Distribution and antimicrobial resistance of pathogens in oral and maxillofacial infections during and Post-COVID-19 pandemic

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Background This study investigated the distribution characteristics and antimicrobial resistance patterns of pathogens isolated from patients with oral and maxillofacial infections during and after the COVID-19 pandemic. Methods This retrospective study analyzed microbial cultures of specimens obtained from patients with odontogenic and non-odontogenic oral and maxillofacial infections during the pandemic period (January 2020–December 2022) and the post-pandemic period (January 2023–December 2024). Pathogen identification was performed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Antimicrobial susceptibility testing was conducted using the VITEK 2 Compact automated analyzer, the Kirby-Bauer disk diffusion method, and the Etest. Data were analyzed using WHONET (version 5.6) and R software (version 4.2.1). This study was approved by the Medical Ethics Committee of West China Hospital of Stomatology, Sichuan University (Approval No.: WCHSIRB-D-2025-280). Results While the microbial culture submission rate remained stable, the culture positivity rate decreased from 20.19 during the pandemic to 18.71% in the post-pandemic period. In odontogenic infections, anaerobic bacteria predominated, with Viridans streptococci, P. intermedia , and P. acnes being the most frequently isolated species. Notably, clindamycin resistance among Viridans streptococci significantly decreased from 93.81 to 82.35%. In contrast, non-odontogenic infections were predominantly caused by aerobic bacteria, most frequently involving K. pneumoniae, A. baumannii, S. aureus , and P. aeruginosa . Resistance to ceftriaxone in K. pneumoniae decreased significantly from 14.91 to 9%, whereas resistance to levofloxacin in P. aeruginosa markedly increased from 2.88 to 11.49%. In addition, the proportion of carbapenem-resistant A. baumannii (CR-AB) rose from 9.52 to 17.11%. Conclusion Following the COVID-19 pandemic, shifts in both the pathogen spectrum and antimicrobial resistance patterns were observed in odontogenic and non-odontogenic infections. These findings reflect an evolving microbial landscape and highlight the need for tailored, etiology-specific antimicrobial strategies in the management of oral and maxillofacial infections. However, as these changes may be attributable to multiple confounding factors, further studies are warranted to establish causality.

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