The Increase in Invasive Bacterial Infections With Respiratory Transmission in Germany, 2022/2023

Dtsch Arztebl Int. 2024 Feb 23;121(4):114-120. doi: 10.3238/arztebl.m2023.0261.


Background: In late 2022, health care institutions in Germany reported an unusual number of severe, invasive bacterial infections in association with a high incidence of viral respiratory infections.

Methods: We analyzed routine data on invasive infections due to Haemophilus influenzae, Neisseria meningitidis, Staphylococcus aureus, Streptococcus pneumoniae, and Streptococcus pyogenes (2017-2023) from a voluntary, laboratory-based surveillance system involving continuously participating facilities providing diagnostic routine data that cover approximately one-third of the German population.

Results: In the first quarter (Q1) of 2023, the number of invasive S. pyogenes isolates rose by 142% (n = 837 vs. mean Q1/2017-2019 = 346, 95% CI [258; 434]), while the number of H. influenzae isolates rose by 90% (n = 209 in Q1/2023 vs. mean Q1/2017-2019 = 110, 95% CI [79; 142]), compared to pre-pandemic seasonal peak values. The number of invasive S. pneumoniae isolates was high in two quarters (n = 1732 in Q4/2022 und Q1/2023). Adults aged 55 and older and children younger than 5 years were most affected by invasive H. influenzae, S. pneumoniae, and S. pyogenes infections. N. meningitidis was most commonly found in children under age 5.

Conclusion: The reason for the marked rise in invasive bacterial infections may be an increased circulation of respiratory pathogens and elevated susceptibility in the population after relaxation of the measures taken to prevent COVID-19 infection. Coinfections with respiratory viruses may have reinforced this effect. We recommend continuous surveillance, preventive measures such as raising awareness about invasive bacterial diseases, and vaccination as recommended by the German Standing Committee on Vaccinations (STIKO).

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Anti-Bacterial Agents
  • Bacterial Infections* / epidemiology
  • Child
  • Haemophilus influenzae
  • Humans
  • Neisseria meningitidis*
  • Respiratory Tract Infections* / epidemiology
  • Respiratory Tract Infections* / microbiology
  • Staphylococcal Infections*
  • Streptococcus pneumoniae
  • Streptococcus pyogenes


  • Anti-Bacterial Agents