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

Patil, Sandip; Chen, Hongyu; Dong, Shaowei; Liu, Sixi; Wen, Fu Qiang

doi:10.1016/j.jinf.2023.01.003

Cited by 4 publications

(3 citation statements)

References 6 publications

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“…The lack of effective treatments for infections involving multidrug-resistant Klebsiella pneumoniae infections may result in higher risks of mortality and disease burden, which merits attention. Our results showed that after the outbreak of the pandemic, the risk of CR-kpn decreased significantly, which was consistent with recent research ( 39 , 40 ). There were also increasing cases of carbapenems-resistant Enterobacter after the COVID-19 outbreak ( 41–44 ).…”

Section: Discussionsupporting

confidence: 93%

Multiple impacts of the COVID-19 pandemic and antimicrobial stewardship on antimicrobial resistance in nosocomial infections: an interrupted time series analysis

Li,

Yang,

Liu

et al. 2024

Front. Public Health

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ObjectivesThe emergency response to the COVID-19 pandemic may disrupt hospital management activities of antimicrobial resistance (AMR). This study aimed to determine the changing AMR trend over the period in China when stringent COVID-19 response measures were implemented.MethodsThis retrospective study was conducted in a designated hospital for COVID-19 patients in Guangzhou, China from April 2018 to September 2021. The prevalence of 13 antimicrobial-resistant bacteria was compared before and after the COVID-19 responses through Chi-square tests. Interrupted time series (ITS) models on the weekly prevalence of AMR were established to determine the changing trend. Controlled ITS models were performed to compare the differences between subgroups.ResultsA total of 10,134 isolates over 1,265 days were collected. And antimicrobial-resistant strains presented in 38.6% of the testing isolates. The weekly AMR prevalence decreased by 0.29 percentage point (95% CI [0.05–0.80]) after antimicrobial stewardship (AMS) policy, despite an increase in the prevalence of penicillin-resistant Streptococcus pneumoniae (from 0/43 to 15/43, p < 0.001), carbapenem-resistant Escherichia coli (from 20/1254 to 41/1184, p = 0.005), and carbapenem-resistant Klebsiella pneumoniae (from 93/889 to 114/828, p = 0.042). And the changing trend did not vary by gender (male vs. female), age (<65 vs. ≥65 years), service setting (outpatient vs. inpatient), care unit (ICU vs. non-ICU), the primary site of infection (Lung vs. others), and Gram type of bacteria (positive vs. negative).ConclusionThe response to COVID-19 did not lead to an increase in overall AMR; however, it appears that management strategy on the prudent use of antimicrobials likely contributed to a sizable long-term drop. The frequency of several multidrug-resistant bacteria continues to increase after the COVID-19 epidemic. It is crucial to continue to monitor AMR when COVID-19 cases have surged in China after the relaxation of restriction measures.

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Section: Discussionsupporting

confidence: 93%

Multiple impacts of the COVID-19 pandemic and antimicrobial stewardship on antimicrobial resistance in nosocomial infections: an interrupted time series analysis

Li,

Yang,

Liu

et al. 2024

Front. Public Health

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“…K. pneumoniae is considered the most common cause of nosocomial pneumonia. It accounts for 3 to 8% of all nosocomial bacterial infections 11 . The percentage of K. pneumoniae showed a significant decreasing trend (P < 0.05) during the strict control of the novel coronavirus epidemic from 2020 to 2022.…”

Section: Resultsmentioning

confidence: 99%

Distribution and molecular characterization of carbapenemase-producing gram-negative bacteria in Henan, China

