Bacterial Coinfection in Influenza: A Grand Rounds Review
Abstract
Bacterial coinfection complicated nearly all influenza deaths in the 1918 influenza pandemic and up to 34% of 2009 pandemic influenza A(H1N1) infections managed in intensive care units worldwide. More than 65,000 deaths attributable to influenza and pneumonia occur annually in the United States. Data from 683 critically ill patients with 2009 pandemic influenza A(H1N1) infection admitted to 35 intensive care units in the United States reveal that bacterial coinfection commonly occurs within the first 6 days of influenza infection, presents similarly to influenza infection occurring alone, and is associated with an increased risk of death. Pathogens that colonize the nasopharynx, including Staphylococcus aureus, Streptococcus pneumoniae, and Streptococcus pyogenes, are most commonly isolated. Complex viral, bacterial, and host factors contribute to the pathogenesis of coinfection. Reductions in morbidity and mortality are dependent on prevention with available vaccines as well as early diagnosis and treatment.
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The bacteria most commonly associated with influenza infection are those which commonly colonise the nasopharynx, such as Streptococcus pneumoniae, Staphylococcus aureus, and Streptococcus pyogenes, with secondary infection usually occurring in the first 6 days of influenza.
“The bacteria most commonly associated with influenza infection have been reported to be those which commonly colonise the nasopharynx, such as Streptococcus pneumoniae, Staphylococcus aureus, and Streptococcus pyogenes, with secondary infection usually occurring in the first 6 days of influenza.43, 44, 45”
From Co-infections in people with COVID-19: a systematic review and meta-analysis. (2020) · cites this paper as [44]
The frequency of overall bacterial coinfection in influenza patients is still poorly characterized.
“While prior studies have examined the frequency of select bacterial species in influenza cases,13, 14 particularly the presence of methicillin‐resistant S. aureus (MRSA),15, 16, 17, 18 the frequency of overall coinfection in influenza patients is still poorly characterized.”
From The frequency of influenza and bacterial coinfection: a systematic review and meta-analysis. (2016) · cites this paper as [13]
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References 72 · Cited by 390
- Authors
- Chertow, D. S., & Memoli, M. J.
- Affiliations
- National Institutes of Health (US)
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2013-01-16
- Volume
- 309
- Issue
- 3
- Pages
- 275
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2112332584
- Cited by
- 390
- References
- 72
- Citations by year
- 2026: 7 · 2025: 16 · 2024: 24 · 2023: 38 · 2022: 47 · 2021: 58 · 2020: 47 · 2019: 28 · 2018: 31 · 2017: 18 · 2016: 21 · 2015: 24 · 2014: 21 · 2013: 10
- FWCI
- 18.45
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- Topics
- Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
- Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
- Health Sciences › Medicine › Epidemiology › Respiratory viral infections research
- Keywords
- bacterial co-infection, influenza, 2009 H1N1 pandemic, 1918 influenza pandemic, pneumonia, critically ill patients, intensive care, Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes, nasopharyngeal carriage, mortality, prevention, early diagnosis
- MeSH terms
- Anti-Bacterial Agents, Critical Care, Humans, Influenza, Human, Influenza Vaccines, Male, Middle Aged, Morbidity, Staphylococcal Infections, Critical Illness, Community-Acquired Infections, Fatal Outcome, Pneumonia, Bacterial, Influenza A Virus, H1N1 Subtype, Coinfection
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