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

The N3C Consortium

doi:10.1097/INF.0000000000004575

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

The N3C Consortium

Research output: Contribution to journal › Article › peer-review

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, complicatedpneumonia,andcomplicatedsinusitishavebeenhigher.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.

Original language	English
Pages (from-to)	217-227
Number of pages	11
Journal	Pediatric Infectious Disease Journal
Volume	44
Issue number	3
DOIs	https://doi.org/10.1097/INF.0000000000004575
State	Published - Mar 1 2025

Keywords

COVID-19
invasive bacterial infection
post-viral

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10.1097/INF.0000000000004575

Cite this

@article{45d68d67e8334e0988632225227b0688,

title = "The Recent Increase in Invasive Bacterial Infections A Report From the National COVID Cohort Collaborative",

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, complicatedpneumonia,andcomplicatedsinusitishavebeenhigher.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.",

keywords = "COVID-19, invasive bacterial infection, post-viral",

author = "{The N3C Consortium} and Blake Martin and DeWitt, {Peter E.} and Seth Russell and Melissa Haendel and Nelson Sanchez-Pinto and Albers, {David J.} and Jhaveri, {Ravi R.} and Richard Moffitt and Bennett, {Tellen D.} and Wilcox, {Adam B.} and Lee, {Adam M.} and Alexis Graves and Alfred Anzalone and Amin Manna and Amit Saha and Amy Olex and Andrea Zhou and Williams, {Andrew E.} and Andrew Southerland and Girvin, {Andrew T.} and Anita Walden and Sharathkumar, {Anjali A.} and Benjamin Amor and Benjamin Bates and Brian Hendricks and Brijesh Patel and Caleb Alexander and Carolyn Bramante and Cavin Ward-Caviness and Charisse Madlock-Brown and Christine Suver and Christopher Chute and Christopher Dillon and Chunlei Wu and Clare Schmitt and Cliff Takemoto and Dan Housman and Davera Gabriel and Eichmann, {David A.} and Diego Mazzotti and Don Brown and Eilis Boudreau and Elaine Hill and Elizabeth Zampino and Marti, {Emily Carlson} and Pfaff, {Emily R.} and Evan French and Koraishy, {Farrukh M.} and Federico Mariona and Fred Prior and George Sokos and Greg Martin and Harold Lehmann and Heidi Spratt and Hemalkumar Mehta and Hongfang Liu and Hythem Sidky and Hayanga, {J. W.Awori} and Jami Pincavitch and Jaylyn Clark and Harper, {Jeremy Richard} and Jessica Islam and Jin Ge and Joel Gagnier and Saltz, {Joel H.} and Joel Saltz and Johanna Loomba and John Buse and Jomol Mathew and Rutter, {Joni L.} and McMurry, {Julie A.} and Justin Guinney and Justin Starren and Karen Crowley and Bradwell, {Katie Rebecca} and Walters, {Kellie M.} and Ken Wilkins and Gersing, {Kenneth R.} and Cato, {Kenrick Dwain} and Kimberly Murray and Kristin Kostka and Lavance Northington and Pyles, {Lee Allan} and Leonie Misquitta and Lesley Cottrell and Lili Portilla and Mariam Deacy and Bissell, {Mark M.} and Marshall Clark and Mary Emmett and Saltz, {Mary Morrison} and Palchuk, {Matvey B.} and Haendel, {Melissa A.} and Meredith Adams and Meredith Temple-O{\textquoteright}Connor and Kurilla, {Michael G.} and Michele Morris and Nabeel Qureshi and Nasia Safdar and Nicole Garbarini and Noha Sharafeldin and Ofer Sadan and Francis, {Patricia A.} and Burgoon, {Penny Wung} and Peter Robinson and Payne, {Philip R.O.} and Rafael Fuentes and Randeep Jawa and Rebecca Erwin-Cohen and Rena Patel and Moffitt, {Richard A.} and Zhu, {Richard L.} and Rishi Kamaleswaran and Robert Hurley and Miller, {Robert T.} and Saiju Pyarajan and Michael, {Sam G.} and Samuel Bozzette and Sandeep Mallipattu and Satyanarayana Vedula and Scott Chapman and O{\textquoteright}Neil, {Shawn T.} and Soko Setoguchi and Hong, {Stephanie S.} and Steve Johnson and Bennett, {Tellen D.} and Tiffany Callahan and Umit Topaloglu and Usman Sheikh and Valery Gordon and Vignesh Subbian and Kibbe, {Warren A.} and Wenndy Hernandez and Will Beasley and Will Cooper and William Hillegass and Zhang, {Xiaohan Tanner}",

note = "Publisher Copyright: Copyright {\textcopyright} 2024 The Author(s). Published by Wolters Kluwer Health, Inc.",

year = "2025",

month = mar,

day = "1",

doi = "10.1097/INF.0000000000004575",

language = "English",

volume = "44",

pages = "217--227",

journal = "Pediatric Infectious Disease Journal",

issn = "0891-3668",

number = "3",

}

TY - JOUR

T1 - The Recent Increase in Invasive Bacterial Infections A Report From the National COVID Cohort Collaborative

AU - The N3C Consortium

AU - Martin, Blake

AU - DeWitt, Peter E.

AU - Russell, Seth

AU - Haendel, Melissa

AU - Sanchez-Pinto, Nelson

AU - Albers, David J.

