Changes in Antibiotic Resistance Patterns Before and During the COVID-19 Pandemic in Hospitalized Children at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia
Downloads
Highlights:
-
Antibiotic resistance patterns before and during COVID-19 have changed.
-
There was an increase in MDR, MRSA, ESBL, and CRE isolates.
Abstract
Introduction: The coronavirus disease (COVID-19) pandemic has influenced antibiotic usage patterns due to overlapping clinical symptoms between viral and bacterial infections. This may lead to inappropriate antibiotic prescriptions, thereby increasing antimicrobial resistance. This study examined antibiotic resistance patterns in hospitalized children before and during the COVID-19 pandemic, highlighting their clinical and epidemiological significance.
Methods: This was a retrospective cross-sectional study using secondary data from the Central Laboratory Installation at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia. All patients aged 1 month to 18 years old with blood cultures and antibiotic sensitivity test results were included. The data were analyzed using Chi-square and linear regression in Microsoft Excel and the International Business Machines Corporation (IBM) Statistical Package for the Social Sciences (SPSS) version 26.0 for Windows.
Results: The proportion of Gram-positive bacterial isolates increased from 66% before the pandemic to 75% during the pandemic. The proportion of multidrug-resistant (MDR) isolates rose from 71.7% to 74.3%. Methicillin-resistant Staphylococcus aureus (MRSA) isolates rose from 20.6% to 25.8%. The proportion of extended-spectrum beta-lactamase (ESBL) isolates increased from 81.8% to 88.9%. All Enterobacteriaceae isolates were carbapenem-resistant Enterobacteriaceae (CRE). Significant resistance changes were observed in S. aureus to oxacillin.
Conclusion: There was a change in antibiotic resistance patterns during the pandemic. These findings are crucial for antibiotic stewardship and clinical policy-making.
World Health Organization (WHO). Clinical Management of COVID-19: Interim Guidance, 27 May 2020. Geneva, (2020). [Website]
Rawson TM, Moore LSP, Zhu N, Ranganathan N, Skolimowska K, Gilchrist M, et al. Bacterial and Fungal Coinfection in Individuals with Coronavirus: A Rapid Review to Support COVID-19 Antimicrobial Prescribing. Clin Infect Dis 2020; 71: 2459–2468. [PubMed]
Wang CN, Tong J, Yi B, Huttner BD, Cheng Y, Li S, et al. Antibiotic Use among Hospitalized Children and Neonates in China: Results from Quarterly Point Prevalence Surveys in 2019. Front Pharmacol 2021; 12: 601561. [PubMed]
Rioza BU. Dampak Pandemi COVID-19 terhadap Pola Penggunaan Antibiotik pada Pasien Rawat Inap Anak di RSUP Dr. Mohammad Hoesin Palembang. Universitas Sriwijaya Palembang, (2021). [Website]
Knight GM, Glover RE, McQuaid CF, Olaru ID, Gallandat K, Leclerc QJ, et al. Antimicrobial Resistance and COVID-19: Intersections and Implications. Elife; 10. February 2021. [PubMed]
Langford BJ, So M, Raybardhan S, Leung V, Westwood D, MacFadden DR, et al. Bacterial Co-Infection and Secondary Infection in Patients with COVID-19: A Living Rapid Review and Meta-Analysis. Clin Microbiol Infect 2020; 26: 1622–1629. [PubMed]
Vaughn VM, Gandhi TN, Petty LA, Patel PK, Prescott HC, Malani AN, et al. Empiric Antibacterial Therapy and Community-Onset Bacterial Coinfection in Patients Hospitalized with Coronavirus Disease 2019 (COVID-19): A Multi-Hospital Cohort Study. Clin Infect Dis An Official Publ Infect Dis Soc Am 2021; 72: e533–e541. [PubMed]
Getahun H, Smith I, Trivedi K, Paulin S, Balkhy HH. Tackling Antimicrobial Resistance in the COVID-19 Pandemic. Bulletin of the World Health Organization 2020; 98: 442-442A. [PubMed]
Hsu J. How COVID-19 is Accelerating the Threat of Antimicrobial Resistance. BMJ 2020; 369: m1983. [PubMed]
Centers for Disease Control and Prevention (CDC). Antibiotic Resistance Threats in the United States, 2019. CDC, (2019). [Website]
Siahaan S, Rukmini R, Roosihermiatie B, Andarwati P, Handayani RS, Tarigan IU, et al. The Effort to Rationalize Antibiotic Use in Indonesian Hospitals: Practice and Its Implication. J Trop Med 2023; 2023: 7701712. [PubMed]
