An analysis of surveillance data found that US children commonly received antibiotics for severe COVID-19 during the first year of the pandemic, despite a low prevalence of bacterial infections, researchers reported today in Open Forum Infectious Diseases.
Using data from the Overcoming COVID-19 Public Health Surveillance Registry, which includes children with SARS-CoV-2 infection–related complications who were treated at more than 70 hospitals in 25 states, a team led by researchers with Boston Children's Hospital evaluated children and adolescents aged 19 and younger who were admitted to an intensive care or high acuity unit for COVID-19 from March to December 2020. The primary outcomes assessed were prescription of antibiotics and the presence of community-onset bacterial co-infection. The researchers also examined factors associated with antibiotic prescriptions and bacterial co-infections.
Of the 532 children who met criteria for inclusion in the study, 63.3% were prescribed empiric antibiotics (most commonly ceftriaxone, vancomycin, and cefepime) and almost half received multiple antibiotics (21.1% received two, 10.0% received three, and 18.4% received four or more). But only 7.1% had bacterial co-infection, and only 3.0% had a respiratory bacterial co-infection.
There may be a lower likelihood of bacterial coinfection with SARS-CoV-2 infection.
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 to 1.79), those requiring any respiratory support except mechanical ventilation (aRR, 1.41; 95% CI, 1.05 to 1.90), and those requiring invasive mechanical ventilation (aRR, 1.83; 95% CI, 1.36 to 2.47). The presence of a pulmonary comorbidity other than asthma was associated with bacterial co-infection (aRR, 2.31; 95% CI, 1.15 to 4.62).
The study authors note that the findings are similar to those in US adults with COVID-19 during the first year of the pandemic.
"Pediatric providers accustomed to caring for children hospitalized with other respiratory viruses should be aware that there may be a lower likelihood of bacterial coinfection with SARS-CoV-2 infection, even in children requiring pediatric intensive care," they wrote.