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Cited by 840Influenza Virus Research StudiesRespiratory Support and MechanismsCOVID-19 Clinical Research Studies

Critically Ill patients with 2009 influenza A(H1N1) in Mexico

Domínguez-Cherit, Guillermo·2009·JAMA
DOI 10.1001/jama.2009.1536
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Abstract

CONTEXT: In March 2009, novel 2009 influenza A(H1N1) was first reported in the southwestern United States and Mexico. The population and health care system in Mexico City experienced the first and greatest early burden of critical illness. OBJECTIVE: To describe baseline characteristics, treatment, and outcomes of consecutive critically ill patients in Mexico hospitals that treated the majority of such patients with confirmed, probable, or suspected 2009 influenza A(H1N1). DESIGN, SETTING, AND PATIENTS: Observational study of 58 critically ill patients with 2009 influenza A(H1N1) at 6 hospitals between March 24 and June 1, 2009. Demographic data, symptoms, comorbid conditions, illness progression, treatments, and clinical outcomes were collected using a piloted case report form. MAIN OUTCOME MEASURES: The primary outcome measure was mortality. Secondary outcomes included rate of 2009 influenza (A)H1N1-related critical illness and mechanical ventilation as well as intensive care unit (ICU) and hospital length of stay. RESULTS: Critical illness occurred in 58 of 899 patients (6.5%) admitted to the hospital with confirmed, probable, or suspected 2009 influenza (A)H1N1. Patients were young (median, 44.0 [range, 10-83] years); all presented with fever and all but 1 with respiratory symptoms. Few patients had comorbid respiratory disorders, but 21 (36%) were obese. Time from hospital to ICU admission was short (median, 1 day [interquartile range {IQR}, 0-3 days]), and all patients but 2 received mechanical ventilation for severe acute respiratory distress syndrome and refractory hypoxemia (median day 1 ratio of Pao(2) to fraction of inspired oxygen, 83 [IQR, 59-145] mm Hg). By 60 days, 24 patients had died (41.4%; 95% confidence interval, 28.9%-55.0%). Patients who died had greater initial severity of illness, worse hypoxemia, higher creatine kinase levels, higher creatinine levels, and ongoing organ dysfunction. After adjusting for a reduced opportunity of patients dying early to receive neuraminidase inhibitors, neuraminidase inhibitor treatment (vs no treatment) was associated with improved survival (odds ratio, 8.5; 95% confidence interval, 1.2-62.8). CONCLUSION: Critical illness from 2009 influenza A(H1N1) in Mexico occurred in young individuals, was associated with severe acute respiratory distress syndrome and shock, and had a high case-fatality rate.

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  • Bacterial co-infection was detected in ~30% of cases in the 2009 H1N1 pandemic, with high mortality rates despite administration of appropriate antibiotics.

    “Bacterial co-infection was also detected in ~30% of cases in the 2009 H1N1 pandemic, with high mortality rates despite administration of appropriate antibiotics”

    From Respiratory viral infection-induced microbiome alterations and secondary bacterial pneumonia. (2018) · cites this paper as [18]

  • The increase in Proteobacteria appears to be mediated by type I interferons (IFNs), which not only depleted anaerobic bacteria but also increased susceptibility to secondary Salmonella colitis.

    “The increase in Proteobacteria appears to be mediated by type I interferons (IFNs) (18), which not only depleted anaerobic bacteria but also increased susceptibility to secondary Salmonella colitis.”

    From Respiratory viral infection-induced microbiome alterations and secondary bacterial pneumonia. (2018) · cites this paper as [18]

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Authors
Domínguez-Cherit, G.
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2009-11-04
Volume
302
Issue
17
Pages
1880
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2009.1536
OpenAlex
W2168691128
Cited by
840
References
25
Citations by year
2026: 1 · 2025: 7 · 2024: 9 · 2023: 11 · 2022: 14 · 2021: 27 · 2020: 39 · 2019: 18 · 2018: 23 · 2017: 24 · 2016: 36 · 2015: 37 · 2014: 40 · 2013: 66 · 2012: 89
FWCI
108.76
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
  • Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
Keywords
pandemic influenza, critical illness, mortality, mechanical ventilation, acute respiratory distress syndrome, refractory hypoxemia, neuraminidase inhibitors, ICU length of stay, obesity, organ dysfunction, Mexico City, hospitalized patients, mortality risk factors, treatment outcomes, clinical outcomes, comorbidities, creatine kinase, creatinine
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Hypoxia, Antiviral Agents, Child, Female, Hospitalization, Humans, Influenza, Human, Male, Mexico, Middle Aged, Multiple Organ Failure, Neuraminidase, Respiration, Artificial, Respiratory Distress Syndrome, Retrospective Studies, Critical Illness, Age Distribution, APACHE, Influenza A Virus, H1N1 Subtype, Kaplan-Meier Estimate, Young Adult

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