Evaluating the Antibiotic Resistance Pattern Before and After the COVID-19 Pandemic Among Cancer Patients

Abstract

Background: Antimicrobial resistance (AMR) has been a concerning public health issue even before the coronavirus disease 2019 (COVID-19) outbreak. However, the impact of the COVID-19 pandemic on AMR has not been comprehensively investigated. Objectives: The main objective of this study was to investigate the patterns of AMR before, during, and after the COVID-19 pandemic. Methods: Data from hospital records of cancer patients in the hematology ward were obtained for this cross-sectional study using a census sampling method from January 2018 to July 2023. Clinical specimens were collected, including urine, stool, cerebrospinal fluid, ascites, pleural fluid, oropharynx, blood, and synovial fluid. All specimens were sent to the central laboratory of the hospital. The obtained samples were cultured on blood agar (Merck) and MacConkey agar (Merck) media and incubated for 24 hours. The classification of strains as resistant, intermediate, or susceptible was determined according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: In the present study, 382 isolates were obtained from 186 (48.7%) males and 196 (51.3%) females admitted to the hematology ward at Taleqani Hospital. Among the 382 isolates, 102 were Escherichia coli, 97 were Klebsiella pneumoniae, 51 were Pseudomonas aeruginosa, 49 were coagulase-negative Staphylococcus, 30 were S. aureus, and 53 were other species. There was a changing trend in the antibiotic susceptibility patterns of ceftazidime for coagulase-negative Staphylococcus, as well as in multiple agents including meropenem, amikacin, and piperacillin-tazobactam for P. aeruginosa. For K. pneumoniae, there was a significant change in the antibiotic susceptibility patterns for amikacin, piperacillin, and ceftriaxone. For S. aureus, a significant difference was observed in the antibiotic susceptibility patterns of meropenem and clindamycin. For E. coli, significant differences were found in antibiotic susceptibility patterns for imipenem, amikacin, and cefazolin. Conclusions: Although we have navigated through the COVID-19 pandemic, its consequences, such as altered trends in AMR, continue to pose challenges to the healthcare system. Coronavirus disease 2019 has influenced the resistance patterns of both gram-negative and gram-positive bacteria. Monitoring adherence to guidelines is crucial to prevent further spread of resistant strains, particularly in developing countries where improvements in attitudes toward antibiotic prescription and hygiene standards are needed.