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The Recent Increase in Invasive Bacterial Infections: A Report From the National COVID Cohort Collaborative.

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Following COVID-19, invasive bacterial infections (IBIs) like iGAS and complicated sinusitis increased in children. Pandemic RSV and influenza correlated with sinusitis, though other viral-respiratory infection to IBI links weakened.

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Area of Science:

  • Infectious Diseases
  • Epidemiology
  • Public Health

Background:

  • The waning of coronavirus disease 2019 (COVID-19) mitigation measures coincided with a surge in viral respiratory infections (VRIs).
  • This surge may have elevated the risk of post-viral invasive bacterial infections (IBIs), including complicated pneumonia, complicated sinusitis, and invasive group A Streptococcus (iGAS).
  • The study aimed to analyze the evolving epidemiology and interrelationships between specific VRIs and IBIs using the National COVID Cohort Collaborative (N3C) dataset.

Purpose of the Study:

  • To evaluate changes in the epidemiology of viral respiratory infections (VRIs) and invasive bacterial infections (IBIs) from the pre-pandemic to the pandemic era.
  • To assess the temporal correlations between specific VRIs (e.g., RSV, influenza) and subsequent IBIs (e.g., complicated sinusitis, iGAS) in pediatric and adult populations.
  • To compare these VRI-IBI relationships between the pre-pandemic and pandemic periods.

Main Methods:

  • A secondary analysis was conducted on prospectively collected data from 58 N3C institutions, encompassing pediatric (<19 years) and adult encounters.
  • Data were stratified into two eras: pre-pandemic (January 1, 2018–February 28, 2020) and pandemic (March 1, 2020–June 1, 2023).
  • Characteristics and outcomes of patients with specified VRIs and IBIs were compared, alongside correlation analyses between VRI cases and subsequent IBI occurrences.

Main Results:

  • The pandemic era saw higher mean monthly cases of adenovirus, iGAS, complicated pneumonia, and complicated sinusitis in children compared to the pre-pandemic period (P < 0.005 for all).
  • In pandemic-era children, peak correlations were observed between Respiratory Syncytial Virus (RSV) and complicated sinusitis (60-day lag, r=0.56) and between influenza and complicated sinusitis (33-day lag, r=0.55).
  • Correlations between other VRI-IBI pairs were generally modest during the pandemic and often weaker than those observed in the pre-pandemic era.

Conclusions:

  • Since the emergence of COVID-19, there has been an observed increase in mean monthly cases of iGAS, complicated pneumonia, and complicated sinusitis.
  • RSV and influenza infections during the pandemic were correlated with subsequent cases of complicated sinusitis in children.
  • Despite these specific links, the overall correlation between many viral respiratory infections and invasive bacterial infections decreased during the pandemic period.