Changes of pathogen distribution in children with wound infections before and after the COVID-19 pandemic in Henan, China

The pathogen distribution in bronchoalveolar lavage fluid, blood and cerebrospinal fluid changed under the impact of COVID-19 pandemic reported in the Journal of Infection,1Li L. Yu Z. Li M. Sun H. Changes of Acinetobacter baumannii infections in children before and after the COVID-19 pandemic in Zhengzhou, China.J Infect. 2022; Abstract Full Text Full Text PDF Scopus (16) Google Scholar, 2Cheng P. Li L. Sun H. Zhu C. Changes of pathogen distribution in children with bacterial meningitis before and after the COVID-19 pandemic in Zhengzhou, China.J Infect. 2022; Abstract Full Text Full Text PDF Google Scholar, 3Li T. Li X. Gao K. Dong G. Yang J. Changes in pathogen distribution in the blood culture of neonates before and after the COVID-19 pandemic, Henan, China.J Infect. 2022; Abstract Full Text Full Text PDF Google Scholar whereas gaps occurred in the pathogen distribution causing wound infections among children before and after the COVID-19 epidemic. Hence, we reported changed prevalence of wound infections among children. All wounds start from the time when the skin or mucosa were injured and colonized with bacteria from surroundings, only the wound escape the host immune system could heal, otherwise would cause infection.4Thet N.T. Mercer-Chalmers J. Greenwood R.J. Young A.E.R. Coy K. Booth S. et al.Swab: point-of-care sensor for simple and rapid detection of acute wound infection.ACS Sens. 2020; 5: 2652-2657Crossref PubMed Scopus (16) Google Scholar The clinical manifestations of wound infection include peri-wound redness, wound heat, and pain. If missing the early diagnosis and treatment, serious systemic infection or sepsis could occur, which caused by some pathogenic virulence factors, such as rhamnolipids from Pseudomonas aeruginosa.4Thet N.T. Mercer-Chalmers J. Greenwood R.J. Young A.E.R. Coy K. Booth S. et al.Swab: point-of-care sensor for simple and rapid detection of acute wound infection.ACS Sens. 2020; 5: 2652-2657Crossref PubMed Scopus (16) Google Scholar Among the children with surgical-site infections, the most common pathogens was methicillin-resistant and methicillin-susceptible Staphylococcus aureus (MRSA and MSSA, respectively), which showed significantly increasing trend from 1994 to 2015, Enterococcus spp., Streptococcus spp., and Pseudomonas aeruginosa were also common.5Woltmann J. Schaffzin J.K. Washam M. Connelly B.L. Pathogen and procedure trends among surgical-site infections at a children's hospital: a 20-year experience.Infect Control Hosp Epidemiol. 2017; 38: 380-382Crossref PubMed Scopus (3) Google Scholar In 2020, the emergence of COVID-19 pandemic had negative influence on global health care, and increased burden on patients had chronic wound.6Sen C.K. Human wound and its burden: updated 2020 compendium of estimates.Adv Wound Care. 2021; 10: 281-292Crossref PubMed Scopus (152) Google Scholar The non-pharmaceutical interventions changed the epidemiological features of many pathogens.7Zhang Y. Quigley A. Wang Q. MacIntyre C.R. Non-pharmaceutical interventions during the roll out of covid-19 vaccines.BMJ. 2021; 375: n2314Crossref PubMed Scopus (17) Google Scholar, 8Li T. Li X. Gao K. Dong G. Yang J. Changes in pathogen distribution in the blood culture of neonates before and after the COVID-19 pandemic, Henan, China.J Infect. 2022; Abstract Full Text Full Text PDF Google Scholar, 9Li Y. Guo Y. Duan Y. Changes in Streptococcus pneumoniae infection in children before and after the COVID-19 pandemic in Zhengzhou, China.J Infect. 2022; 85: e80-e81Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar, 10Liping Li Chunlan Song Peng Li Li.Y. Changes of Escherichia coli infection in children before and after the COVID-19 pandemic in Zhengzhou, China.J Infect. 2022; PubMed Google Scholar, 11Lumley S.F. Richens N. Lees E. Cregan J. Kalimeris E. Oakley S. et al.Changes in paediatric respiratory infections at a UK teaching hospital 2016-2021; impact of the SARS-CoV-2 pandemic.J Infect. 