Abstract
Aim: This study aims to evaluate the impact of the COVID-19 pandemic on hospitalization rates, patient characteristics, and treatment practices in a pediatric infectious diseases outpatient clinic by comparing the pre-pandemic, pandemic, and post-pandemic periods.
Materials and Methods: The hospitalization rates of patients who presented to the Pediatric Infectious Diseases outpatient clinic at Aydın Adnan Menderes University Hospital between July 1, 2018, and October 1, 2023, as well as the data of those who were hospitalized, were retrospectively compared and analyzed across the pre-pandemic (Pr-P), pandemic (PP), and post-pandemic (Po-P) periods.
Results: The numbers of patients admitted to the PID outpatient clinic in Pr-P, PP, and Po-P were 10,906, 6,396 and 15835, respectively. The proportion of hospitalized patients was higher in PP, at 7.8%, compared to the other periods (p<0.001). The median patient age was higher in Pr-P compared to the other periods (Pr-P: 56 (22-109) months, PP: 31 (11-71) months, and Po-P: 40 (15-75) months, p<0.001). The presence of any underlying disease was more common in PP patients (p=0.003), and neurological conditions were the most frequently encountered diseases in across all periods. The most common diagnoses for hospitalization during PP were prolonged fever, bacteremia, or sepsis. Antibiotic use was most frequent in Po-P (p<0.001). The rate of use of wider-spectrum antibiotics, such as piperacillin-tazobactam (p=0.006) and meropenem (p=0.018) increased during and after PP. Transfer to the pediatric intensive care unit (PICU) requirements were more frequent during PP.
Conclusion: A higher hospitalization rate in the PID outpatient clinic, younger children being hospitalized and monitored, an increased use of broad-spectrum antibiotics, and greater transfer from the PID ward to the intensive care unit requirements were observed during the pandemic.
Note: This study was presented as an oral presentation at the 3rd Aydın Pediatric Autumn School Congress held in Didim, Aydın, on October 27–29, 2023.
Keywords
References
- World Health Organization. Coronavirus (COVID-19) data. [Internet]. Available from: www.covid19.who.int [Accessed 9 May 2024].
- T.C. Sağlık Bakanlığı [homepage on the Internet]. Artık açık havada maske kullanmak zorunda değiliz. Available from: https://www.saglik.gov.tr/TR,87522/artik-acik-havada-maske-kullanmak-zorunda-degiliz.html [Accessed 5 Jul 2025]
- Viner RM, Ward JL, Hudson LD, Ashe M, Patel SV, Hargreaves D, et al. Systematic review of reviews of symptoms and signs of COVID-19 in children and adolescents. Arch Dis Child. 2020 Dec 17: archdischild-2020-320972.
- Cao Q, Chen YC, Chen CL, Chiu CH. SARS-CoV-2 infection in children: Transmission dynamics and clinical characteristics. J Formos Med Assoc. 2020;119(3):670-3.
- Zhu F, Ang JY. COVID-19 Infection in Children: Diagnosis and Management. Current Infectious Disease Reports. 2022;24(4):51-62.
- Chow EJ, Englund JA. Severe Acute Respiratory Syndrome Coronavirus 2 Infections in Children. Infectious Disease Clinics of North America 2022;36(2):435-79.
- Siebach MK, Piedimonte G, Ley SH. COVID‐19 in childhood: Transmission, clinical presentation, complications and risk factors. Pediatric Pulmonology. 2021;56(6):1342-56.
- Kompaniyets L, Bull-Otterson L, Boehmer TK, Baca S, Alvarez P, Hong K, et al. Post-COVID-19 Symptoms and Conditions Among Children and Adolescents - United States, March 1, 2020-January 31, 2022. MMWR Morb Mortal Wkly Rep. 2022;71(31):993-9.
- Bertran M, Amin-Chowdhury Z, Sheppard CL, Eletu S, Zamarreño DV, Ramsay ME, Litt D, Fry NK, Ladhani SN. Increased Incidence of Invasive Pneumococcal Disease among Children after COVID-19 Pandemic, England. Emerg Infect Dis. 2022 Aug;28(8):1669-1672. doi: 10.3201/eid2808.220304. PMID: 35876698; PMCID: PMC9328924.
