Written by Kimiko Dunbar
Spoon Feed
There has been an increase in cases of invasive group A strep, complicated pneumonia, and complicated sinusitis since the COVID-19 pandemic.
It’s complicated…
Infection prevention measures implemented during the COVID-19 pandemic decreased the incidence of viral infections in children. Now that these measures have been lifted, we are seeing an increase in viral infections and thus invasive bacterial infection (IBI), possibly due to viral-related mucosal injury (increasing risk of IBI) and decreased herd immunity post-pandemic. This large retrospective cohort study used N3C data to assess changes in IBI rates and viral-bacterial correlations in U.S. children pre-COVID versus during the COVID-19 pandemic (2020-2023). The N3C database is a national dataset aimed at facilitating research on COVID-19 and related conditions. Hospitalized pediatric IBI cases, including invasive group-A strep (iGAS), complicated pneumonia, and sinusitis, increased significantly (e.g., pneumonia: 282 vs. 178/month, P<0.001). RSV and influenza infection were moderately correlated with complicated sinusitis (r ≈ 0.56). Unsurprisingly, authors also found an increase in the percentage of infections occurring outside the typical respiratory season. Limitations of this study include observational design, evolving viral testing practices, and incomplete pre-pandemic mortality data, affecting causal inference and comparability.
How does this change my practice?
This study echoes what we have been feeling in the wards; cases of IBI are increasing, especially iGAS and complicated pneumonia, warranting increased suspicion for these complicated infections. It’s interesting to note that RSV and influenza were correlated with complicated sinusitis. Perhaps the threshold to evaluate for complicated sinusitis with dedicated imaging should be a bit lower in those with prior flu/RSV infection, although I think we need more data. I’d be interested to know if these trends continue in the coming years, given that the study period only includes data through June 2023.
Source
The Recent Increase in Invasive Bacterial Infections: A Report From the National COVID Cohort Collaborative. Pediatr Infect Dis J. 2025 Mar 1;44(3):217-227. doi: 10.1097/INF.0000000000004575. Epub 2024 Oct 9. PMID: 39951364