AU - Jhaveri, Ravi R.

AU - Moffitt, Richard

AU - Bennett, Tellen D.

AU - Wilcox, Adam B.

AU - Lee, Adam M.

AU - Graves, Alexis

AU - Anzalone, Alfred

AU - Manna, Amin

AU - Saha, Amit

AU - Olex, Amy

AU - Zhou, Andrea

AU - Williams, Andrew E.

AU - Southerland, Andrew

AU - Girvin, Andrew T.

AU - Walden, Anita

AU - Sharathkumar, Anjali A.

AU - Amor, Benjamin

AU - Bates, Benjamin

AU - Hendricks, Brian

AU - Patel, Brijesh

AU - Alexander, Caleb

AU - Bramante, Carolyn

AU - Ward-Caviness, Cavin

AU - Madlock-Brown, Charisse

AU - Suver, Christine

AU - Chute, Christopher

AU - Dillon, Christopher

AU - Wu, Chunlei

AU - Schmitt, Clare

AU - Takemoto, Cliff

AU - Housman, Dan

AU - Gabriel, Davera

AU - Eichmann, David A.

AU - Mazzotti, Diego

AU - Brown, Don

AU - Boudreau, Eilis

AU - Hill, Elaine

AU - Zampino, Elizabeth

AU - Marti, Emily Carlson

AU - Pfaff, Emily R.

AU - French, Evan

AU - Koraishy, Farrukh M.

AU - Mariona, Federico

AU - Prior, Fred

AU - Sokos, George

AU - Martin, Greg

AU - Lehmann, Harold

AU - Spratt, Heidi

AU - Mehta, Hemalkumar

AU - Liu, Hongfang

AU - Sidky, Hythem

AU - Hayanga, J. W.Awori

AU - Pincavitch, Jami

AU - Clark, Jaylyn

AU - Harper, Jeremy Richard

AU - Islam, Jessica

AU - Ge, Jin

AU - Gagnier, Joel

AU - Saltz, Joel H.

AU - Saltz, Joel

AU - Loomba, Johanna

AU - Buse, John

AU - Mathew, Jomol

AU - Rutter, Joni L.

AU - McMurry, Julie A.

AU - Guinney, Justin

AU - Starren, Justin

AU - Crowley, Karen

AU - Bradwell, Katie Rebecca

AU - Walters, Kellie M.

AU - Wilkins, Ken

AU - Gersing, Kenneth R.

AU - Cato, Kenrick Dwain

AU - Murray, Kimberly

AU - Kostka, Kristin

AU - Northington, Lavance

AU - Pyles, Lee Allan

AU - Misquitta, Leonie

AU - Cottrell, Lesley

AU - Portilla, Lili

AU - Deacy, Mariam

AU - Bissell, Mark M.

AU - Clark, Marshall

AU - Emmett, Mary

AU - Saltz, Mary Morrison

AU - Palchuk, Matvey B.

AU - Haendel, Melissa A.

AU - Adams, Meredith

AU - Temple-O’Connor, Meredith

AU - Kurilla, Michael G.

AU - Morris, Michele

AU - Qureshi, Nabeel

AU - Safdar, Nasia

AU - Garbarini, Nicole

AU - Sharafeldin, Noha

AU - Sadan, Ofer

AU - Francis, Patricia A.

AU - Burgoon, Penny Wung

AU - Robinson, Peter

AU - Payne, Philip R.O.

AU - Fuentes, Rafael

AU - Jawa, Randeep

AU - Erwin-Cohen, Rebecca

AU - Patel, Rena

AU - Moffitt, Richard A.

AU - Zhu, Richard L.

AU - Kamaleswaran, Rishi

AU - Hurley, Robert

AU - Miller, Robert T.

AU - Pyarajan, Saiju

AU - Michael, Sam G.

AU - Bozzette, Samuel

AU - Mallipattu, Sandeep

AU - Vedula, Satyanarayana

AU - Chapman, Scott

AU - O’Neil, Shawn T.

AU - Setoguchi, Soko

AU - Hong, Stephanie S.

AU - Johnson, Steve

AU - Bennett, Tellen D.

AU - Callahan, Tiffany

AU - Topaloglu, Umit

AU - Sheikh, Usman

AU - Gordon, Valery

AU - Subbian, Vignesh

AU - Kibbe, Warren A.

AU - Hernandez, Wenndy

AU - Beasley, Will

AU - Cooper, Will

AU - Hillegass, William

AU - Zhang, Xiaohan Tanner

PY - 2025/3/1

Y1 - 2025/3/1

N2 - 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, complicatedpneumonia,andcomplicatedsinusitishavebeenhigher.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.

AB - 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, complicatedpneumonia,andcomplicatedsinusitishavebeenhigher.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.

KW - COVID-19

KW - invasive bacterial infection

KW - post-viral

UR - http://www.scopus.com/inward/record.url?scp=85207344796&partnerID=8YFLogxK

U2 - 10.1097/INF.0000000000004575

DO - 10.1097/INF.0000000000004575

M3 - Article

C2 - 39736073

AN - SCOPUS:85207344796

SN - 0891-3668

VL - 44

SP - 217

EP - 227

JO - Pediatric Infectious Disease Journal

JF - Pediatric Infectious Disease Journal

IS - 3

ER -

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

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