- Cobo-Vázquez E, Aguilera-Alonso D, Carrasco-Colom J, Calvo C, Saavedra-Lozano J; PedGAS-net Working Group. Increasing incidence and severity of invasive Group A streptococcal disease in Spanish children in 2019-2022. Lancet Reg Health Eur. 2023;27: 100597.
- Rubens JH, Akindele NP, Tschudy MM, Sick-Samuels AC. Acute covid-19 and multisystem inflammatory syndrome in children. BMJ. 2021;n385.
- Cowling BJ, Ali ST, Ng TWY, Tsang TK, Li JCM, Fong MW, et al. Impact assessment of non-pharmaceutical interventions against coronavirus disease 2019 and influenza in Hong Kong: an observational study. Lancet Public Health. 2020;5(5):e279-e88.
- Kuitunen I, Artama M, Mäkelä L, Backman K, Heiskanen-Kosma T, Renko M. Effect of Social Distancing Due to the COVID-19 Pandemic on the Incidence of Viral Respiratory Tract Infections in Children in Finland During Early 2020. The Pediatric infectious disease journal, 39(12), e423-e427.
- Cheng CW, Huang YB, Chao HY, Ng CJ, Chen SY. Impact of the COVID-19 pandemic on pediatric emergency medicine: A systematic review. Medicina (Kaunas). 2022;58(8):1112
- Brisca G, Vagelli G, Tagliarini G, Rotulo A, Pirlo D, Romanengo M, et al. The impact of COVID-19 lockdown on children with medical complexity in pediatric emergency department. Am J Emerg Med. 2021;42:225–7.
- Nascimento MS, Baggio DM, Fascina LP, Prado C. Impact of social isolation due to COVID-19 on the seasonality of pediatric respiratory diseases. PLoS One. 2020;15(12): e0243694
- Lazzerini M, Barbi E, Apicella A, Marchetti F, Cardinale F, Trobia G. Delayed access or provision of care in Italy resulting from fear of COVID-19. Lancet Child Adolesc Health. 2020; 4(5):e10-e11
- Chow EJ, Uyeki TM, Chu HY. The effects of the COVID-19 pandemic on community respiratory virus activity. Nat Rev Microbiol. 2023 Mar;21(3):195-210.
- Shmueli M, Lendner I, Ben Shimol S. Effect of the COVID 19 pandemic on the pediatric infectious disease landscape: Review. European Journal of Pediatrics. 2024,183.3:1001-1009.
- Friedrich F, Ongaratto R, Scotta MC, Veras TN, Stein R, Lumertz MS, et al. Early Impact of social distancing in response to COVID-19 on hospitalizations for acute bronchiolitis in infants in Brazil. Clin Infect Dis. 2021;72(12):2071-75
- Guo F, Qin Y, Fu H, Xu F. The impact of COVID-19 on Emergency Department length of stay for urgent and life-threatening patients. BMC Health Serv Res. 2022;22(1):696.
- Thorburn K, Jardine M, Taylor N, Reilly N, Sarginson RE, van Saene HK. Antibiotic-resistant bacteria and infection in children with cerebral palsy requiring mechanical ventilation. Pediatr Crit Care Med. 2009;10(2):222-6.
- Young NL, McCormick AM, Gilbert T, Ayling-Campos A, Burke T, Fehlings D, et al. Reasons for hospital admissions among youth and young adults with cerebral palsy. Arch Phys Med Rehabil. 2011;92(1):46-50.
- Ren L, Lin L, Zhang H, Wang Q, Cheng Y, Liu Q, et al. Epidemiological and clinical characteristics of respiratory syncytial virus and influenza infections in hospitalized children before and during the COVID-19 pandemic in Central China. Influenza Other Respir Viruses. 2023;17(2):e13103.
