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

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Area of Science:

  • Epidemiology
  • Infectious Diseases
  • Public Health

Background:

  • The waning of COVID-19 mitigation measures led to a rise in viral respiratory infections (VRIs).
  • This surge in VRIs may increase the risk of secondary invasive bacterial infections (IBIs).
  • Understanding the evolving relationship between specific VRIs and IBIs is crucial for public health.

Purpose of the Study:

  • To evaluate changes in the epidemiology of viral respiratory infections (VRIs) and invasive bacterial infections (IBIs).
  • To assess the temporal relationships between specific VRIs (e.g., RSV, influenza) and subsequent IBIs (e.g., complicated pneumonia, sinusitis, invasive group A Streptococcus).
  • To analyze these trends using the National COVID Cohort Collaborative (N3C) dataset.

Main Methods:

  • A secondary analysis of prospectively collected pediatric and adult patient encounters from 58 N3C institutions.
  • Data were stratified into pre-pandemic and pandemic eras for comparison.
  • Characteristics, outcomes, and correlations between VRI and IBI cases were analyzed.

Main Results:

  • Pandemic-era children showed higher mean monthly cases of adenovirus, invasive group A Streptococcus (iGAS), complicated pneumonia, and complicated sinusitis compared to pre-pandemic.
  • In pandemic-era children, Respiratory Syncytial Virus (RSV) and influenza cases showed a significant correlation with subsequent complicated sinusitis cases.
  • Correlations between other VRI-IBI pairs were generally modest during the pandemic and often lower than in the pre-pandemic era.

Conclusions:

  • Since the emergence of COVID-19, there has been an increase in mean monthly cases of iGAS, complicated pneumonia, and complicated sinusitis.
  • Pandemic-era RSV and influenza infections were correlated with subsequent complicated sinusitis in children.
  • Despite specific correlations, many other VRI-IBI relationships showed decreased association during the pandemic period.