Cited by 391Influenza Virus Research StudiesPneumonia and Respiratory InfectionsRespiratory viral infections research

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Critical illness from 2009 pandemic influenza A virus and bacterial coinfection in the United States.

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Rice, Todd W., Rubinson, Lewis, Uyeki, Timothy M., Vaughn, Frances L., John, Benjamin B., Miller, Russell R., Higgs, Elizabeth, Randolph, Adrienne G., Smoot, B. Elizabeth, Thompson, B. Taylor·2012·Critical Care Medicine

DOI 10.1097/ccm.0b013e3182416f23PMC PMC3653183

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Abstract

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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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)
ORCID: Rice, Todd W.
Uyeki, Timothy M.
Randolph, Adrienne G.
Thompson, B. Taylor
Venue: Critical Care Medicine
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2012-05
Volume: 40
Issue: 5
Pages: 1487-1498
ISSN: 0090-3493 (ISSN-L)
DOI: 10.1097/ccm.0b013e3182416f23
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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