- Kapoor D, Kumar V, Pemde H, Singh P. Impact of Comorbidities on Outcome in Children With COVID-19 at a Tertiary Care Pediatric Hospital. Indian Pediatr. 2021;58(6):572-5.
- Katz SE, Spencer H, Zhang M, Banerjee R. Impact of the COVID-19 pandemic on infectious diagnoses and antibiotic use in pediatric ambulatory practices. J Pediatric Infect Dis Soc. 2021;10(1):62-4.
- Aldè M, DI Berardino C, Marchisio P, Braga L, Franchi M, DI Berardino F. Impact of COVID-19 containment measures on antibiotic prescribing for respiratory and ear diseases in pediatric primary care. Minerva Pediatr (Torino). 2022 Sep 30.
- Vestesson E, Booth J, Hatcher J, McGarrity O, Sebire NJ, Steventon A, et al. The impact of the COVID-19 pandemic on antimicrobial prescribing at a specialist paediatric hospital: An observational study. J Antimicrob Chemother. 2022;77(4):1185-8.
- Yazıcı Özkaya P, Arı HF, Baş İ, Turanlı EE, Karapınar B. Impact of the COVID-19 pandemic on pediatric intensive care unit admissions: A single centre experience. J Pediatr Res. 2022;9(2):164-8.
COVID-19 pandemisinin pediatrik enfeksiyon hastalıkları servisinde izlenen hastalar üzerindeki etkisi
Abstract
Amaç: Bu çalışma, COVID-19 pandemisinin pediatrik enfeksiyon hastalıkları polikliniğinden hastaneye yatış oranları, hasta özellikleri ve tedavi uygulamaları üzerindeki etkisini; pandemi öncesi, pandemi ve pandemi sonrası dönemlerini karşılaştırarak değerlendirmeyi amaçlamaktadır.
Gereç ve Yöntem: Aydın Adnan Menderes Üniversitesi Hastanesi Çocuk enfeksiyon hastalıkları polikliniğine 1 Temmuz 2018- 1 Ekim 2023 tarihleri arasında ayaktan başvuran hastaların yatış oranları ve hastaneye yatırılan hastaların verileri pandemi önesi dönem (Pr-P), pandemi dönemi (PP) ve pandemi sonrası dönem (Po-P) olarak retrospektif karşılaştırılmış ve analiz edilmiştir.
Bulgular: Pediatrik enfeksiyon hastalıkları polikliniğine başvuran toplam hasta sayıları Pr-P, PP ve Po-P dönemlerinde sırasıyla 10.906, 6.396 ve 15.835 olarak kaydedilmiştir. Hastaneye yatırılan hasta oranı, %7,8 ile pandemi döneminde diğer dönemlere göre anlamlı olarak daha yüksekti (p<0,001). Ortanca hasta yaşı Pr-P döneminde diğer dönemlere göre daha yüksekti (Pr-P: 56 (22–109) ay, PP: 31 (11–71) ay, Po-P: 40 (15–75) ay; p<0,001). Altta yatan hastalık varlığı PP dönemindeki hastalarda daha yaygındı (p=0,003) ve tüm dönemlerde en sık karşılaşılan altta yatan hastalıklar nörolojik rahatsızlıklar oldu. PP döneminde en sık hastaneye yatış nedenleri uzun süreli ateş, bakteriyemi ve sepsis olarak belirlendi. Antibiyotik kullanımı Po-P döneminde en yüksekti (p<0,001). Piperasilin-tazobaktam (p=0,006) ve meropenem (p=0,018) gibi geniş spektrumlu antibiyotiklerin kullanım oranı PP ve Po-P dönemlerinde artış gösterdi. Pediatrik yoğun bakım ünitesine transfer gereksinimi PP döneminde daha sıktı.
Sonuç: COVID-19 pandemisi sürecinde, Pediatrik enfeksiyon hastalıkları polikliniğine başvuran hastalarda hastaneye yatış oranlarının arttığı, daha küçük yaştaki çocukların yatırılarak izlendiği, geniş spektrumlu antibiyotik kullanımında artış olduğu ve pediatrik enfeksiyon hastalıkları servisinden yoğun bakıma transfer oranlarının yükseldiği gözlemlenmiştir.
