Critical illness from 2009 pandemic influenza A virus and bacterial coinfection in the United States*
Top Cited Papers
Open Access
- 1 May 2012
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Critical Care Medicine
- Vol. 40 (5), 1487-1498
- https://doi.org/10.1097/ccm.0b013e3182416f23
Abstract
Objectives: The contribution of bacterial coinfection to critical illness associated with 2009 influenza A virus infection remains uncertain. The objective of this study was to determine whether bacterial coinfection increased the morbidity and mortality of 2009 influenza A. Design: Retrospective and prospective cohort study. Setting: Thirty-five adult U.S. intensive care units over the course of 1 yr. Patients: Six hundred eighty-three critically ill adults with confirmed or probable 2009 influenza A. Interventions: None. Measurements and Main Results: A confirmed or probable case was defined as a positive 2009 influenza A test result or positive test for influenza A that was otherwise not subtyped. Bacterial coinfection was defined as documented bacteremia or any presumed bacterial pneumonia with or without positive respiratory tract culture within 72 hrs of intensive care unit admission. The mean age was 45 ± 16 yrs, mean body mass index was 32.5 ± 11.1 kg/m2, and mean Acute Physiology and Chronic Health Examination II score was 21 ± 9, with 76% having at least one comorbidity. Of 207 (30.3%) patients with bacterial coinfection on intensive care unit admission, 154 had positive cultures with Staphylococcus aureus (n = 57) and Streptococcus pneumoniae (n = 19), the most commonly identified pathogens. Bacterial coinfected patients were more likely to present with shock (21% vs. 10%; p = .0001), require mechanical ventilation at the time of intensive care unit admission (63% vs. 52%; p = .005), and have longer duration of intensive care unit care (median, 7 vs. 6 days; p = .05). Hospital mortality was 23%; 31% in bacterial coinfected patients and 21% in patients without coinfection (p = .002). Immunosuppression (relative risk 1.57; 95% confidence interval 1.20 –2.06; p = .0009) and Staphylococcus aureus at admission (relative risk 2.82; 95% confidence interval 1.76–4.51; p < .0001) were independently associated with increased mortality. Conclusions: Among intensive care unit patients with 2009 influenza A, bacterial coinfection diagnosed within 72 hrs of admission, especially with Staphylococcus aureus, was associated with significantly higher morbidity and mortality.Keywords
This publication has 35 references indexed in Scilit:
- Risk Factors for Severe Illness with 2009 Pandemic Influenza A (H1N1) Virus Infection in ChinaClinical Infectious Diseases, 2011
- Severe pandemic 2009 H1N1 influenza disease due to pathogenic immune complexesNature Medicine, 2010
- 2009 Pandemic Influenza A (H1N1): Pathology and Pathogenesis of 100 Fatal Cases in the United StatesThe American Journal of Pathology, 2010
- Clinical Aspects of Pandemic 2009 Influenza A (H1N1) Virus InfectionNew England Journal of Medicine, 2010
- Clinical Findings and Demographic Factors Associated With ICU Admission in Utah Due to Novel 2009 Influenza A(H1N1) InfectionChest, 2010
- Correlates of severe disease in patients with 2009 pandemic influenza (H1N1) virus infectionCMAJ : Canadian Medical Association Journal, 2010
- Critically Ill Patients With 2009 Influenza A(H1N1) Infection in CanadaJAMA, 2009
- Pneumonia and Respiratory Failure from Swine-Origin Influenza A (H1N1) in MexicoNew England Journal of Medicine, 2009
- Intensive care adult patients with severe respiratory failure caused by Influenza A (H1N1)v in SpainCritical Care, 2009
- Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics supportJournal of Biomedical Informatics, 2008