Pandemic influenza A(H1N1) virus infection in solid organ transplant recipients: impact of viral and non-viral co-infection
Open accessAbstract
Solid organ transplant recipients (SOTR) are at risk of serious influenza-related complications. The impact of respiratory co-infection in SOTR with 2009 pandemic influenza A(H1N1) is unknown. A multicentre prospective study of consecutive cases of pandemic influenza A(H1N1) in SOTR was carried out to assess the clinical characteristics and outcome and the risk factors for co-infection. Overall, 51 patients were included. Median time from transplant was 3.7 years, 5.9% of the cases occurred perioperatively and 7.8% were hospital-acquired. Pneumonia was diagnosed in 15 (29.4%) patients. Ten cases were severe (19.6%): 13.7% were admitted to intensive care units, 5.9% suffered septic shock, 5.9% developed acute graft rejection and 7.8% died. Co-infection was detected in 15 patients (29.4%): eight viral, six bacterial and one fungal. Viral co-infection did not affect the outcome. Patients with non-viral co-infection had a worse outcome: longer hospital stay (26.2 ± 20.7 vs. 5.5 ± 10.2) and higher rate of severe diseases (85.7% vs. 2.3%) and mortality (42.8% vs. 2.3%). Independent risk factors for non-viral co-infection were: diabetes mellitus and septic shock. Other factors associated with severe influenza were: delayed antiviral therapy, diabetes mellitus, time since transplantation <90 days and pneumonia. In conclusion, pandemic influenza A can cause significant direct and indirect effects in SOTR, especially in the early post-transplant period, and should be treated early. Clinicians should be aware of the possibility of non-viral co-infection, mainly in diabetic patients and severe cases. An effort should be made to prevent influenza with immunization of the patient and the environment.
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An additional six studies reported that 12-50% of patients had preceding antibiotic treatment at enrollment.
“An additional six studies reported on participant antibiotic use at the time of enrollment and found that 12–50% of patients had preceding antibiotic treatment which may have led to an underestimation of the true frequency of bacterial coinfection in their sample population.30, 33, 40, 45, 47, 52”
From The frequency of influenza and bacterial coinfection: a systematic review and meta-analysis. (2016) · cites this paper as [33]
Preceding antibiotic treatment may have led to an underestimation of the true frequency of bacterial coinfection in the sample population.
“An additional six studies reported on participant antibiotic use at the time of enrollment and found that 12–50% of patients had preceding antibiotic treatment which may have led to an underestimation of the true frequency of bacterial coinfection in their sample population.30, 33, 40, 45, 47, 52”
From The frequency of influenza and bacterial coinfection: a systematic review and meta-analysis. (2016) · cites this paper as [33]
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- Authors
- Cordero, E., Pérez-Romero, P., Moreno, A., Len, O., Montejo, M., Vidal, E., Martín-Dávila, P., Fariñas, M. C., Fernández-Sabé, N., Giannella, M., & Pachón, J.
- Affiliations
- Instituto de Biomedicina de Sevilla (ES)
- Hospital Clínic de Barcelona (ES)
- Hospital de Cruces (ES)
- Instituto Maimónides de Investigación Biomédica de Córdoba (ES)
- Marqués de Valdecilla University Hospital (ES)
- Hospital General Universitario Gregorio Marañón (ES)
- Corresponding author
- Cordero, E.
- Venue
- Clinical Microbiology and Infection
- Publisher
- Elsevier BV
- Published
- 2012-01
- Volume
- 18
- Issue
- 1
- Pages
- 67-73
- ISSN
- 1198-743X (ISSN-L)
- PMC
- PMC7129435
- OpenAlex
- W2172048972
- Cited by
- 77
- References
- 35
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 2 · 2023: 3 · 2022: 3 · 2021: 6 · 2020: 15 · 2019: 2 · 2018: 6 · 2017: 2 · 2016: 9 · 2015: 3 · 2014: 5 · 2013: 7 · 2012: 9
- FWCI
- 5.04
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Clinical Microbiology and Infection (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
- Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
- Health Sciences › Medicine › Epidemiology › Respiratory viral infections research
- Keywords
- 2009 H1N1 pandemic, solid organ transplant recipients, respiratory co-infection, bacterial co-infection, fungal co-infection, influenza severity, mortality, diabetes mellitus, septic shock, acute rejection, pneumonia, antiviral treatment timing, influenza vaccination, nosocomial infections
- MeSH terms
- Adolescent, Adult, Aged, Cross Infection, Diabetes Mellitus, Female, Humans, Influenza, Human, Male, Middle Aged, Pneumonia, Prospective Studies, Risk Factors, Organ Transplantation, Treatment Outcome, Diabetes Complications, Influenza A Virus, H1N1 Subtype, Young Adult, Coinfection
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