Changes in the epidemiology of neonatal bacteremia during the COVID-19 pandemic in Wuhan, China.

Abstract

Objective: To investigate the incidence, pathogen distribution, and antibiotic susceptibility of early- and late-onset neonatal bacteremia, and to analyze pathogen trends before and during the COVID-19 pandemic.

Methods: Between January 2016 to December 2022, we collected 879 blood and cerebrospinal fluid specimens from newborns with bacteremia. Bacterial identification used biochemical methods and MALDI-TOF, and antibiotic susceptibility was tested with the VITEK 2 system. Incidence per 1,000 admissions was calculated with Wilson's 95% confidence intervals, and categorical variables were compared using χ²-test or Fisher's exact test.

Results: Early-onset bacteremia incidence was 2.6 per 1,000 admissions, and late-onset bacteremia was 26.3, with a significant decline from 70.7 to 10.5 per 1,000 admissions over the study period. Late-onset bacteremia was more common before COVID-19, while early-onset bacteremia increased during the pandemic. The top five pathogens were CoNS(39.9%), E. faecalis(17.7%), E. faecium(13.7%), E. coli(8.4%), and GBS(5.8%). During the COVID-19 pandemic, the incidence of CoNS and S. aureus infections significantly decreased. Throughout the entire study period, CoNS and S. aureus showed high resistance to penicillin G and erythromycin but were sensitive to vancomycin and linezolid. E. faecalis and E. faecium were susceptible to vancomycin, linezolid, and teicoplanin but resistant to erythromycin, tetracycline, and rifampin. MRCoNS and MRSA were detected in 72.7% and 31.0% of isolates, respectively. Resistance rates of E. faecium and E. faecalis to ampicillin decreased significantly, clindamycin resistance in GBS decreased during the pandemic.

Conclusion: This study highlights notable shifts in neonatal bacteraemia patterns during the COVID-19 Pandemic that were likely influenced by increased infection control and disruptions in maternal care, leading to changes in pathogen distribution and antimicrobial resistance.