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The Increasing Incidence of Invasive Bacterial Infections During the COVID-19 Pandemic

Monday, January 22, 2024
10:15 AM – 10:25 AM MT
Location: Connections Central - Star Research Theater
Introduction: COVID-19 mitigation strategies were associated with decreased respiratory viral transmission early in the pandemic. As mitigation efforts waned, respiratory syncytial virus (RSV) cases surged. Viral respiratory infections can increase risk of invasive bacterial infection (IBI) via direct mucosal injury and enhancing bacterial attachment. It is unknown how different viral respiratory infections and IBIs changed during the pandemic. We analyzed the National COVID Cohort Collaborative (N3C) dataset to measure viral respiratory infections and IBI in children during pre-pandemic (1/1/2018-2/28/2020) and pandemic (3/1/2020-6/8/2023) eras. We hypothesized IBI would be more common during the pandemic and correlate with preceding viral case numbers.


Methods: We identified all hospitalized children ( < 19-years-old) at 60 N3C sites. We used lagged correlation to measure correlation between respiratory viral infections and subsequent IBI (invasive group A strep [iGAS], complicated pneumonia, and complicated sinusitis).


Results: We analyzed 1,252,581 pediatric admissions. Compared to pre-pandemic, pandemic-era children had higher mean monthly cases of iGAS (7.3 vs 4.3), complicated pneumonia (344 vs 222), and complicated sinusitis (36.2 vs 19.9), p< 0.005 for all. During the pandemic, children with iGAS and complicated sinusitis were less likely to require mechanical ventilation (24.3% vs 37.2% and 6.6% vs 10.8%, respectively, p< 0.01 for all). Children with complicated pneumonia and sinusitis during the pandemic were more likely to need vasoactive support (40.8% vs 35.3% and 17.4% vs 12.4%, respectively, p< 0.01 for all), while children with iGAS during the pandemic demonstrated similar, high rates of vasoactive use (36.6% vs 45.1%, p=0.1). A lag of 58 days yielded the strongest correlation between RSV cases and subsequent complicated sinusitis cases (correlation coefficient 0.55, 95% confidence interval 0.51-0.59, p< 0.001). Peak correlation between influenza and complicated sinusitis occurred with a 32 day lag (0.50, 0.46-0.55, p< 0.001).


Conclusions: During the COVID pandemic, mean monthly cases of multiple IBIs increased, and RSV and influenza were correlated with subsequent complicated sinusitis cases. This the first report of correlation timing and strength between viral respiratory and IBI cases.