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. 2025 Mar 1;44(3):217-227.
doi: 10.1097/INF.0000000000004575. Epub 2024 Oct 9.

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

Collaborators, Affiliations

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

Blake Martin et al. Pediatr Infect Dis J. .

Abstract

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.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1.
FIGURE 1.
Viral encounters over time. Twenty-nine-day moving average number of hospitalized encounters of (A) children with RSV, influenza, and COVID-19, (B) children with other viral respiratory infections, (C) adults with RSV, influenza and COVID-19 and (D) adults with other viral respiratory infections.RV/EV indicates rhino/enterovirus.
FIGURE 2.
FIGURE 2.
Invasive bacterial infection encounters over time. Number of hospitalized encounters (29-d moving average) of (A) children with iGAS, (B) children with complicated pneumonia, (C) children with complicated sinusitis, (D) adults with iGAS, (E) adults with complicated pneumonia and (F) adults with complicated sinusitis. For each panel, the viral respiratory infection most strongly correlated with subsequent counts of each invasive bacterial infection (Tables, Supplemental Digital Contents 25 and 26, http://links.lww.com/INF/F762) during the pandemic era is also shown. The dashed, black, vertical line denotes the start of the COVID-19 pandemic era as defined in our study (March 1, 2020).
FIGURE 3.
FIGURE 3.
VRI–IBI correlation. Correlation coefficient and 95% confidence interval by lag days between selected viral respiratory infection encounters (both hospitalized and nonhospitalized) and subsequent invasive bacterial infection encounters for children (A, B) and adults (C, D), stratified by era: pre-pandemic (red) versus pandemic (blue).

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