Dear editor:
Prakrut Paidisetty et al. [1] reported in the Indian Journal of Microbiology showed that the clinical characteristics of patients with mucormycosis infection in India during the COVID-19 pandemic. However, there is no report on the infection changes of Klebsiella pneumoniae (K. pneumoniae), a main pathogenic microorganism that causing of hospital acquired pneumonia also can cause a wide range of diseases, during the COVID-19 pandemic. Therefore, we hope to provide additional information to support these conclusions by presenting the findings from one of our studies that examined the dynamics of K. pneumoniae infection in children before and after the COVID-19 pandemic in Henan, China, spanning from 2018 to 2022.
Klebsiella pneumoniae, an opportunistic pathogen, is an important gram-negative Enterobacteriaceae bacteria, which is considered to be the main cause of hospital acquired pneumonia and can cause a series of diseases [2]. Klebsiella pneumoniae can colonize in human mucosa, including skin, nasopharynx and gastrointestinal tract, from which it can invade other tissues, causing pneumonia, sepsis, meningitis, liver abscess, urinary tract infection and numerous other challenging ailments. It’s important to note that the mortality caused by K. pneumoniae blood flow infection in young children can reach 12.3–26.6% [3–5]. The resistance of K. pneumoniae to carbapenems is mediated by different resistance mechanisms, including the production of carbapenemase, the change in porins and the increase in efflux pump activity, the most important of which is the production of carbapenemase [6, 7]. Unfortunately, due to the high drug resistance rate of K. pneumoniae, it is more difficult to treat the infection. What was worse, there is no vaccine to prevent K. pneumoniae infection, so effective strategies are urgently needed to prevent K. pneumoniae infection. However, there are few articles have examined the impact of COVID-19 pandemic on the epidemiological characteristics of K. pneumoniae. Therefore, monitoring the dynamic changes of K. pneumoniae is of great significance and assumes a pivotal role in preventing and controlling K. pneumoniae infection in children.
The present study aims to assess the prevalence rate, age-specific characteristics, and temporal trends of K. pneumoniae infection in pediatric patients before and after the COVID-19 pandemic, thereby providing a foundation for the clinical implementation of preventive strategies. The data of children with positive K. pneumoniae infection from 0 to 18 years old from January, 2018 to December, 2022 were studied and the differences in infection rates were compared among neonates (0–28 days), infants (29 days–1 year), preschool children (1 year–3 years), and school-age children (3 years–18 years) based on laboratory surveillance of Henan Children’s Hospital (National Children’s Regional Medical Center, Henan Children’s Medical Center), a 3A pediatric hospital with more than 2.4 million outpatient service per year, accounting for approximately 10% of total number of children in Henan. A total of 4, 730 children infected by K. pneumoniae were included (n = 1284 in 2018, n = 966 in 2019, n = 909 in 2020, n = 971 in 2021, n = 600 in 2022). Compared with the high incidence of K. pneumoniae infection in children from 2018 to 2019, the outbreak of the first COVID-19 pandemic in Henan (December of 2019) has led to a downward trend in the number of children infected by K. pneumoniae. The total number and positive rate of K. pneumoniae infection decreased significantly in the first half of 2020, which may be related to the stricter epidemic control, the isolation of children at home, the reduction of external contact, the avoidance of crowd gathering and the widespread use of disinfectants in the first half of 2020. Subsequently, in July 2020, the relative stability of the epidemic, children starting school and the relative gathering of people led to an increase in the number and rate of infection. However, due to the second wave of COVID-19 pandemic (July 2021) and the third wave of COVID-19 pandemic (October 2022) in Henan, both the number of K. pneumoniae infections and the positive detection rate declined again (Fig. 1A). Therefore, the epidemiological pattern of the infection of K. pneumoniae in children had indeed changed before and after the COVID-19 pandemic in Henan.
Fig. 1.
A The positive number and the positive rate of K. pneumoniae from 2018 to 2022. B The number of positive infections of K. pneumoniae from 2018 to 2022 in age groups. C The number of K. pneumoniae positive in different ages from 2018 to 2022
Furthermore, the number of neonates and infants infected with K. pneumoniae accounted for 82.92% of the total number of infected children (Fig. 1B). It is suggested that K. pneumoniae infection mainly occurs in children under 1 year old. In addition, it was found that the number of infected children of different ages declined during the three waves of COVID-19 pandemic, indicating that the blocking control policy inhibited the transmission of K. pneumonia (Fig. 1C). In addition, we explored the change of antibiotic resistance rate of K. pneumoniae before and after COVID-19 pandemic, indicating that the antibiotic resistance rate has declined after the occurrence of COVID-19, especially aztreonam (Table 1). Therefore, the COVID-19 pandemic has affected the infection of K. pneumoniae in children of different ages.
Table 1.
The change of antibiotic resistance rate of K. pneumoniae in children
| Antibiotics | 2018 (n = 957) | 2019 (n = 397) | 2020 (n = 403) | 2021 (n = 99) | 2022 (n = 127) |
|---|---|---|---|---|---|
| Amikacin | 392 (40.96%) | 142 (35.77%) | 128 (31.76%) | 27 (27.27%) | 43 (33.86%) |
| Aztreonam | 582 (60.82%) | 5 (1.26%) | 0 (0.00%) | 1 (1.01%) | 1 (0.79%) |
| Amoxicillin clavulanate potassium | 634 (66.25%) | 238 (59.95%) | 234 (58.06%) | 52 (52.53%) | 73 (57.48%) |
| Chloramphenicol | 318 (33.23%) | 100 (25.19%) | 90 (22.33%) | 18 (18.18%) | 28 (22.05%) |
| Meropenem | 527 (55.07%) | 216 (54.41%) | 174 (43.18%) | 40 (40.40%) | 61 (48.03%) |
| Gentamicin | 553 (57.78%) | 214 (53.90%) | 172 (42.68%) | 35 (35.35%) | 57 (44.88%) |
| Ceftazidime | 680 (71.06%) | 264 (66.50%) | 218 (54.09%) | 52 (52.53%) | 85 (66.93%) |
In short, the COVID-19 pandemic has affected the epidemic trend of K. pneumoniae infection in children in Henan, China. A series of epidemic prevention measures, including isolation at home, extensive use of disinfectants, wearing masks and enhancement of protection awareness, have played a powerful role. However, there is no clinically relevant K. pneumoniae vaccine, so the long-term prevalence of K. pneumoniae in children deserves our continued attention, and we should constantly optimize the measures to prevent infection of K. pneumoniae.
In conclusion, we found that during the COVID-19 pandemic, the K. pneumoniae infection among children had a downward trend. Maintaining effective and continuous surveillance is important for preventing K. pneumoniae infection, especially those under 1 years of age.
Acknowledgements
This work was funded by the National Natural Science Foundation of China (32201237), China Postdoctoral Science Foundation (2020M672301), Scientific and technological projects of Henan province (222102310270, 222102310109), Henan medical science and technology program (LHGJ 20210618).
Declarations
Competing interest
The authors declare that they have no competing interests.
Footnotes
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Contributor Information
Jieming Li, Email: jiemingli@hactcm.edu.cn.
Xianwei Zhang, Email: zhangxw956658@126.com.
Wancun Zhang, Email: zhangwancun@126.com.
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