The Burden of Hospitalization Due to Klebsiella pneumoniae–Associated Pneumonia in Children Under 5 Years in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Introduction: Pneumonia is a significant cause of morbidity and mortality in pediatric populations, especially in low- and middle-income countries (LMICs). Knowing the prevalence and role of pathogens in pneumonia cases requiring hospitalization is essential for informing diagnosis, treatment, and prevention approaches. This review aimed to establish the burden of Klebsiella pneumoniae–associated pneumonia hospitalizations among children under 5 years of age in LMICs. Methods: A comprehensive search was conducted across major databases, including Google Scholar, PubMed, Scopus, and Web of Science, from inception up to April 18, 2024. The studies were screened, and the inclusion criteria were applied to identify eligible studies. Data analysis involved descriptive statistics, proportional meta-analysis, and subgroup analysis. Results: Out of 238 identified records, 16 studies met the inclusion criteria, encompassing 61,030 hospitalizations, with 2337 from Africa and 58,693 from Asia. K. pneumoniae accounted for 5% (95% CI: 2%–8%; I² = 98%) of pneumonia-related hospitalizations. Subgroup analyses showed higher prevalence in upper-middle-income countries (7%; 95% CI: 1%–14%; I² = 98.6%) compared to lower-middle-income countries (4%; 95% CI: 0%–8%; I² = 89.5%) and low-income countries (1%; 95% CI: 0%–2%; I² = 30.6%). Regionally, the prevalence was greater in Asia (6%; 95% CI: 1%–10%; I² = 83%) than in Africa (3%; 95% CI: 1%–5%; I² = 83%). Antibiotic susceptibility testing revealed complete sensitivity to meropenem, whereas resistance to gentamicin, ceftriaxone, sulfamethoxazole, and ciprofloxacin varied widely, ranging from 6.4% to 100%. Conclusion: This review highlights the notable occurrence of K. pneumoniae in hospitalized pediatric pneumonia cases, particularly in Asia. The findings emphasize the need for further research, standardized criteria for classifying pneumonia severity, and targeted strategies for diagnosing, treating, and preventing K. pneumoniae-associated pneumonia in pediatric populations.