Not: Bu çalışma, 27–29 Ekim 2023 tarihlerinde Didim, Aydın’da düzenlenen 3. Aydın Pediatri Güz Okulu Kongresinde sözlü bildiri olarak sunulmuştur.
Keywords
References
- World Health Organization. Coronavirus (COVID-19) data. [Internet]. Available from: www.covid19.who.int [Accessed 9 May 2024].
- T.C. Sağlık Bakanlığı [homepage on the Internet]. Artık açık havada maske kullanmak zorunda değiliz. Available from: https://www.saglik.gov.tr/TR,87522/artik-acik-havada-maske-kullanmak-zorunda-degiliz.html [Accessed 5 Jul 2025]
- Viner RM, Ward JL, Hudson LD, Ashe M, Patel SV, Hargreaves D, et al. Systematic review of reviews of symptoms and signs of COVID-19 in children and adolescents. Arch Dis Child. 2020 Dec 17: archdischild-2020-320972.
- Cao Q, Chen YC, Chen CL, Chiu CH. SARS-CoV-2 infection in children: Transmission dynamics and clinical characteristics. J Formos Med Assoc. 2020;119(3):670-3.
- Zhu F, Ang JY. COVID-19 Infection in Children: Diagnosis and Management. Current Infectious Disease Reports. 2022;24(4):51-62.
- Chow EJ, Englund JA. Severe Acute Respiratory Syndrome Coronavirus 2 Infections in Children. Infectious Disease Clinics of North America 2022;36(2):435-79.
- Siebach MK, Piedimonte G, Ley SH. COVID‐19 in childhood: Transmission, clinical presentation, complications and risk factors. Pediatric Pulmonology. 2021;56(6):1342-56.
- Kompaniyets L, Bull-Otterson L, Boehmer TK, Baca S, Alvarez P, Hong K, et al. Post-COVID-19 Symptoms and Conditions Among Children and Adolescents - United States, March 1, 2020-January 31, 2022. MMWR Morb Mortal Wkly Rep. 2022;71(31):993-9.
- Bertran M, Amin-Chowdhury Z, Sheppard CL, Eletu S, Zamarreño DV, Ramsay ME, Litt D, Fry NK, Ladhani SN. Increased Incidence of Invasive Pneumococcal Disease among Children after COVID-19 Pandemic, England. Emerg Infect Dis. 2022 Aug;28(8):1669-1672. doi: 10.3201/eid2808.220304. PMID: 35876698; PMCID: PMC9328924.
- Cobo-Vázquez E, Aguilera-Alonso D, Carrasco-Colom J, Calvo C, Saavedra-Lozano J; PedGAS-net Working Group. Increasing incidence and severity of invasive Group A streptococcal disease in Spanish children in 2019-2022. Lancet Reg Health Eur. 2023;27: 100597.
- Rubens JH, Akindele NP, Tschudy MM, Sick-Samuels AC. Acute covid-19 and multisystem inflammatory syndrome in children. BMJ. 2021;n385.
- Cowling BJ, Ali ST, Ng TWY, Tsang TK, Li JCM, Fong MW, et al. Impact assessment of non-pharmaceutical interventions against coronavirus disease 2019 and influenza in Hong Kong: an observational study. Lancet Public Health. 2020;5(5):e279-e88.
- Kuitunen I, Artama M, Mäkelä L, Backman K, Heiskanen-Kosma T, Renko M. Effect of Social Distancing Due to the COVID-19 Pandemic on the Incidence of Viral Respiratory Tract Infections in Children in Finland During Early 2020. The Pediatric infectious disease journal, 39(12), e423-e427.
- Cheng CW, Huang YB, Chao HY, Ng CJ, Chen SY. Impact of the COVID-19 pandemic on pediatric emergency medicine: A systematic review. Medicina (Kaunas). 2022;58(8):1112
- Brisca G, Vagelli G, Tagliarini G, Rotulo A, Pirlo D, Romanengo M, et al. The impact of COVID-19 lockdown on children with medical complexity in pediatric emergency department. Am J Emerg Med. 2021;42:225–7.
