Community-Acquired Respiratory Coinfection in Critically Ill Patients With Pandemic 2009 Influenza A(H1N1) Virus

Martín‐Loeches, Ignacio; Sanchez-Corral, Ana; Dı́az, Emili; Granada, R.; Zaragoza, Rafael; Villavicencio, Christian; Albaya, Antonio; Cerdá, Enrique; Catalán, Rosa Marı́a Jiménez; Luqué, Pilar; Paredes, Amparo; Navarrete, Inés; Rello, Jordi; Rodríguez, Alejandro

doi:10.1378/chest.10-1396

Cited by 178 publications

(171 citation statements)

References 34 publications

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“…Similar to previously reported data from this group [5], Streptococcus pneumoniae was the predominant pathogen recovered, followed by Pseudomonas aeruginosa and methicillin-susceptible Staphylococcus aureus (MSSA). Not unexpectedly, data from the USA found that S. aureus was the predominant organism, with a higher prevalence of methicillin-resistant S. aureus (MRSA) [6].…”

supporting

confidence: 89%

Co-infection in severe influenza: a new epidemiology?

Luyt

Rice

2016

Intensive Care Med

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supporting

confidence: 89%

Co-infection in severe influenza: a new epidemiology?

Luyt

Rice

2016

Intensive Care Med

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“…The full‐text review resulted in the exclusion of an additional 74 articles. A total of 27 articles encompassing 3215 patients met all the inclusion criteria and were included in the final analysis 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54. Of those 27, only eight studies, with 334 patients, provided the numbers or percentages of each bacterial coinfecting pathogen 28, 32, 33, 34, 38, 43, 46, 47.…”

Section: Resultsmentioning

confidence: 99%

“…All 27 included studies were observational, of which 13 (1218 patients) were prospective studies,30, 32, 33, 36, 40, 41, 43, 44, 48, 49, 50, 51, 52 and 14 (1997 patients) were retrospective analyses (Table 1). The majority (21) of studies were cohort studies, and the rest were case–control studies.…”

Section: Resultsmentioning

confidence: 99%

“…Severity of illness varied among studies, but all were focused on hospitalized patients, suggesting a greater than average severity. Eleven of the studies (1007 patients) focused exclusively on patients initially enrolled in an intensive care unit (ICU),32, 34, 35, 38, 39, 41, 42, 44, 46, 47, 51 10 enrolled non‐ICU hospitalized patients (973 patients),30, 33, 36, 37, 40, 43, 45, 49, 53, 54 3 enrolled patients in the emergency department (ED; 135 patients),28, 48, 50 and 2 enrolled patients in a mix of inpatient and outpatient settings (1100 patients) 29, 52. The median sample size was 51 (IQR, 18·5–101), and the mean was 119 (SD: 203), which was driven by three large studies29, 44, 53 that contributed 1958 (61%) of the total number of patients included in this analysis.…”

Section: Resultsmentioning

confidence: 99%

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The frequency of influenza and bacterial coinfection: a systematic review and meta‐analysis

Klein

Monteforte

Gupta

et al. 2016

Influenza Resp Viruses

452

355

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AimCoinfecting bacterial pathogens are a major cause of morbidity and mortality in influenza. However, there remains a paucity of literature on the magnitude of coinfection in influenza patients.MethodA systematic search of MeSH, Cochrane Library, Web of Science, SCOPUS, EMBASE, and PubMed was performed. Studies of humans in which all individuals had laboratory confirmed influenza, and all individuals were tested for an array of common bacterial species, met inclusion criteria.ResultsTwenty‐seven studies including 3215 participants met all inclusion criteria. Common etiologies were defined from a subset of eight articles. There was high heterogeneity in the results (I 2 = 95%), with reported coinfection rates ranging from 2% to 65%. Although only a subset of papers were responsible for observed heterogeneity, subanalyses and meta‐regression analysis found no study characteristic that was significantly associated with coinfection. The most common coinfecting species were Streptococcus pneumoniae and Staphylococcus aureus, which accounted for 35% (95% CI, 14%–56%) and 28% (95% CI, 16%–40%) of infections, respectively; a wide range of other pathogens caused the remaining infections. An assessment of bias suggested that lack of small‐study publications may have biased the results.ConclusionsThe frequency of coinfection in the published studies included in this review suggests that although providers should consider possible bacterial coinfection in all patients hospitalized with influenza, they should not assume all patients are coinfected and be sure to properly treat underlying viral processes. Further, high heterogeneity suggests additional large‐scale studies are needed to better understand the etiology of influenza bacterial coinfection.

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“…Infections occurring later were considered nosocomial [11]. Patients who presented healthcare-associated pneumonia were excluded from the present study [12].…”

Section: Methodsmentioning

confidence: 99%

Acute kidney injury in critical ill patients affected by influenza A (H1N1) virus infection

et al. 2011

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IntroductionLittle information exists about the impact of acute kidney injury (AKI) in critically ill patients with the pandemic 2009 influenza A (H1N1) virus infection.MethodsWe conducted a prospective, observational, multicenter study in 148 Spanish intensive care units (ICUs). Patients with chronic renal failure were excluded. AKI was defined according to Acute Kidney Injury Network (AKIN) criteria.ResultsA total of 661 patients were analyzed. One hundred eighteen (17.7%) patients developed AKI; of these, 37 (31.4%) of the patients with AKI were classified as AKI I, 15 (12.7%) were classified as AKI II and 66 (55.9%) were classified as AKI III, among the latter of whom 50 (75.7%) required continuous renal replacement therapy. Patients with AKI had a higher Acute Physiology and Chronic Health Evaluation II score (19.2 ± 8.3 versus 12.6 ± 5.9; P < 0.001), a higher Sequential Organ Failure Assessment score (8.7 ± 4.2 versus 4.8 ± 2.9; P < 0.001), more need for mechanical ventilation (MV) (87.3% versus 56.2%; P < 0.01, odds ratio (OR) 5.3, 95% confidence interval (CI) 3.0 to 9.4), a greater incidence of shock (75.4% versus 38.3%; P < 0.01, OR 4.9, 95% CI, 3.1 to 7.7), a greater incidence of multiorgan dysfunction syndrome (92.4% versus 54.7%; P < 0.01, OR 10.0, 95% CI, 4.9 to 20.21) and a greater incidence of coinfection (23.7% versus 14.4%; P < 0.01, OR 1.8, 95% CI, 1.1 to 3.0). In survivors, patients with AKI remained on MV longer and ICU and hospital length of stay were longer than in patients without AKI. The overall mortality was 18.8% and was significantly higher for AKI patients (44.1% versus 13.3%; P < 0.01, OR 5.1, 95% CI, 3.3 to 7.9). Logistic regression analysis was performed with AKIN criteria, and it demonstrated that among patients with AKI, only AKI III was independently associated with higher ICU mortality (P < 0.001, OR 4.81, 95% CI 2.17 to 10.62).ConclusionsIn our cohort of patients with H1N1 virus infection, only those cases in the AKI III category were independently associated with mortality.

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Community-Acquired Respiratory Coinfection in Critically Ill Patients With Pandemic 2009 Influenza A(H1N1) Virus

Cited by 178 publications

References 34 publications

Co-infection in severe influenza: a new epidemiology?

Co-infection in severe influenza: a new epidemiology?

The frequency of influenza and bacterial coinfection: a systematic review and meta‐analysis

Acute kidney injury in critical ill patients affected by influenza A (H1N1) virus infection

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