tetano
Editor, Senior Moderator
Int J Infect Dis
. 2023 Apr 6;S1201-9712(23)00135-2.
doi: 10.1016/j.ijid.2023.04.003. Online ahead of print.
Determinants of poor clinical outcome in patients with influenza pneumonia: a systematic review and meta-analysis
Javier Arranz-Herrero[SUP] 1 [/SUP], Jesús Presa[SUP] 2 [/SUP], Sergio Rius-Rocabert[SUP] 3 [/SUP], Alberto Utrero-Rico[SUP] 4 [/SUP], José Ángel Arranz-Arija[SUP] 5 [/SUP], Antonio Lalueza[SUP] 6 [/SUP], María Marta Escribese[SUP] 2 [/SUP], Jordi Ochando[SUP] 7 [/SUP], Vicente Soriano[SUP] 8 [/SUP], Estanislao Nistal-Villan[SUP] 9 [/SUP]
Affiliations
Abstract
Background: The clinical burden of influenza is increasing globally. Aging, immunosuppression, and underlying respiratory illness are determinants of poor clinical outcomes, including greater mortality. Bacterial infections seem to be the main reason. Updated information on the role of bacterial infection as the cause of complications would be of value in improving the prognosis of influenza patients.
Methods: A systematic review and meta-analysis were performed by using the Pubmed repository using keywords like: Influenza, H1N1, Streptococcus pneumoniae, bacterial coinfection, secondary coinfection, bacterial complications in pneumonia, and seasonal influenza. Only articles written in English were only included on publications from 2010 to 2020. Analyses were conducted following PRISMA guidelines. The results were independently validated using a TrinetX database cohort of roughly 4 million patients.
Results: We included 136 studies that contained data from 48,259 influenza-hospitalized patients of any age. Bacterial infections were diagnosed in 5,391 (11.2%). Streptococcus pneumoniae (30.7%) and Staphylococcus aureus (30.4%) were the most frequent microorganisms, followed by Haemophilus influenzae (7.1%) and Pseudomonas aeruginosa (5.9%). The random effects model of the meta-analysis indicated that bacterial infections posed a 3.4-fold increased risk of death compared to influenza infection alone. Unexpectedly, asthma was protective (odds ratio 0.8).
Conclusion: Bacterial infections diagnosed in 11.2% of influenza patients increase 3.4-fold the mortality risk. S. pneumoniae, S. aureus, H. influenzae and P. aeruginosa account for nearly 75% of cases. Earlier diagnosis and use of antibiotics should improve outcomes in this population.
Keywords: Influenza; Staphylococcus aureus; Streptococcus pneumoniae; antibiotic use; bacterial infection; outcome; prognosis.
. 2023 Apr 6;S1201-9712(23)00135-2.
doi: 10.1016/j.ijid.2023.04.003. Online ahead of print.
Determinants of poor clinical outcome in patients with influenza pneumonia: a systematic review and meta-analysis
Javier Arranz-Herrero[SUP] 1 [/SUP], Jesús Presa[SUP] 2 [/SUP], Sergio Rius-Rocabert[SUP] 3 [/SUP], Alberto Utrero-Rico[SUP] 4 [/SUP], José Ángel Arranz-Arija[SUP] 5 [/SUP], Antonio Lalueza[SUP] 6 [/SUP], María Marta Escribese[SUP] 2 [/SUP], Jordi Ochando[SUP] 7 [/SUP], Vicente Soriano[SUP] 8 [/SUP], Estanislao Nistal-Villan[SUP] 9 [/SUP]
Affiliations
- PMID: 37030656
- DOI: 10.1016/j.ijid.2023.04.003
Abstract
Background: The clinical burden of influenza is increasing globally. Aging, immunosuppression, and underlying respiratory illness are determinants of poor clinical outcomes, including greater mortality. Bacterial infections seem to be the main reason. Updated information on the role of bacterial infection as the cause of complications would be of value in improving the prognosis of influenza patients.
Methods: A systematic review and meta-analysis were performed by using the Pubmed repository using keywords like: Influenza, H1N1, Streptococcus pneumoniae, bacterial coinfection, secondary coinfection, bacterial complications in pneumonia, and seasonal influenza. Only articles written in English were only included on publications from 2010 to 2020. Analyses were conducted following PRISMA guidelines. The results were independently validated using a TrinetX database cohort of roughly 4 million patients.
Results: We included 136 studies that contained data from 48,259 influenza-hospitalized patients of any age. Bacterial infections were diagnosed in 5,391 (11.2%). Streptococcus pneumoniae (30.7%) and Staphylococcus aureus (30.4%) were the most frequent microorganisms, followed by Haemophilus influenzae (7.1%) and Pseudomonas aeruginosa (5.9%). The random effects model of the meta-analysis indicated that bacterial infections posed a 3.4-fold increased risk of death compared to influenza infection alone. Unexpectedly, asthma was protective (odds ratio 0.8).
Conclusion: Bacterial infections diagnosed in 11.2% of influenza patients increase 3.4-fold the mortality risk. S. pneumoniae, S. aureus, H. influenzae and P. aeruginosa account for nearly 75% of cases. Earlier diagnosis and use of antibiotics should improve outcomes in this population.
Keywords: Influenza; Staphylococcus aureus; Streptococcus pneumoniae; antibiotic use; bacterial infection; outcome; prognosis.