Outcomes and Prognostic Features of Patients With Influenza Requiring Hospitalization and Receiving Early Antiviral Therapy

Maruyama, Takaya; Fujisawa, Takao; Suga, Shigeru; Nakamura, Haruna; Nagao, Mizuho; Taniguchi, Kiyosu; Tsutsui, Kiyoyuki; Ihara, Toshiaki; Niederman, Michael S.

doi:10.1378/chest.14-2768

Cited by 50 publications

(43 citation statements)

References 27 publications

(21 reference statements)

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“…It is highly probable that the mechanism explaining the higher mortality is due to either to the bacterial infection itself or to an association of virulence factors from both virus and bacteria. Lastly, as shown in this paper and others, the epidemiology of pathogens responsible for co-infection is regional and likely depends on many local factors, but may also be subject to change over time, with emergence in the community of pathogens usually seen in nosocomial infections [6,7,9,12].…”

mentioning

confidence: 82%

“…Furthermore, they could have classified patients as having co-infection whereas they were only colonized [8]. This potential overestimation could also explain the high rate of P. aeruginosa co-infection observed in that study (14.1%): in another recent study in patients with influenza-related infection, the authors found a 1.3% rate of P. aeruginosa co-infection in patients with CAP and 8.3% in patients with healthcare-associated pneumonia (HCAP) [9]. The high incidence found in the present study cannot be explained by a local (national) feature, since same authors reported lower rates of P. aeruginosa CAP and HCAP in Spain during this same time [10,11].…”

mentioning

confidence: 82%

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Co-infection in severe influenza: a new epidemiology?

Luyt

Rice

2016

Intensive Care Med

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confidence: 82%

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confidence: 82%

Co-infection in severe influenza: a new epidemiology?

Luyt

Rice

2016

Intensive Care Med

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“…These patients who develop pneumonia are more likely to be young (< 5 years old), old (> 65 years old), Caucasian, and nursing home residents; have chronic lung or heart disease and history of smoking; and are more commonly immunocompromised. Of note, pregnant women, extreme obesity, Native Americans, and Alaska natives are also more prone to develop severe Influenza complications [32][33][34][35]. Nonetheless, unlike seasonal epidemics of influenza virus infection that display these classic risk factors, pandemics such as the 2009 H1N1 were associated with a higher rate of hospitalized respiratory failure in previously healthy and young adults [36,37].…”

Section: Influenza Clinical Progression To Pneumonia and Ardsmentioning

confidence: 99%

Influenza virus-related critical illness: pathophysiology and epidemiology

2019

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Influenza virus affects the respiratory tract by direct viral infection or by damage from the immune system response. In humans, the respiratory epithelium is the only site where the hemagglutinin (HA) molecule is effectively cleaved, generating infectious virus particles. Virus transmission occurs through a susceptible individual’s contact with aerosols or respiratory fomites from an infected individual. The inability of the lung to perform its primary function of gas exchange can result from multiple mechanisms, including obstruction of the airways, loss of alveolar structure, loss of lung epithelial integrity from direct epithelial cell killing, and degradation of the critical extracellular matrix. Approximately 30–40% of hospitalized patients with laboratory-confirmed influenza are diagnosed with acute pneumonia. These patients who develop pneumonia are more likely to be < 5 years old, > 65 years old, Caucasian, and nursing home residents; have chronic lung or heart disease and history of smoking, and are immunocompromised. Influenza can primarily cause severe pneumonia, but it can also present in conjunction with or be followed by a secondary bacterial infection, most commonly by Staphylococcus aureus and Streptococcus pneumoniae . Influenza is associated with a high predisposition to bacterial sepsis and ARDS. Viral infections presenting concurrently with bacterial pneumonia are now known to occur with a frequency of 30–50% in both adult and pediatric populations. The H3N2 subtype has been associated with unprecedented high levels of intensive care unit (ICU) admission. Influenza A is the predominant viral etiology of acute respiratory distress syndrome (ARDS) in adults. Risk factors independently associated with ARDS are age between 36 and 55 years old, pregnancy, and obesity, while protective factors are female sex, influenza vaccination, and infections with Influenza A (H3N2) or Influenza B viruses. In the ICU, particularly during the winter season, influenza should be suspected not only in patients with typical symptoms and epidemiology, but also in patients with severe pneumonia, ARDS, sepsis with or without bacterial co-infection, as well as in patients with encephalitis, myocarditis, and rhabdomyolysis.

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“…40 Different studies showed that approximately one-third of hospitalized patients with laboratoryconfirmed influenza have pneumonia. [41][42][43] In a study that included 4765 patients hospitalized with influenza, those with pneumonia were older 43 During an influenza season, the attributed mortality to pneumonia and influenza in the United States ranges from 5.6% to 11.1%. 44 In a cohort study that included laboratory-confirmed cases of influenza admitted to the hospital, those with pneumonia, as compared with those without pneumonia, were more likely to require intensive care unit (ICU) admission (27% vs 10%) and mechanical ventilation (18% vs 5%), and to die (9% vs 2%) 42 (Fig.…”

Section: Influenzamentioning

confidence: 99%