Community-Onset Bacterial Coinfection in Children Critically Ill With Severe Acute Respiratory Syndrome Coronavirus 2 Infection

Author:

Moffitt Kristin L12ORCID,Nakamura Mari M123,Young Cameron C4ORCID,Newhams Margaret M4,Halasa Natasha B5,Reed J Nelson6,Fitzgerald Julie C7,Spinella Philip C8,Soma Vijaya L9,Walker Tracie C10,Loftis Laura L11,Maddux Aline B12,Kong Michele13,Rowan Courtney M14,Hobbs Charlotte V15ORCID,Schuster Jennifer E16,Riggs Becky J17,McLaughlin Gwenn E18,Michelson Kelly N19,Hall Mark W20,Babbitt Christopher J21,Cvijanovich Natalie Z22,Zinter Matt S23,Maamari Mia24,Schwarz Adam J25,Singh Aalok R26,Flori Heidi R27,Gertz Shira J28,Staat Mary A29,Giuliano John S30,Hymes Saul R31,Clouser Katharine N32,McGuire John33,Carroll Christopher L34,Thomas Neal J35,Levy Emily R36,Randolph Adrienne G2437ORCID

Affiliation:

1. Division of Infectious Diseases, Boston Children's Hospital , Boston, Massachusetts , USA

2. Department of Pediatrics, Harvard Medical School , Boston, Massachusetts , USA

3. Antimicrobial Stewardship Program, Boston Children's Hospital , Boston, Massachusetts , USA

4. Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital , Boston, Massachusetts , USA

5. Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center , Nashville, Tennessee , USA

6. Department of Pediatrics, Medical University of South Carolina , Charleston, South Carolina , USA

7. Division of Critical Care, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine , Philadelphia, Pennsylvania , USA

8. Division of Critical Care, Department of Pediatrics, Washington University School of Medicine in St Louis , St Louis, Missouri , USA

9. Division of Pediatric Infectious Diseases, Department of Pediatrics, New York University Grossman School of Medicine, Hassenfeld Children's Hospital , New York, New York , USA

10. Department of Pediatrics, University of North Carolina at Chapel Hill Children’s Hospital , Chapel Hill, North Carolina , USA

11. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine , Houston, Texas , USA

12. Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children’s Hospital Colorado , Aurora, Colorado , USA

13. Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham , Birmingham, Alabama , USA

14. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children , Indianapolis, Indiana , USA

15. Department of Pediatrics, Division of Disease, University of Mississippi Medical Center , Jackson, Mississippi , USA

16. Division of Pediatric Infectious Disease, Department of Pediatrics, Children’s Mercy Kansas City , Kansas City, Missouri , USA

17. Division of Pediatric Anesthesiology and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine , Baltimore, Maryland , USA

18. Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Miami Miller School of Medicine , Miami, Florida , USA

19. Division of Critical Care Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois , USA

20. Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children’s Hospital , Columbus, Ohio , USA

21. Miller Children’s and Women’s Hospital of Long Beach , Long Beach, California , USA

22. Division of Critical Care Medicine, University of California, San Francisco Benioff Children’s Hospital, Oakland, California , USA

23. School of Medicine, Department of Pediatrics, Division of Critical Care Medicine, University of California, San Francisco , San Francisco, California , USA

24. Department of Pediatrics, Division of Critical Care Medicine, University of Texas Southwestern, Children’s Health Medical Center Dallas , Dallas, Texas , USA

25. Division of Critical Care Medicine, Children’s Hospital Orange County , Orange, California , USA

26. Pediatric Critical Care Division, Maria Fareri Children’s Hospital at Westchester Medical Center and New York Medical College , Valhalla, New York , USA

27. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mott Children's Hospital and University of Michigan , Ann Arbor, Michigan , USA

28. Division of Pediatric Critical Care, Department of Pediatrics, Cooperman Barnabas Medical Center , Livingston, New Jersey , USA

29. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center , Cincinnati, Ohio , USA

30. Department of Pediatrics, Division of Critical Care, Yale University School of Medicine , New Haven, Connecticut , USA

31. Division of Pediatric Infectious Diseases, Stony Brook Children's Hospital, Renaissance School of Medicine , Stony Brook, New York , USA

32. Department of Pediatrics, Hackensack Meridian School of Medicine , Hackensack, New Jersey , USA

33. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children’s Hospital and the University of Washington , Seattle, Washington , USA

34. Division of Critical Care, Connecticut Children’s , Hartford, Connecticut , USA

35. Department of Pediatrics, Penn State Hershey Children's Hospital, Pennsylvania State University College of Medicine , Hershey, Pennsylvania , USA

36. Divisions of Pediatric Infectious Diseases and Pediatric Critical Care Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic , Rochester, Minnesota , USA

37. Department of Anaesthesia, Harvard Medical School , Boston, Massachusetts , USA

Abstract

AbstractBackgroundCommunity-onset bacterial coinfection in adults hospitalized with coronavirus disease 2019 (COVID-19) is reportedly uncommon, though empiric antibiotic use has been high. However, data regarding empiric antibiotic use and bacterial coinfection in children with critical illness from COVID-19 are scarce.MethodsWe evaluated children and adolescents aged <19 years admitted to a pediatric intensive care or high-acuity unit for COVID-19 between March and December 2020. Based on qualifying microbiology results from the first 3 days of admission, we adjudicated whether patients had community-onset bacterial coinfection. We compared demographic and clinical characteristics of those who did and did not (1) receive antibiotics and (2) have bacterial coinfection early in admission. Using Poisson regression models, we assessed factors associated with these outcomes.ResultsOf the 532 patients, 63.3% received empiric antibiotics, but only 7.1% had bacterial coinfection, and only 3.0% had respiratory bacterial coinfection. In multivariable analyses, empiric antibiotics were more likely to be prescribed for immunocompromised patients (adjusted relative risk [aRR], 1.34 [95% confidence interval {CI}, 1.01–1.79]), those requiring any respiratory support except mechanical ventilation (aRR, 1.41 [95% CI, 1.05–1.90]), or those requiring invasive mechanical ventilation (aRR, 1.83 [95% CI, 1.36–2.47]) (compared with no respiratory support). The presence of a pulmonary comorbidity other than asthma (aRR, 2.31 [95% CI, 1.15–4.62]) was associated with bacterial coinfection.ConclusionsCommunity-onset bacterial coinfection in children with critical COVID-19 is infrequent, but empiric antibiotics are commonly prescribed. These findings inform antimicrobial use and support rapid de-escalation when evaluation shows coinfection is unlikely.

Funder

CDC

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Oncology

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