Cited by 54Influenza Virus Research StudiesSepsis Diagnosis and TreatmentCOVID-19 Clinical Research Studies

Coinfection with Staphylococcus aureus increases risk of severe coagulopathy in critically ill children with influenza A (H1N1) virus infection.

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Nguyen, Trung, Kyle, Ursula G., Jaimon, Nancy, Tcharmtchi, M. Hossein, Coss-Bu, Jorge A., Lam, Fong, Teruya, Jun, Loftis, Laura·2012·Critical Care Medicine

Abstract

OBJECTIVES: H1N1 influenza with coinfections has been implicated to have high morbidity and mortality. We hypothesized that critically ill children with 2009 H1N1 and coinfections are at a higher risk of developing disseminated intravascular coagulation. DESIGN: The chart review included demographics, length-of-stay, severity of illness score (Pediatric Risk of Mortality III acute physiology score), clinical laboratories, and outcomes at hospital day 90 data. Patients were classified as having methicillin-sensitive or -resistant Staphylococcus aureus, other, or no coinfections. SETTING: Single-center pediatric intensive care unit. PATIENTS: Sixty-six consecutive patients with 2009 H1N1 and influenza A infection. INTERVENTIONS: None. MAIN RESULTS: : There were 12, 22, and 32 patients with methicillin-sensitive or -resistant Staphylococcus aureus, other, and no coinfections, respectively. Pediatric critical care unit length-of-stay was 11, 10, and 5.5 days (median), and survival at day 90 was 83%, 96%, and 91% in patients with methicillin-sensitive or -resistant Staphylococcus aureus, other, and no coinfections. Patients with methicillin-sensitive or -resistant Staphylococcus aureus coinfections compared to patients with other, and no coinfections had higher Pediatric Risk of Mortality III acute physiology scores (14 [6-25] vs. 7 [2-10], p = .052 and 6 [2.5-10], p = .008; median [interquartile range]), higher D-dimer (16.1 [7.9-19.3] vs. 1.6 [1.1-4], p = .02 and 2.3 [0.8-8.7] µg/mL, p = .05), longer prothrombin time (19.3 [15.4-25.9] vs. 15.3 [14.8-17.1], p = .04 and 16.6 [14.7-20.4] secs, p < .39) at admission, and lower day-7 platelet counts (90K [26-161K] vs. 277K [98-314], p = .03 and 256K [152-339]/mm, p < .07). Patients with methicillin-sensitive or -resistant Staphylococcus aureus coinfections compared to patients without coinfections were more likely to be sicker with Pediatric Risk of Mortality III acute physiology score >10 vs. <10 (relative risk 2.4; 95% confidence interval 1.2-4.7; p = .035) and have overt disseminated intravascular coagulation (relative risk 4.4; 95% confidence interval 1.3-15.8, p = .025). CONCLUSIONS: During the 2009-2010 H1N1 pandemic, pediatric patients with influenza A and methicillin-sensitive or -resistant Staphylococcus aureus coinfections were sicker and more likely to develop disseminated intravascular coagulation than patients with other or no coinfections.

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  • In that pediatric ICU study, those with S. aureus showed more severe morbidity and were more likely to develop disseminated intravascular coagulation.

    “Those with S. aureus showed more severe morbidity and were more likely to develop disseminated intravascular coagulation which leads to a compromised blood flow within body tissue and therefore tissue damage (Nguyen et al., 2012).”

    From Secondary bacterial infections associated with influenza pandemics (2017) · cites this paper as Nguyen et al., 2012

  • In another US pediatric intensive care unit study, 51% of children with influenza infection had bacterial co/secondary infection; of these 35% had S. aureus, 18% P. aeruginosa, 18% M. catarrhalis, 9% NTHI, 6% S. pneumoniae, and 6% Group A Streptococcus.

    “In another study of vulnerable and critically ill children in a pediatric intensive care unit in the United States, 51% of those with influenza infection had bacterial co/secondary infection. Of these 35% presented with S. aureus, 18% P. aeruginosa, 18% M. catarrhalis, 9% NTHI, 6% S. pneumoniae and 6% Group A Streptococcus.”

    From Secondary bacterial infections associated with influenza pandemics (2017) · cites this paper as Nguyen et al., 2012

  • In early influenza pandemics such as the 1918 Spanish pandemic, M. catarrhalis rarely appears to be a noted cause of co-infection, whereas in the 2009 pandemic it is seen in up to 18% of cases.

    “In early influenza pandemics such as the 1918 Spanish pandemic, M. catarrhalis rarely appears to be a noted cause of co-infection. However, in the 2009 pandemic it is seen in up to 18% of cases (Nguyen et al., 2012).”

    From Secondary bacterial infections associated with influenza pandemics (2017) · cites this paper as Nguyen et al., 2012

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Authors
Nguyen, T., Kyle, U. G., Jaimon, N., Tcharmtchi, M. H., Coss-Bu, J. A., Lam, F., Teruya, J., & Loftis, L.
Affiliations
Baylor College of Medicine (US)
Venue
Critical Care Medicine
Published
2012-12
Volume
40
Issue
12
Pages
3246-3250
ISSN
0090-3493 (ISSN-L)
OpenAlex
W2037332832
Cited by
54
References
34
Citations by year
2026: 2 · 2025: 3 · 2024: 1 · 2023: 5 · 2022: 5 · 2021: 3 · 2020: 3 · 2019: 2 · 2018: 8 · 2017: 5 · 2016: 3 · 2015: 6 · 2014: 3 · 2013: 5
FWCI
3.34
Type
journal article
Language
en
Open access
Locations
  • Critical Care Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (n01hr56179-17-0-1)
  • National Heart, Lung, and Blood Institute (N01 HR056179)
  • National Institute of General Medical Sciences (K08GM083212)
Topics
  • Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
  • Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
  • Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
Keywords
2009 H1N1 influenza A, disseminated intravascular coagulation, coagulopathy, critically ill children, methicillin-resistant Staphylococcus aureus, methicillin-susceptible Staphylococcus aureus, D-dimer, prothrombin time, platelet count, mortality
MeSH terms
Blood Coagulation Disorders, Child, Child, Preschool, Female, Humans, Infant, Influenza, Human, Male, Medical Audit, Severity of Illness Index, Staphylococcal Infections, Staphylococcus aureus, Intensive Care Units, Pediatric, Critical Illness, Risk Assessment, Influenza A Virus, H1N1 Subtype, Coinfection

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