MRSA a major factor in kids? H1N1 flu deaths, study finds

[tetano]

Many of the pediatric deaths and critical illnesses in the 2009-2010 H1N1 influenza pandemic occurred among children who acquired antibiotic-resistant bacterial infections in addition to being infected with that flu virus, a study in the journal Pediatrics reports Monday morning.

The study looked at 838 cases in which children (under age 21) infected with H1N1 were admitted to 35 pediatric intensive care units (PICUs) across the country. The median age of children who were critically ill with an H1N1 infection was six. Simultaneous infection with methicillin-resistant Staphylococcus aureus (MRSA) bacteria in the lungs increased eightfold the risk that children with no pre-existing conditions would die, the study found. Here?s the frightening part: Most of the children were treated with an antibiotic (vancomycin) aimed at combating those bacteria ? but to little apparent benefit.

Of the children whose records the study examined, 8.9 percent died. Sixty-two percent were critically ill from H1N1 infection without there being evidence of bacterial infection when they were admitted to the PICU. Vaccination status was unknown for most of the children, largely because the H1N1 vaccine wasn?t made ready until the pandemic was well underway. Many severe illnesses and deaths occurred among young people with previously existing, chronic neurological and immune-system conditions.

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http://www.washingtonpost.com/blogs...s-study-finds/2010/12/20/gIQAUWBIuM_blog.html

 

[Gert van der Hoek]

Re: MRSA a major factor in kids? H1N1 flu deaths, study finds

November 7, 2011

Flu Can Be Fatal in Children With MRSA

By NICHOLAS BAKALAR

A nationwide study has found that previously healthy children hospitalized with flu were significantly more likely to die if they were also infected with MRSA, or methicillin-resistant Staphylococcus aureus. The findings are important because MRSA, a severe type of staph infection, is a growing concern among healthy children.

MRSA ?used to be seen only in hospitalized people or people who worked in health care facilities,? said Dr. Michael Cappello, a professor of pediatric infectious disease at Yale. ?This is no longer the case.?

The study looked only at the most severe cases of flu in the United States during the 2009-10 H1N1 outbreak, children so sick they had to be hospitalized in intensive care. About 4,000 children end up in pediatric intensive care units each year because of flu, a small percentage of the millions of children who get flu each year.

?When you think about the whole population, and that pretty much everyone got the flu, for most it was a very mild illness,? said Dr. Adrienne G. Randolph, the lead author of the study and an associate professor of anesthesia at Harvard. Still, she said, ?there is a risk for death, and vaccination is still the most effective prevention strategy.?

read more - Well blogs

 

[Gert van der Hoek]

Re: MRSA a major factor in kids? H1N1 flu deaths, study finds

Mike Coston wrote a good piece on the subject:


Study: Kids, Pandemic H1N1 & MRSA Co-Infection


Highly recommended.

 

[tetano]

Re: MRSA a major factor in kids? H1N1 flu deaths, study finds

Pediatrics
(doi: 10.1542/peds.2011-0774)


Critically Ill Children During the 2009?2010 Influenza Pandemic in the United States

Adrienne G. Randolph, MD, MSca,b,
Frances Vaughn, PhDc,
Ryan Sullivan, RNa,
Lewis Rubinson, MD, PhDc,
B. Taylor Thompson, MDd,
Grace Yoon, RN, NNPa,
Elizabeth Smoot, MSd,
Todd W. Rice, MD, MSce,
Laura L. Loftis, MDf,
Mark Helfaer, MDg,
Allan Doctor, MDh,
Matthew Paden, MDi,
Heidi Flori, MDj,
Christopher Babbitt, MDk,
Ana Lia Graciano, MDl,
Rainer Gedeit, MDm,
Ronald C. Sanders, MD, MSn,
John S. Giuliano, MDo,
Jerry Zimmerman, MDp,
Timothy M. Uyeki, MD, MPH, MPPq,
the Pediatric Acute Lung Injury and Sepsis Investigator's Network and the National Heart, Lung, and Blood Institute ARDS Clinical Trials Network

