p> <p>Time-series analysis revealed pandemic-induced shifts: <i>Enterobacter </i>spp. reversed its pre-pandemic rise post-COVID (p &lt; 0.001), while <i>Stenotrophomonas maltophilia </i>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.</p> <p>Among Gram-negative fermenters, carbapenems and amikacin remained the most effective antibiotics. While <i>Acinetobacter </i>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 <i>S. aureus</i> (MRSA) rates doubled (24% to 50%, p &lt; 0.0001), with increased resistance to ciprofloxacin. High 54 rates of vancomycin-resistant <i>Enterococci </i>(VRE, 62%) were observed, with a 55 non-significant upward change (67%).</p> Conclusions <p>The study highlights shifts in pathogen epidemiology and antibiotic resistance during the pandemic, emphasizing the need for continuous surveillance and targeted antibiotic stewardship programs.</p>

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Changes in microbiological characteristics of bloodstream infections before and after the COVID-19 pandemic in a tertiary teaching hospital in Iran

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月14日

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  • Zahra Jafarpour,
  • Masoud Karimi,
  • Gholamreza Pouladfar,
  • Bahman Pourabbas,
  • Amin Abbasian,
  • Mohebat Vali,
  • Pejman Abbasi,
  • Fatemeh Ghasemi,
  • Mohammad Ali Dehyadegari

摘要

Background

The 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.

Methods

This 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).

Results

Among 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%).

Conclusions

The study highlights shifts in pathogen epidemiology and antibiotic resistance during the pandemic, emphasizing the need for continuous surveillance and targeted antibiotic stewardship programs.