Impact of COVID-19 on Invasive Pneumococcal Disease: A Comparative Analysis of Clinical Features and Antibiotic Resistance across Pandemic Periods.

Abstract

Background: The coronavirus disease 2019 pandemic and associated infection control measures (lockdowns, masking) dramatically altered infectious disease epidemiology, including reduced invasive pneumococcal disease (IPD) incidence. This study aimed to assess the pandemic effects on IPD clinical features, outcomes, and antibiotic resistance in children.

Materials and methods: This study included pediatric patients (1 month to 18 years) diagnosed with IPD, comparing two distinct periods: the pre-pandemic era (March 2014-February 2020) and pandemic/post-pandemic era (March 2020-March 2024). Clinical characteristics and antibiotic resistance patterns of IPD patients were compared between the pre-pandemic and pandemic/post-pandemic periods.

Results: Among 61 cases (27 pre-pandemic, 34 pandemic/post-pandemic), age distribution remained similar (median 46 vs. 49 months, P=0.799). The distribution of IPD manifestations and vaccine failure rates (70.4% vs. 76.5%) were consistent between periods. Comparative analysis revealed significantly reduced susceptibility rates during the pandemic/post-pandemic period versus pre-pandemic for penicillin, ceftriaxone, and fluoroquinolones.

Conclusion: IPD remains a significant pediatric health concern. IPD continues to disproportionately affect children under five years of age, with no significant pandemic-related changes in age distribution, disease manifestations, or clinical outcomes. The concerning rise in resistance to first-line antibiotics during the pandemic underscores the urgent need for robust antimicrobial stewardship programs.