Shifts in Epidemiology and Antibiotic Resistance of Haemophilus Influenzae in Children From Chongqing (2019-2024): Pre-, During, and Post-COVID-19.

Objective: To comprehensively investigate the epidemiology and analyze the antimicrobial resistance of Haemophilus influenzae isolated from children in Chongqing before, during, and after the COVID-19 pandemic.

Methods: A total of 21,723 Haemophilus influenzae strains from four Chongqing hospitals during 2019-2024 were included. Antimicrobial susceptibility testing was conducted according to Clinical and Laboratory Standards Institute 2024 breakpoints using Kirby-Bauer method or automated systems. β-lactamase was detected by the cefinase disc method. Specimen types, age-and season-specific distributions, and antibiotic susceptibility results were analyzed.

Results: Among the isolates, 91.43% of infected children were under 6 years old and 57.30% were male. Sputum was the main source (94.22%). Detection rates were higher in spring and winter (p < 0.001). β-lactamase-positive strains accounted for 71.82% and BLNAR strains accounted for 4.99%. High resistance was found for ampicillin (79.05%), cefuroxime (58.95%), ampicillin-sulbactam (59.82%), sulfamethoxazole-trimethoprim (68.51%), azithromycin (49.67%), and cefixime (37.78%), while meropenem (0.48%), levofloxacin (0.11%), chloramphenicol (4.85%), ceftriaxone (0.62%), rifampicin (0.15%), tetracycline (5.55%), and cefepime (6.11%) showed low resistance. The COVID-19 pandemic affected resistance patterns: resistance to ampicillin, aztreonam, cefuroxime, amoxycillin-clavulanic, and ampicillin-sulbactam were higher before and after the COVID-19 pandemic than during it (p< 0.001). Throughout the pre-pandemic, pandemic, and post-pandemic periods, the resistance rates of sulfamethoxazole-trimethoprim cefixime and cefepime showed a downward trend, while the resistance rate of azithromycin showed an upward trend.

Conclusion: Haemophilus influenzae infections mainly occur in children under 6 years old, with seasonal peaks in spring and winter. The COVID-19 pandemic influenced infection patterns of specific age groups and resistance trends. Caution is required for commonly resistant antibiotics, and continuous resistance monitoring is necessary.