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reported a reduction in the incidence of carbapenem-producing Enterobacteriaceae after the COVID-19 pandemic. However, few studies have examined the impact of the COVID-19 pandemic on S. aureus bloodstream infection in children. We hope to provide additional information to support these conclusions by sharing the results of one of our studies, which analyzed changes in S. aureus bloodstream infection in children before and after the COVID-19 pandemic in Henan, China.
S. aureus is one of the major pathogens responsible for bloodstream infections or bacteremia, and it is the most commonly isolated single pathogen associated with nosocomial infections.
It has high rates of morbidity and mortality. According to the sensitivity to methicillin, S. aureus can be divided into methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible Staphylococcus aureus (MSSA). Compared with MSSA bacteremia patients, the mortality of MRSA bacteremia patients increased by 40%.
During the COVID-19 pandemic, the government has adopted relatively strict control measures and non-pharmaceutical interventions(NPI), which have changed the original epidemic trend of many pathogens.
Impact of the coronavirus disease 2019 (COVID-19) pandemic on invasive pneumococcal disease and risk of pneumococcal coinfection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): prospective national cohort study, England.
Therefore, analysis of the trend of S. aureus bloodstream infection in children before and after the COVID-19 pandemic can provide a reference for the development of relevant prevention and treatment measures for children.
This study was a multicenter retrospective study. To evaluate the impact of COVID-19 on the epidemiological characteristics of S. aureus bloodstream infection in children, we compared and analyzed the laboratory data of children with blood culture records from three large hospitals in Henan Province from 2017 to October 2022. They were all younger than 18 years of age and included 306,404 children (n=45,939 in 2017, n=52,917 in 2018, n=57,755 in 2019, n=40,233 in 2020, n=53,652 in 2021, 2022 n=55,908). When we analyzed the total number of positive blood cultures, the number of S. aureus positive blood cultures, and the number of MRSA positive blood cultures (Fig. 1a), as well as the S. aureus positive rate and the MRSA positive rate (Fig. 1b), according to year, we found that the total number of positive blood cultures, the number of S. aureus positive blood cultures, and the number of MRSA positive blood cultures all decreased significantly in 2020 after the outbreak of the COVID-19 pandemic. In addition, the positive rate of MRSA in S. aureus bloodstream infections in children was higher (55.7% in 2017, 72.0% in 2018, 58.3% in 2019, 49.1% in 2020, 53.1% in 2021 and 55.9% in 2022). The prevalence of S. aureus and MRSA decreased after the COVID-19 pandemic, indicating that the epidemiological characteristics of S. aureus bloodstream infection in children were significantly affected by the COVID-19 pandemic. However, the total number of positive blood cultures, the positive number and positive rate of S. aureus and the positive number and positive rate of MRSA have increased in 2021, and the number of positive S. aureus and MRSA in 2022 has approached the level before the COVID-19 pandemic, so we need to be alert to the risk of recurrence.
Fig. 1The total number of positive cases, the number of S. aureus positive cases, and the number of MRSA positive cases (a), the S. aureus positive rate and the MRSA positive rate (b)in children with blood cultures from 2017-2022.
The rise of antibiotic resistance remains a global crisis. With the widespread use of highly effective antimicrobials in clinical practice, MRSA resistance has increased, and the picture for multi-drug resistance is grim. We analyzed the resistance of MRSA strains to common antimicrobial agents before and after the COVID-19 pandemic (Table 1).In addition, our analysis of children with S. aureus bloodstream infection according to different age groups found that the number of S. aureus positive (Fig. 2a) and the positive rate (Fig. 2b), the number of MRSA positive (Fig. 2c) and the positive rate (Fig. 2d) decreased in children under 3 years old after the COVID-19 pandemic, and the downward trend was more significant in infants under 1 years old. Interestingly, before and after the COVID-19 pandemic, S. aureus as well as the number of MRSA infections accounted for the highest proportion of infants younger than 1 year, indicating that S. aureus and MRSA infections were predominantly in infants younger than 1 year, a feature that does not seem to be related to the COVID-19 pandemic.
Table 1Analysis of drug resistance of MRSA strains to common drugs from 2017 to 2022.
Fig. 2The number of S. aureus positive (a) and the positive rate (b), the number of MRSA positive (c) and the positive rate (d) in different age groups from 2017-2022.
In summary, the ongoing COVID-19 pandemic and associated public health measures have altered the epidemic trend of S. aureus bloodstream infection in children in Henan, China. During the COVID-19 pandemic, the number of positive cases and positive rates of S. aureus and MRSA showed a downward trend. However, with the easing of the COVID-19 pandemic and the relaxation of relevant policies, the number of S. aureus bloodstream infections in children has shown signs of recovery, which should cause us to remain vigilant and closely monitor their trends.
References
Kouijzer IJE
Fowler Jr, VG
Ten Oever J.
Redefining Staphylococcus aureus bacteremia: a structured approach guiding diagnostic and therapeutic management.
Impact of the coronavirus disease 2019 (COVID-19) pandemic on invasive pneumococcal disease and risk of pneumococcal coinfection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): prospective national cohort study, England.
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