Li,

Chen,

Qiao

et al. 2024

Sci Rep

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This study aimed to investigate the epidemiological characteristics and trends over time of carbapenemase-producing (e.g., KPC, NDM, VIM, IMP, and OXA-48) Gram-negative bacteria (CPGNB). Non-duplicated multi-drug resistant Gram-negative bacteria (MDRGNB) were collected from the First Affiliated Hospital of Zhengzhou University from April 2019 to February 2023. Species identification of each isolate was performed using the Vitek2 system and confirmed by matrix-assisted laser desorption ionization-time of flight mass spectrometry according to the manufacturer's instructions. PCR detected carbapenem resistance genes in the strains, strains carrying carbapenem resistance genes were categorized as CPGNB strains after validation by carbapenem inactivation assay. A total of 5705 non-repetitive MDRGNB isolates belonging to 78 different species were collected during the study period, of which 1918 CPGNB were validated, with the respiratory tract being the primary source of specimens. Epidemiologic statistics showed a significant predominance of ICU-sourced strains compared to other departments. Klebsiella pneumoniae, Escherichia coli, Acinetobacter baumannii, and Pseudomonas aeruginosa were the significant CPGNB in Henan, and KPC and NDM were the predominant carbapenemases. Carbapenem-resistant infections in Henan Province showed an overall increasing trend, and the carriage of carbapenemase genes by CPGNB has become increasingly prevalent and complicated. The growing prevalence of CPGNB in the post-pandemic era poses a significant challenge to public safety.

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“…The resistance patterns of neonatal K. pneumoniae , in a recent study comparing pre- and post-COVID-19 pandemic, revealed an increase in resistance toward cephalosporins such as ceftolozane, ceftazidime, cefepime, and cefoperazone-sulbactam and highlights the fact that, resistance to various classes of antibiotics increased due to drug overuse during the pandemic. 34 Close monitoring of AMR trends is crucial to ensure effective treatment strategies. Although, the last-resort antibiotics like colistin and tigecycline showed some hope, the high nephrotoxicity associated with the last-resort drugs compelled us to delve deeper into the susceptibility patterns of β-lactams.…”

Section: Discussionmentioning

confidence: 99%

Changing Landscape of Antimicrobial Resistance in Neonatal Sepsis: An in silico Analyses of Multidrug Resistance in Klebsiella pneumoniae

Vijayakumar,

Kumar,

Basu

et al. 2024

Pediatric Infectious Disease Journal

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Background: Neonatal sepsis poses a critical healthcare concern, as multidrug-resistant Klebsiella pneumoniae (K. pneumoniae) infections are on the rise. Understanding the antimicrobial susceptibility patterns and underlying resistance mechanism is crucial for effective treatment. Objectives: This study aimed to comprehensively investigate the antimicrobial susceptibility patterns of K. pneumoniae strains responsible for neonatal sepsis using in silico tools. We sought to identify trends and explore reasons for varying resistance levels, particularly for β-lactams and fluoroquinolone. Methods: K. pneumoniae isolated from neonates at Kanchi Kamakoti CHILDS Trust Hospital (2017–2020) were analyzed for antimicrobial resistance. Elevated resistance to β-lactam and fluoroquinolone antibiotics was further investigated through molecular docking and interaction analysis. β-lactam affinity with penicillin-binding proteins and β-lactamases was examined. Mutations in ParC and GyrA responsible for quinolone resistance were introduced to investigate ciprofloxacin interactions. Results: Of 111 K. pneumoniae blood sepsis isolates in neonates, high resistance was detected to β-lactams such as cefixime (85.91%, n = 71), ceftriaxone (84.9%, n = 106), cefotaxime (84.9%, n = 82) and fluoroquinolone (ciprofloxacin- 79.44%, n = 107). Molecular docking revealed low β-lactam binding toward penicillin-binding proteins and higher affinities for β-lactamases, attributing to the reduced β-lactam efficiency. Additionally, ciprofloxacin showed decreased affinity toward mutant ParC and GyrA in comparison to their corresponding wild-type proteins. Conclusion: Our study elucidates altered resistance profiles in neonatal sepsis caused by K. pneumoniae, highlighting mechanisms of β-lactam and fluoroquinolone resistance. It underscores the urgent need for the development of sustainable therapeutic alternatives to address the rising antimicrobial resistance in neonatal sepsis.

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

Cited by 4 publications

References 6 publications

Multiple impacts of the COVID-19 pandemic and antimicrobial stewardship on antimicrobial resistance in nosocomial infections: an interrupted time series analysis

Multiple impacts of the COVID-19 pandemic and antimicrobial stewardship on antimicrobial resistance in nosocomial infections: an interrupted time series analysis

Distribution and molecular characterization of carbapenemase-producing gram-negative bacteria in Henan, China

Changing Landscape of Antimicrobial Resistance in Neonatal Sepsis: An in silico Analyses of Multidrug Resistance in Klebsiella pneumoniae

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