Klebsiella pneumoniae infection in the paediatric population before and after the COVID-19 pandemic in Shenzhen, China

Healthcare professionals epically infectious diseases are under high pressure during the COVID-19 pandemic or even after the pandemic due to co-infection such as influenza and bacterial pneumonia (11–35% of cases) in hospitalized patients caused mostly by Streptococcus pneumoniae and Staphylococcus aureus. The recent data published in this journal by Li et al., Zhu et al., and Ying et al. has reported reduced Streptococcus pneumoniae and Haemophilus influenzae and Mycoplasma pneumoniae infections, respectively in the paediatric population during and after the COVID-19 pandemic.^{,  ,}  In addition, data from France revealed that ultra-broad-spectrum β-lactamases in Escherichia coli infections have declined and the number of infections decreased after the lockdown. However, best of our knowledge no data is available regarding ESBL-producing Klebsiella pneumoniae (K. pneumoniae) infection during the COVID-19 pandemic amongst paediatric clinical cases. Here, we report the changes in K. pneumoniae infection before and after the COVID-19 pandemic in Shenzhen, China.

K. pneumoniae is a gram-negative, encapsulated, non-motile bacterium found in the environment and humans and has been associated with pneumonia, bloodstream infection, wound or surgical site infections, and meningitis resulting in mortality of about 20% in particular children. It can show high virulence and antimicrobial resistance carbapenems after entering the host. It's a major concern in sick patients who are receiving treatment for other conditions such as SARS-COVID-19 infection. So far, K. pneumoniae pneumonia is considered the most common cause of nosocomial pneumonia and accounts for 3 to 8% of all nosocomial bacterial infections. With changing the epidemiology of other infectious agents, particularly in paediatric patients. It is important to conduct a surveillance study of K. pneumoniae infection and antimicrobial resistance change during the COVID-19 pandemic in Children. In the present study, we inlight on the changes in K. pneumoniae infection and antimicrobial resistance in children before and after the COVID-19 pandemic, which may help to get data to use in management and prevention strategies in the health care settings. Shenzhen Children's Hospital is one of the major paediatric hospitals in south China. In the present study, K. pneumoniae infection was monitored in the hospital and isolates were collected from January 1, 2018, to December 31, 2021. All isolates were identified by the Vitek-2 system with 395hhhhhh further confirmed by using the API-20 strip. In addition, the antimicrobial susceptibility test (AST) was performed by the Vitek-2 system.

A total of 1243 isolates were recovered for paediatric patients, n = 518 from females while n = 725 from males which were from different departments of the hospital. The data revealed that male patients get more infected than females. The present study revealed the year 2018 has a high rate of infection but a decline in 2019. Although, in 2020 it increased slightly in the covid-19 pandemic but did not reach up to 2018. The present study supports the previous studies regarding the decline of Streptococcus pneumoniae and Haemophilus influenzae and Mycoplasma pneumoniae infections in children in China. We report the age group 0–1year shows the highest changes as a decline in infection, but the age group 5–10 does not have many changes During the COVID-19 pandemic. >10 age children group has lower infection during the COVID-19 and after the pandemic. This lower rate may be mainly related to increased awareness of wearing masks and paying attention to hand hygiene during the COVID-19 pandemic. All details are shown in Fig. 1. AST results suggested that K. pneumoniae increased the development of resistance against Ceftazidime, cefoperazone/sulbactam, Ceftolozane, and cefepime but the resistance trend declined in the case of Amoxicillin+clavulanic acid, Ceftriaxone, and Cefoxitin. The increased resistance against the cephalosporin group may result from the overuse of antibiotics during the pandemic. To support this, a recent study has reported K. pneumoniae shows high resistance to cephalosporin antibiotics because the high capacity for clonal expansion and exchange of mobile genetic elements carries resistance determinants. ESBLs producing isolates analysis showed a decline in the COVID-19 pandemic but again increased in 2021. AST data are shown in Fig. 2 and it indicates K. pneumoniae MDR phenotype which is worrisome in the management of clinical conditions. K. pneumoniae infection declined in paediatric patients compared to the year 2018 but constant surveillance is needed not for this but also for various pathogens. We all face the COVID −19 pandemic and found it an enemy to humans. The scientific community must come together to help each other, jointly address risks and challenges and jointly safeguard the world. In conclusion, K. pneumoniae infection in children of all ages has declined during and after the COVID-19 pandemic but resistance development has increased. Close monitoring of epidemiological trends helps to prevent K. pneumonia infection in children.