- Nascimento MS, Baggio DM, Fascina LP, Prado C. Impact of social isolation due to COVID-19 on the seasonality of pediatric respiratory diseases. PLoS One. 2020;15(12): e0243694
- Lazzerini M, Barbi E, Apicella A, Marchetti F, Cardinale F, Trobia G. Delayed access or provision of care in Italy resulting from fear of COVID-19. Lancet Child Adolesc Health. 2020; 4(5):e10-e11
- Chow EJ, Uyeki TM, Chu HY. The effects of the COVID-19 pandemic on community respiratory virus activity. Nat Rev Microbiol. 2023 Mar;21(3):195-210.
- Shmueli M, Lendner I, Ben Shimol S. Effect of the COVID 19 pandemic on the pediatric infectious disease landscape: Review. European Journal of Pediatrics. 2024,183.3:1001-1009.
- Friedrich F, Ongaratto R, Scotta MC, Veras TN, Stein R, Lumertz MS, et al. Early Impact of social distancing in response to COVID-19 on hospitalizations for acute bronchiolitis in infants in Brazil. Clin Infect Dis. 2021;72(12):2071-75
- Guo F, Qin Y, Fu H, Xu F. The impact of COVID-19 on Emergency Department length of stay for urgent and life-threatening patients. BMC Health Serv Res. 2022;22(1):696.
- Thorburn K, Jardine M, Taylor N, Reilly N, Sarginson RE, van Saene HK. Antibiotic-resistant bacteria and infection in children with cerebral palsy requiring mechanical ventilation. Pediatr Crit Care Med. 2009;10(2):222-6.
- Young NL, McCormick AM, Gilbert T, Ayling-Campos A, Burke T, Fehlings D, et al. Reasons for hospital admissions among youth and young adults with cerebral palsy. Arch Phys Med Rehabil. 2011;92(1):46-50.
- Ren L, Lin L, Zhang H, Wang Q, Cheng Y, Liu Q, et al. Epidemiological and clinical characteristics of respiratory syncytial virus and influenza infections in hospitalized children before and during the COVID-19 pandemic in Central China. Influenza Other Respir Viruses. 2023;17(2):e13103.
- Kapoor D, Kumar V, Pemde H, Singh P. Impact of Comorbidities on Outcome in Children With COVID-19 at a Tertiary Care Pediatric Hospital. Indian Pediatr. 2021;58(6):572-5.
- Katz SE, Spencer H, Zhang M, Banerjee R. Impact of the COVID-19 pandemic on infectious diagnoses and antibiotic use in pediatric ambulatory practices. J Pediatric Infect Dis Soc. 2021;10(1):62-4.
- Aldè M, DI Berardino C, Marchisio P, Braga L, Franchi M, DI Berardino F. Impact of COVID-19 containment measures on antibiotic prescribing for respiratory and ear diseases in pediatric primary care. Minerva Pediatr (Torino). 2022 Sep 30.
- Vestesson E, Booth J, Hatcher J, McGarrity O, Sebire NJ, Steventon A, et al. The impact of the COVID-19 pandemic on antimicrobial prescribing at a specialist paediatric hospital: An observational study. J Antimicrob Chemother. 2022;77(4):1185-8.
- Yazıcı Özkaya P, Arı HF, Baş İ, Turanlı EE, Karapınar B. Impact of the COVID-19 pandemic on pediatric intensive care unit admissions: A single centre experience. J Pediatr Res. 2022;9(2):164-8.
Details
| Primary Language | English |
|---|---|
| Subjects | Pediatric Infectious Diseases |
| Journal Section | Research Article |
| Authors | |
| Publication Date | December 8, 2025 |
| Submission Date | June 24, 2025 |
| Acceptance Date | July 24, 2025 |
| Published in Issue | Year 2025 Volume: 64 Issue: 4 |
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