tetano
Editor, Senior Moderator
Influenza Other Respi Viruses. 2012 Apr 6. doi: 10.1111/j.1750-2659.2012.00360.x. [Epub ahead of print]
The impact of bacterial and viral co-infection in severe influenza.
Blyth CC, Webb SA, Kok J, Dwyer DE, van Hal SJ, Foo H, Ginn AN, Kesson AM, Seppelt I, Iredell JR; on behalf of the ANZIC Influenza Investigators and COSI Microbiological Investigators.
Source
Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research (ICPMR), Westmead Hospital, Sydney, NSW, Australia. School of Paediatrics and Child Health, University of Western Australia, Princess Margaret Hospital, Perth, WA, Australia. Department of Paediatric and Adolescent Medicine, Princess Margaret Hospital, Perth, WA, Australia. Intensive Care Unit, Royal Perth Hospital, Perth, WA, Australia. School of Medicine and Pharmacology and School of Population Health, University of Western Australia, Perth, WA, Australia. Sydney Medical School, University of Sydney, Sydney, NSW, Australia. Department of Microbiology and Infectious Diseases, Sydney South West Pathology Service - Liverpool, South Western Sydney Local Health Network, Sydney, NSW, Australia. Antibiotic Resistance and Mobile Elements Group, Microbiology and Infectious Diseases Unit, School of Medicine, University of Western Sydney, Sydney NSW, Australia. Infection Management and Control Service (IMACS), Wollongong Hospital, Wollongong, NSW, Australia. Infectious Diseases and Microbiology Service, Children's Hospital Westmead, Sydney, NSW, Australia. Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia. Department of Intensive Care Medicine, Nepean Hospital, Sydney, NSW, Australia.
Abstract
Please cite this paper as: Blyth et al. (2012) The impact of bacterial and viral co-infection in severe influenza. Influenza and Other Respiratory Viruses DOI: 10.1111/j.1750-2659.2012.00360.x. 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.
? 2012 Blackwell Publishing Ltd.
PMID:
22487223
[PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/22487223
The impact of bacterial and viral co-infection in severe influenza.
Blyth CC, Webb SA, Kok J, Dwyer DE, van Hal SJ, Foo H, Ginn AN, Kesson AM, Seppelt I, Iredell JR; on behalf of the ANZIC Influenza Investigators and COSI Microbiological Investigators.
Source
Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research (ICPMR), Westmead Hospital, Sydney, NSW, Australia. School of Paediatrics and Child Health, University of Western Australia, Princess Margaret Hospital, Perth, WA, Australia. Department of Paediatric and Adolescent Medicine, Princess Margaret Hospital, Perth, WA, Australia. Intensive Care Unit, Royal Perth Hospital, Perth, WA, Australia. School of Medicine and Pharmacology and School of Population Health, University of Western Australia, Perth, WA, Australia. Sydney Medical School, University of Sydney, Sydney, NSW, Australia. Department of Microbiology and Infectious Diseases, Sydney South West Pathology Service - Liverpool, South Western Sydney Local Health Network, Sydney, NSW, Australia. Antibiotic Resistance and Mobile Elements Group, Microbiology and Infectious Diseases Unit, School of Medicine, University of Western Sydney, Sydney NSW, Australia. Infection Management and Control Service (IMACS), Wollongong Hospital, Wollongong, NSW, Australia. Infectious Diseases and Microbiology Service, Children's Hospital Westmead, Sydney, NSW, Australia. Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia. Department of Intensive Care Medicine, Nepean Hospital, Sydney, NSW, Australia.
Abstract
Please cite this paper as: Blyth et al. (2012) The impact of bacterial and viral co-infection in severe influenza. Influenza and Other Respiratory Viruses DOI: 10.1111/j.1750-2659.2012.00360.x. 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.
? 2012 Blackwell Publishing Ltd.
PMID:
22487223
[PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/22487223