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The Recent Increase in Invasive Bacterial Infections: A Report From the National COVID Cohort Collaborative
Blake Martin1,2, Peter E DeWitt2, Seth Russell2
1From the Section of Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.
Background:
When coronavirus disease 2019 (COVID-19) mitigation efforts waned, viral respiratory infections (VRIs) surged, potentially increasing the risk of postviral invasive bacterial infections (IBIs). We sought to evaluate the change in epidemiology and relationships between specific VRIs and IBIs [complicated pneumonia, complicated sinusitis and invasive group A streptococcus (iGAS)] over time using the National COVID Cohort Collaborative (N3C) dataset.
Methods:
We performed a secondary analysis of all prospectively collected pediatric (<19 years old) and adult encounters at 58 N3C institutions, stratified by era: pre-pandemic (January 1, 2018, to February 28, 2020) versus pandemic (March 1, 2020, to June 1, 2023). We compared the characteristics and outcomes of patients with prespecified VRIs and IBIs, including correlation between VRI cases and subsequent IBI cases.
Results:
We identified 965,777 pediatric and 9,336,737 adult hospitalizations. Compared with pre-pandemic, pandemic-era children demonstrated higher mean monthly cases of adenovirus (121 vs. 79.1), iGAS (5.8 vs. 3.3), complicated pneumonia (282 vs. 178) and complicated sinusitis (29.8 vs. 16.3), P < 0.005 for all. Among pandemic-era children, peak correlation between RSV cases and subsequent complicated sinusitis cases occurred with a 60-day lag (correlation coefficient 0.56, 95% confidence interval: 0.52-0.59, P < 0.001) while peak correlation between influenza and complicated sinusitis occurred with a 33-day lag (0.55, 0.51-0.58, P < 0.001). Correlation among other VRI-IBI pairs was modest during the pandemic and often lower than during the pre-pandemic era.
Conclusions:
Since COVID-19 emerged, mean monthly cases of iGAS, complicated pneumonia, and complicated sinusitis have been higher. Pandemic-era RSV and influenza cases were correlated with subsequent cases of complicated sinusitis in children. However, many other VRI-IBI correlations decreased during the pandemic.
Insights
Viral respiratory infections (VRIs) surged post-COVID-19, increasing invasive bacterial infections (IBIs) like pneumonia and sinusitis in children. Pandemic RSV and influenza correlated with sinusitis, but other VRI-IBI links weakened.
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.
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