Bacterial coinfections in hospitalized children with COVID-19 during the SARS-CoV-2 Omicron BA.2 variant pandemic in Taiwan

Abstract

BackgroundBacterial coinfections have been widely recognized in adults with coronavirus disease 2019 (COVID-19). However, bacterial coinfections in hospitalized children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have not been sufficiently researched. This study aimed to determine the clinical presentations and risk factors for bacterial coinfections of pediatric inpatients during the SARS-CoV-2 Omicron BA.2 variant pandemic.MethodsThis retrospective, observational study included patients younger than 18 years of age who were hospitalized for COVID-19 confirmed by polymerase chain reaction (PCR) or antigen rapid tests during the SARS-CoV-2 Omicron BA.2 variant pandemic. Data and outcomes of these patients with or without bacterial coinfections were compared.ResultsDuring this study period, 161 children with confirmed COVID-19 were hospitalized. Twenty-four had bacterial coinfections. The most frequently reported concurrent diagnosis was bacterial enteritis, followed by lower respiratory tract infections. Children with bacterial coinfections had higher white blood cell (WBC) counts and PCR cycle threshold values. The bacterial coinfection group comprised a relatively greater proportion of patients who required high-flow nasal cannula oxygen and remdesivir. The length of stay in the hospital and that in the intensive care unit were longer for children with COVID-19 with bacterial coinfections. Mortality was not observed in either group. Abdominal pain, diarrhea, and comorbidity with neurologic illnesses were risk factors for bacterial coinfections with COVID-19.ConclusionThis study provides clinicians with reference points for the detection of COVID-19 in children and its possible association with bacterial infections. Children with COVID-19 and neurologic diseases who present with abdominal pain or diarrhea are at risk of bacterial coinfections. Prolonged fever duration and higher PCR test cycle threshold values, WBC levels, and high-sensitivity C-reactive protein (hsCRP) levels may indicate bacterial coinfections in children with COVID-19.

Critically ill children with SARS-COV-2 Omicron infection at a national children medical center, Guangdong, China

“…Recent multicenter, retrospective cohort studies have reported that COVID-19 bacterial co-infections are major risk factors for mortality, ICU admission, and mechanical ventilation [ 21 ]. An observational study in Taiwan revealed that the incidence of bacterial co-infections among hospitalized children with COVID-19 was 14.9% during the Omicron pandemic [ 22 ]. Detecting co-infected pathogens is important, however, most patients with suspected secondary infections may not have undergone thorough microbiological investigations during the pandemic.…”

Critically ill children with SARS-COV-2 Omicron infection at a national children medical center, Guangdong, China

“…Recent multicenter, retrospective cohort studies have reported that COVID-19 bacterial co-infections are major risk factors for mortality, ICU admission, and mechanical ventilation [13]. An observational study in Taiwan revealed that the incidence rate of bacterial co-infections among hospitalized children with COVID-19 was 14.9% during the Omicron pandemic [14]. Detecting co-infected pathogens is important, however, most patients with suspected secondary infections may not have undergone thorough microbiological investigations during the pandemic.…”

Investigation of Microbial Coinfection in 453 Septic COVID-19 Patients Admitted to hospital; a Retrospective Study

“…In another study by Wang et al , 7% of patients (5 of 69) had positive respiratory secretion cultures [ 26 ]. In a recent study of 161 pediatric SARS-CoV-2 Omicron BA.2 confirmed cases, 24 (14.9%) cases had bacterial coinfection [ 27 ]. Besides, a coinfection rate of 8% (14 out of 185 COVID-19 cases) was reported in the Jordanian population [ 28 ].…”