2022; 84: 40-47Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar Therefore, analysis of the prevalence trend and pathogen distribution of wound infection before and after the COVID-19 pandemic would be necessary for the treatments of related diseases. In this study, we analyzed the data of Henan Children’s Hospital from Jan 2018 to Dec 2021 to assess the pathogen infection situations before and after the COVID-19 pandemic. A total of 1, 748 children were included (n = 549 in 2018, n = 569 in 2019, n = 378 in 2020, n = 252 in 2021) as shown in Fig. 1A. Both total testing number and positive number of wound secretions decreased in 2020 and 2021 compared to 2018 and 2019. The total positive rates showed similar tendency (Fig. 1B). Positive rates of four dominating pathogens including Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa and Streptococcus anginosus, also declined in 2020 compared to pre-pandemic period. To evaluate the impact of COVID-19 pandemic on the season distribution, we analyzed the prevalence state per month (Fig. 1C). Both total and positive cases decreased in two COVID-19 outbreaks of Henan province, the positive rate reached two lowest points in four years of data included in the statistics. These results suggest that the COVID-19 pandemic has a significant impact on the epidemiological characteristics of wound infections among children. Furthermore, positive cases and positive rates of infection in wound infections were analyzed between five age groups (0–1 year, 1–3 years, 3–5 years, 5–10 years and ≥10 years) as shown in Fig. 2. In the post-pandemic period, the positive cases of pathogen infection in every age group significantly declined compared to pre-pandemic era, and children aged over 10 years old were less susceptible to pathogen infection of wound secretions, which was corresponding to the positive rates analysis in Fig. 2B. Otherwise, we found that the detective rates of children under 3 years old fallen off after the COVID-19 pandemic, whereas completely contrary to children older than 5 years old, which might because of the measures respond to the pandemic reduced the opportunities of wound formation among newborn and infant population. These results reminded that the COVID-19 pandemic has changed the age distribution of pathogen infection in wound secretions. In addition, we explored the pathogen distribution in children with wound infections before and after the COVID-19 pandemic (Table 1, Fig. 2C and D). The results showed that before and after the COVID-19 pandemic, the pathogenic bacteria in wound secretion cultures of children were mainly Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa and Streptococcus anginosus, accounting for more than 85% of the pathogenic microorganisms. Among these pathogens, the positive number and rates of Escherichia coli and Staphylococcus aureus gradually decreased from 2018 to 2021, even though the positive number and rates of Streptococcus anginosus increased in 2019, the data after the pandemic presented obviously decreased trend. In addition, the detective rates of Pseudomonas aeruginosa declined in 2020 but sharply increased in 2021, which might result from the lower total positive cases. Remarkably, Streptococcus pneumoniae, Citrobacter braakii, Streptococcus mitis and Trichophyton tonsurans were detected in 2018 and 2019, but were not detected in 2020 and 2021.Table 1The pathogen distribution of wound secretion cultures in children.Pathogens2018 (n = 349)2019 (n = 378)2020 (n = 232)2021 (n = 133)Escherichia coli195 (48.03%)172 (37.89%)108 (37.37%)55 (29.89%)Staphylococcus aureus100 (24.63%)112 (24.67%)61 (21.11%)32 (17.39%)Pseudomonas aeruginosa20 (4.93%)23 (5.07%)11 (3.81%)12 (6.52%)Streptococcus anginosus6 (1.48%)20 (4.41%)7 (2.42%)3 (1.63%)Klebsiella pneumoniae12 (2.96%)12 (2.64%)6 (2.08%)2 (1.09%)Bacteroides fragilis0 (0.00%)2 (0.44%)17 (5.88%)13 (7.07%)Enterococcus faecium5 (1.23%)12 (2.64%)4 (1.38%)5 (2.72%)Enterococcus avium0 (0.00%)11 (2.42%)7 (2.42%)5 (2.72%)Streptococus constelltus6 (1.48%)5 (1.10%)7 (2.42%)4 (2.17%)Staphylococcus epidermidis5 (1.23%)9 (1.98%)4 (1.38%)2 (1.09%)Other pathogens57 (14.04%)76 (16.74%)57 (19.72%)51 (27.72%) Open table in a new tab In conclusion, our data indicated decline of the number of cases and changes in the age and pathogen distribution of children with wound infections after the COVID-19 pandemic. In the future, continuous surveillance should not only center on the epidemic characteristics of pediatric wound infection, but also pay attention on effects among different age groups and pathogen distribution, which would be of great significance for the prevention and control of wound infections in children. The authors declare no conflict of interests. This work was supported by grants from the National Natural Science Foundation of China (31900116) and the Medical Science and Technology Projects of Henan Province (LHGJ20190955).