Murray MT, Beauchemin MP, Neu N, Larson EL. Prior Antibiotic Use and Acquisition of Multidrug-Resistant Oorganisms in Hospitalized Children: A Systematic Review. Infect Control Hosp Epidemiol 2019; 40: 1107–1115. [PubMed]
Fanelli U, Chiné V, Pappalardo M, Gismondi P, Esposito S. Improving the Quality of Hospital Antibiotic Use: Impact on Multidrug-Resistant Bacterial Infections in Children. Front Pharmacol 2020; 11: 745. [PubMed]
Zhu X, Ye T, Zhong H, Luo Y, Xu J, Zhang Q, et al. Distribution and Drug Resistance of Bacterial Pathogens Associated with Lower Respiratory Tract Infection in Children and the Effect of COVID-19 on the Distribution of Pathogens. Can J Infect Dis Med Microbiol = J Can des Mal Infect la Microbiol medicale 2022; 2022: 1181283. [PubMed]
Polcwiartek LB, Polcwiartek C, Andersen MP, Østergaard L, Broccia MD, Gislason GH, et al. Consequences of Coronavirus Disease-2019 (COVID-19) Lockdown on Infection-Related Hospitalizations among the Pediatric Population in Denmark. Eur J Pediatr 2021; 180: 1955–1963. [PubMed]
Wärnhjelm E, Lääperi M, Kuitunen M, Helve O, Puhakka L, Harve-Rytsälä H, et al. Decrease in Paediatric Emergency Room Visits during the COVID-19 Pandemic Restrictions: A Population-Based Study. Acta Paediatr 2022; 111: 2165–2171. [Journal]
Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing. Pennsylvania, (2021). [Website]
Gates B, Allen P. Excel, (2018). [Website]
Nie NH, Bent DH, Hull CH. Statistical Package for the Social Sciences (SPSS), (2018). [Website]
Liptáková E. The Association between Two Categorical Variables Measured by Chi-Square Statistic, W Index, and Contingency Coefficient. Slovak J Sport Sci 2022; 7: 50–55. [Journal]
Wang C, Hao W, Yu R, Wang X, Zhang J, Wang B. Analysis of Pathogen Distribution and Its Antimicrobial Resistance in Bloodstream Infections in Hospitalized Children in East China, 2015-2018. J Trop Pediatr; 67. January 2021. [PubMed]
Ameya G, Weldemedhin T, Tsalla T, Gebremeskel F. Antimicrobial Susceptibility Pattern and Associated Factors of Pediatric Septicemia in Southern Ethiopia. Infect Drug Resist 2020; 13: 3895–3905. [PubMed]
Indrasari DD, Koendhori EB, Kuntaman K. The Impact of the COVID-19 Pandemic on Antimicrobial Resistance at Dr. Soetomo Academic Hospital of Surabaya. Int J Health Sci (Qassim) 2022; 6: 1058–1072. [Journal]
Saini V, Jain C, Singh NP, Alsulimani A, Gupta C, Dar SA, et al. Paradigm Shift in Antimicrobial Resistance Pattern of Bacterial Isolates during the COVID-19 Pandemic. Antibiot (Basel, Switzerland); 10. August 2021. [PubMed]
Jeon K, Jeong S, Lee N, Park MJ, Song W, Kim HS, et al. Impact of COVID-19 on Antimicrobial Consumption and Spread of Multidrug-Resistance in Bacterial Infections. Antibiot (Basel, Switzerland); 11. April 2022. [PubMed]
Siddiqui AH, Koirala J. Methicillin-Resistant Staphylococcus aureus. Treasure Island (FL), 2025. [PubMed]
Langford BJ, Soucy JPR, Leung V, So M, Kwan ATH, Portnoff JS, et al. Antibiotic Resistance Associated with the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. Clin Microbiol Infect 2023; 29: 302–309. [ScienceDirect]
Sulayyim HJ Al, Ismail R, Hamid AA, Ghafar NA. Antibiotic Resistance during COVID-19: A Systematic Review. Int J Environ Res Public Health; 19. September 2022. [PubMed]
Fu P, Xu H, Jing C, Deng J, Wang H, Hua C, et al. Bacterial Epidemiology and Antimicrobial Resistance Profiles in Children Reported by the ISPED Program in China, 2016 to 2020. Microbiol Spectr 2021; 9: e0028321. [PubMed]
Mehta Y, Hegde A, Pande R, Zirpe KG, Gupta V, Ahdal J, et al. Methicillin-Resistant Staphylococcus aureus in Intensive Care Unit Setting of India: A Review of Clinical Burden, Patterns of Prevalence, Preventive Measures, and Future Strategies. Indian J Crit Care Med 2020; 24: 55–62. [PubMed]
Centers for Disease Control and Prevention (CDC). COVID Data Tracker. CDC, (2022). [Website]
Copyright (c) 2025 Winnie Kitty, Yulia Iriani, Ariesti Karmila

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
1. The journal allows the author to hold the copyright of the article without restrictions.
2. The journal allows the author(s) to retain publishing rights without restrictions
3. The formal legal aspect of journal publication accessibility refers to Creative Commons Atribution-Share Alike 4.0 (CC BY-SA).