aDepartment of Anesthesia, Perioperative and Pain Medicine, Children's Hospital Boston, Boston, Massachusetts;
bHarvard Medical School, Boston, Massachusetts;
cNational Disaster Medical System, Office of Preparedness and Emergency Operations, Office of the Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC;
dARDSNet Coordinating Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts;
eDepartment of Medicine, Vanderbilt University School of Medicine, Vanderbilt, Tennessee;
fDepartment of Pediatrics, Texas Children's Hospital, Houston, Texas;
gDepartment of Anesthesia and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
hDepartment of Pediatrics, St Louis Children's Hospital, St Louis, Missouri;
iDepartment of Pediatrics, Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia;
jDepartment of Pediatrics, Children's Hospital Oakland, Oakland, California;
kDepartment of Pediatrics, Miller Children's Hospital, Long Beach, California;
lDepartment of Pediatrics, Children's Hospital of Central California, Madera, California;
mDepartment of Pediatrics, Children's Hospital of Wisconsin, Milwaukee, Wisconsin;
nDepartment of Pediatrics, Arkansas Children's Hospital, Little Rock, Arkansas;
oDepartment of Pediatrics, Yale Children's Hospital, New Haven, Connecticut;
pDivision of Pediatric Critical Care Medicine, Seattle Children's Hospital, Seattle, Washington; and
qInfluenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia

Abstract

Background: The 2009 pandemic influenza A (H1N1) (pH1N1) virus continues to circulate worldwide. Determining the roles of chronic conditions and bacterial coinfection in mortality is difficult because of the limited data for children with pH1N1-related critical illness.

Methods: We identified children (<21 years old) with confirmed or probable pH1N1 admitted to 35 US PICUs from April 15, 2009, through April 15, 2010. We collected data on demographics, baseline health, laboratory results, treatments, and outcomes.

Results: Of 838 children with pH1N1 admitted to a PICU, the median age was 6 years, 58% were male, 70% had ≥1 chronic health condition, and 88.2% received oseltamivir (5.8% started before PICU admission). Most patients had respiratory failure with 564 (67.3%) receiving mechanical ventilation; 162 (19.3%) received vasopressors, and 75 (8.9%) died. Overall, 71 (8.5%) of the patients had a presumed diagnosis of early (within 72 hours after PICU admission) Staphylococcus aureus coinfection of the lung with 48% methicillin-resistant S aureus (MRSA). In multivariable analyses, preexisting neurologic conditions or immunosuppression, encephalitis (1.7% of cases), myocarditis (1.4% of cases), early presumed MRSA lung coinfection, and female gender were mortality risk factors. Among 251 previously healthy children, only early presumed MRSA coinfection of the lung (relative risk: 8 [95% confidence interval: 3.1?20.6]; P < .0001) remained a mortality risk factor.

Conclusions: Children with preexisting neurologic conditions and immune compromise were at increased risk of pH1N1-associated death after PICU admission. Secondary complications of pH1N1, including myocarditis, encephalitis, and clinical diagnosis of early presumed MRSA coinfection of the lung, were mortality risk factors.

http://pediatrics.aappublications.org/content/early/2011/11/04/peds.2011-0774.abstract

 

[Vibrant62]

Re: MRSA a major factor in kids? H1N1 flu deaths, study finds

There is much already known about the propensity for flu suffers to develop pneumonia; data from 1918 suggests that pneumonia co-infection may have been a significant factor in the high death rates. This data (above), and the following animal study could imply that employing a tactic of prevention of pneumonia in flu sufferers could be a critical part of reducing mortality during a future flu pandemic, whilst vaccines are unavailable and anti-virals in short supply.

Further human study would be needed to confirm this, as for now, only animal data and reterospective human data is available.

Health Agencies Update
JAMA. 2011;306(16):1750. doi: 10.1001/jama.2011.1541
Bacteria-H1N1 Coinfection

AMA. 2011;306(16):1750. doi: 10.1001/jama.2011.1541

Bridget M. Kuehn

Since this article does not have an abstract, we have provided the first 150 words of the full text.


Bacterial coinfection may have contributed to many deaths and much of the morbidity seen during the 2009 influenza A(H1N1) pandemic, suggest findings from an animal study by scientists from the National Institute of Allergy and Infectious Diseases.

In the study, mice were infected with the pandemic 2009 influenza A(H1N1) strain or another strain of H1N1 influenza that had been circulating seasonally prior to the pandemic; some of the animals in both groups were then inoculated with Streptococcus pneumoniae (Kash JC et al. mBio. 2011;2[5]:e00172-11). Although all of the mice infected only with influenza virus survived, those coinfected with bacteria had much worse outcomes. All of the animals infected with the pandemic strain and S pneumoniae died after serious weight loss and lung damage. Although all mice coinfected with the bacteria and the seasonal flu strain survived, they also had weight loss and signs of lung damage.

Mice that died showed …

http://jama.ama-assn.org/content/306/16/1750.4.extract