J Korean Med Sci.  2023 Apr;38(16):e127. 10.3346/jkms.2023.38.e127.

Twenty-Five Year Trend Change in the Etiology of Pediatric Invasive Bacterial Infections in Korea, 1996–2020

• Song SH
• Lee H
• Lee HJ
• Song ES
• Ahn JG
• Park SE
• Lee T
• Cho HK
• Lee J
• Kim YJ
• Jo DS
• Kim JH
• Kang HM
• Lee JK
• Kim CS
• Kim DH
• Kim HM
• Choi JH
• Eun BW
• Kim NH
• Cho EY
• Kim YK
• Oh CE
• Kim KH
• Ma SH
• Jung HJ
• Lee KS
• Kim KN
• Choi EH

• KMID: 2541751
• DOI: http://doi.org/10.3346/jkms.2023.38.e127

Abstract

Background
The coronavirus disease-2019 (COVID-19) pandemic has contributed to the change in the epidemiology of many infectious diseases. This study aimed to establish the pre-pandemic epidemiology of pediatric invasive bacterial infection (IBI).
Methods
A retrospective multicenter-based surveillance for pediatric IBIs has been maintained from 1996 to 2020 in Korea. IBIs caused by eight bacteria (Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, Staphylococcus aureus, Streptococcus agalactiae, Streptococcus pyogenes, Listeria monocytogenes, and Salmonella species) in immunocompetent children > 3 months of age were collected at 29 centers. The annual trend in the proportion of IBIs by each pathogen was analyzed.
Results
A total of 2,195 episodes were identified during the 25-year period between 1996 and 2020. S. pneumoniae (42.4%), S. aureus (22.1%), and Salmonella species (21.0%) were common in children 3 to 59 months of age. In children ≥ 5 years of age, S. aureus (58.1%), followed by Salmonella species (14.8%) and S. pneumoniae (12.2%) were common. Excluding the year 2020, there was a trend toward a decrease in the relative proportions of S. pneumoniae (r_s = −0.430, P = 0.036), H. influenzae (r_s = −0.922, P < 0.001), while trend toward an increase in the relative proportion of S. aureus (r_s = 0.850, P < 0.001), S. agalactiae (r_s = 0.615, P = 0.001), and S. pyogenes (r_s = 0.554, P = 0.005).
Conclusion
In the proportion of IBIs over a 24-year period between 1996 and 2019, we observed a decreasing trend for S. pneumoniae and H. influenzae and an increasing trend for S. aureus, S. agalactiae, and S. pyogenes in children > 3 months of age. These findings can be used as the baseline data to navigate the trend in the epidemiology of pediatric IBI in the post COVID-19 era.

Keyword

Invasive Bacterial infections; Epidemiology; COVID-19; Children

Figure

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  Fig. 1 Distribution of causative bacterial organisms in invasive infections in immunocompetent children between 1996 and 2020 according to age group and clinical diagnosis.

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  Fig. 2 Annual trend in the proportion of eight causative organisms of invasive bacterial infections in children 3 months of age or older, 1996–2019.aThe Spearman rank correlation (rs) test was performed using the 2-tailed test to reject the hypothesis that rs = 0 and P < 0.05 was considered statistically significant. As the proportion of invasive bacterial infections in 2020 was markedly different from the previous trend, the value of 2020 was displayed as a dotted line.**P < 0.05.

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