Critical illness from 2009 pandemic influenza A virus and bacterial coinfection in the United States.
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OBJECTIVES: The contribution of bacterial coinfection to critical illness associated with 2009 influenza A virus infection remains uncertain. The objective of this study was to determine whether bacterial coinfection increased the morbidity and mortality of 2009 influenza A. DESIGN: Retrospective and prospective cohort study. SETTING: Thirty-five adult U.S. intensive care units over the course of 1 yr. PATIENTS: Six hundred eighty-three critically ill adults with confirmed or probable 2009 influenza A. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A confirmed or probable case was defined as a positive 2009 influenza A test result or positive test for influenza A that was otherwise not subtyped. Bacterial coinfection was defined as documented bacteremia or any presumed bacterial pneumonia with or without positive respiratory tract culture within 72 hrs of intensive care unit admission. The mean age was 45±16 yrs, mean body mass index was 32.5±11.1 kg/m, and mean Acute Physiology and Chronic Health Examination II score was 21±9, with 76% having at least one comorbidity. Of 207 (30.3%) patients with bacterial coinfection on intensive care unit admission, 154 had positive cultures with Staphylococcus aureus (n=57) and Streptococcus pneumoniae (n=19), the most commonly identified pathogens. Bacterial coinfected patients were more likely to present with shock (21% vs. 10%; p=.0001), require mechanical ventilation at the time of intensive care unit admission (63% vs. 52%; p=.005), and have longer duration of intensive care unit care (median, 7 vs. 6 days; p=.05). Hospital mortality was 23%; 31% in bacterial coinfected patients and 21% in patients without coinfection (p=.002). Immunosuppression (relative risk 1.57; 95% confidence interval 1.20 -2.06; p=.0009) and Staphylococcus aureus at admission (relative risk 2.82; 95% confidence interval 1.76-4.51; p<.0001) were independently associated with increased mortality. CONCLUSIONS: Among intensive care unit patients with 2009 influenza A, bacterial coinfection diagnosed within 72 hrs of admission, especially with Staphylococcus aureus, was associated with significantly higher morbidity and mortality.
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Immunosuppression is associated with more severe morbidity and a higher risk of mortality from co/secondary bacterial infection.
“Immunosuppression is associated with more severe morbidity and a much higher risk of mortality from co/secondary bacterial infection (Rice et al., 2012).”
From Secondary bacterial infections associated with influenza pandemics (2017) · cites this paper as Rice et al., 2012
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- Authors
- Rice, T. W., Rubinson, L., Uyeki, T. M., Vaughn, F. L., John, B. B., Miller, R. R., Higgs, E., Randolph, A. G., Smoot, B. E., & Thompson, B. T.
- Affiliations
- Vanderbilt University (US)
- Centers for Disease Control and Prevention (US)
- University of Utah (US)
- National Institutes of Health (US)
- Boston Children's Hospital (US)
- Harvard University (US)
- Venue
- Critical Care Medicine
- Published
- 2012-05
- Volume
- 40
- Issue
- 5
- Pages
- 1487-1498
- ISSN
- 0090-3493 (ISSN-L)
- PMC
- PMC3653183
- OpenAlex
- W1995615618
- Cited by
- 391
- References
- 37
- Citations by year
- 2026: 12 · 2025: 23 · 2024: 30 · 2023: 30 · 2022: 51 · 2021: 60 · 2020: 48 · 2019: 20 · 2018: 21 · 2017: 20 · 2016: 17 · 2015: 13 · 2014: 15 · 2013: 24 · 2012: 7
- FWCI
- 14.13
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (n01hr56174-20-0-1, n01hr56179-17-0-1)
- National Heart, Lung, and Blood Institute (N01 HR 56179, K23HL081431, N01 HR056179, N01 HR056174)
- 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, critical illness, ICU mortality, Staphylococcus aureus, Streptococcus pneumoniae, bacteremia, bacterial pneumonia, shock, mechanical ventilation, comorbidities, ICU length of stay, mortality risk factors, hospitalized adults
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Bacterial Infections, Female, Humans, Influenza, Human, Intensive Care Units, Male, Middle Aged, Prospective Studies, Retrospective Studies, United States, Chi-Square Distribution, Critical Illness, Statistics, Nonparametric, Influenza A Virus, H1N1 Subtype, Young Adult, Pandemics, Coinfection
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