Unveiling the impact: COVID-19's influence on bacterial resistance in the Kingdom of Bahrain

Table 1 Comparison of bacterial isolates over three periods (before, during, and after the coronavirus disease 2019 pandemic)

Organism	Pre-pandemic			Early pandemic			Post-peak pandemic			P value (2018-2019 vs 2020-2021)	P value (2020-2021 vs 2022-2023)	P value (2018-2019 vs 2022-2023)
	Year 2018	Year 2019	Total	Year 2020	Year 2021	Total	Year 2022	Year 2023	Total
Escherichia coli	2061	1416	3477	1316	1549	2865	1635	3400	5035	< 0.01a	< 0.01a	< 0.01a
Klebsiella pneumoniae	1133	908	2041	809	969	1778	892	1354	2246	0.04a	0.05	0.03a
Proteus mirabilis	204	129	333	117	131	248	144	151	295	0.08	0.12	0.15
Enterobacter spp.	307	241	548	173	196	369	201	279	480	0.03a	0.06	0.04a
Salmonella spp.	149	103	252	104	118	222	162	579	741	0.05	< 0.01a	< 0.01a
Citrobacter spp.	116	116	232	88	101	189	123	159	282	0.07	0.02a	0.05
Serratia marsescenes	84	97	181	77	115	192	97	119	216	0.35	0.20	0.30
Pseudomonas aeruginosa	835	577	1412	550	627	1177	668	683	1351	0.10	0.18	0.19
Acinetobacter baumannii	297	272	569	323	336	659	317	353	670	0.06	0.07	0.08
Stenotrophomonas maltophilia	133	129	262	102	139	241	128	112	240	0.20	0.45	0.35
Haemaphilus influenzae	122	99	221	44	40	84	117	116	233	< 0.01a	< 0.01a	< 0.01a
Staphylococcus aureus	1631	1248	2879	1102	1169	2271	1363	1591	2954	0.02a	0.04a	0.05
Enterococcus spp.	730	486	1216	511	806	1317	712	856	1568	0.05	0.04a	0.05
Coagulase-negative Staphylococci	1062	955	2017	1060	1734	2794	1498	1433	2931	0.10	0.12	0.15
Streptococcus pyogenes	127	83	210	42	21	63	16	99	115	< 0.01a	< 0.01a	< 0.01a
Streptococcus pneumoniae	106	75	181	33	47	80	90	86	176	< 0.01a	0.05	< 0.01a

^aMeans significant P value.

Statistically significant changes (P < 0.05) are observed between the three periods for several organisms, including Escherichia coli, Salmonella spp., Haemaphilus influenzae, Staphylococcus aureus, Streptococcus pyogenes, and Streptococcus pneumoniae. These organisms show significant variations in their prevalence before, during, and after the coronavirus disease 2019 pandemic. Non-significant changes (P > 0.05) are observed for organisms like Serratia marsescenes, Pseudomonas aeruginosa, and Proteus mirabilis, indicating more stable trends.

Table 2 Percentage of multidrug-resistant among different bacterial isolates in the pre-pandemic, early, and post-peak-pandemic era

Organism	Resistance type	Pre-pandemic	Early pandemic	Post-peak pandemic	P value (pre-pandemic vs early pandemic)	P value (prepandemic vs post-peak pandemic)	P value (early pandemic vs post-peak pandemic)
Escherichia coli	ESBL	41.04	44.71	43.61	0.01a	0.01a	0.34
	CRE	1.01	2.51	1.67	< 0.0001a	0.01a	0.01a
Klebsiella pneumoniae	ESBL	42.92	43.98	40.20	0.50	0.07	0.01a
	CRE	13.82	29.58	15.14	< 0.0001a	0.21	< 0.0001a
Acinetobacter baumannii	MDR	79.09	87.86	79.40	< 0.0001a	0.89	< 0.0001a
Pseudomonas aeruginosa	MDR	12.89	13.85	8.96	0.47	0.001a	< 0.0001a
	CRE Pseudomonas aeruginosa	15.65	19.97	17.47	0.01a	0.19	0.10
Staphylococcus aureus	Methicillin-resistant Staphylococcus aureus	38.17	37.08	48.85	0.42	< 0.0001a	< 0.0001a
Enterococcus spp.	Vancomycin-resistant Enterococci	11.02	18.45	24.36	< 0.0001a	< 0.0001a	< 0.0001a

^aMeans significant P value.

CRE: Carbapenem-resistant; ESBL: Extended-spectrum beta-lactamases; Early pandemic: Years 2020 and 2021; MDR: Multidrug-resistant; Post-pandemic: Years 2022 and 2023; Pre-pandemic: Years 2018 and 2019.