The impact of bacterial and viral co‐infection in severe influenza

Influenza and Other Respiratory Viruses

Christopher C. Blyth¹  Steve A. R. Webb⁵  Jen Kok¹  Dominic E. Dwyer¹  Sebastiaan J. van Hal³  Hong Foo³  Andrew N. Ginn¹  Alison M. Kesson²  Ian Seppelt⁴  Jonathan R. Iredell¹ 

[1] Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research (ICPMR), Westmead Hospital, Sydney, NSW, Australia.;Infectious Diseases and Microbiology Service, Children’s Hospital Westmead, Sydney, NSW, Australia.;Department of Microbiology and Infectious Diseases, Sydney South West Pathology Service – Liverpool, South Western Sydney Local Health Network, Sydney, NSW, Australia.;Sydney Medical School, University of Sydney, Sydney, NSW, Australia.;Intensive Care Unit, Royal Perth Hospital, Perth, WA, Australia.

关键词: Co‐infection;    influenza;    intensive care;    pneumonia;    Staphylococcus aureus;    Streptococcus pneumoniae;   

DOI  :  10.1111/j.1750-2659.2012.00360.x

来源: Wiley

【 摘 要 】

Abstract

Please cite this paper as: Blyth et al. (2013) The impact of bacterial and viral co-infection in severe influenza. Influenza and Other Respiratory Viruses 7(2) 168–176.

Background  Many questions remain concerning the burden, risk factors and impact of bacterial and viral co-infection in patients with pandemic influenza admitted to the intensive care unit (ICU).

Objectives  To examine the burden, risk factors and impact of bacterial and viral co-infection in Australian patients with severe influenza.

Patients/Methods  A cohort study conducted in 14 ICUs was performed. Patients with proven influenza A during the 2009 influenza season were eligible for inclusion. Demographics, risk factors, clinical data, microbiological data, complications and outcomes were collected. Polymerase chain reaction for additional bacterial and viral respiratory pathogens was performed on stored respiratory samples.

Results  Co-infection was identified in 23·3–26·9% of patients with severe influenza A infection: viral co-infection, 3·2–3·4% and bacterial co-infection, 20·5–24·7%. Staphylococcus aureus was the most frequent bacterial co-infection followed by Streptococcus pneumoniae and Haemophilus influenzae. Patients with co-infection were younger [mean difference in age = 8·46 years (95% CI: 0·18–16·74 years)], less likely to have significant co-morbidities (32·0% versus 66·2%, P = 0·004) and less frequently obese [mean difference in body mass index = 6·86 (95% CI: 1·77–11·96)] compared to those without co-infection.

Conclusions  Bacterial or viral co-infection complicated one in four patients admitted to ICU with severe influenza A infection. Despite the co-infected patients being younger and with fewer co-morbidities, no significant difference in outcomes was observed. It is likely that co-infection contributed to a need for ICU admission in those without other risk factors for severe influenza disease. Empiric antibiotics with staphylococcal activity should be strongly considered in all patients with severe influenza A infection.

【 授权许可】

Unknown   
© 2012 Blackwell Publishing Ltd