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Cited by 117Influenza Virus Research StudiesRespiratory viral infections researchPneumonia and Respiratory Infections

The impact of bacterial and viral co‐infection in severe influenza

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Blyth, Christopher C., Webb, Steve A. R., Kok, Jen, Dwyer, Dominic E., van Hal, Sebastiaan J., Foo, Hong, Ginn, Andrew N., Kesson, Alison M. +3 more·2013·Influenza and Other Respiratory Viruses
DOI 10.1111/j.1750-2659.2012.00360.xPMC PMC5006004
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Abstract

Please cite this paper as: Blyth et al. (2013) The impact of bacterial and viral co‐infection in severe influenza. Influenza and Other Respiratory Viruses 7(2) 168–176. Background Many questions remain concerning the burden, risk factors and impact of bacterial and viral co‐infection in patients with pandemic influenza admitted to the intensive care unit (ICU). Objectives To examine the burden, risk factors and impact of bacterial and viral co‐infection in Australian patients with severe influenza. Patients/Methods A cohort study conducted in 14 ICUs was performed. Patients with proven influenza A during the 2009 influenza season were eligible for inclusion. Demographics, risk factors, clinical data, microbiological data, complications and outcomes were collected. Polymerase chain reaction for additional bacterial and viral respiratory pathogens was performed on stored respiratory samples. Results Co‐infection was identified in 23·3–26·9% of patients with severe influenza A infection: viral co‐infection, 3·2–3·4% and bacterial co‐infection, 20·5–24·7%. Staphylococcus aureus was the most frequent bacterial co‐infection followed by Streptococcus pneumoniae and Haemophilus influenzae. Patients with co‐infection were younger [mean difference in age = 8·46 years (95% CI: 0·18–16·74 years)], less likely to have significant co‐morbidities (32·0% versus 66·2%, P = 0·004) and less frequently obese [mean difference in body mass index = 6·86 (95% CI: 1·77–11·96)] compared to those without co‐infection. Conclusions Bacterial or viral co‐infection complicated one in four patients admitted to ICU with severe influenza A infection. Despite the co‐infected patients being younger and with fewer co‐morbidities, no significant difference in outcomes was observed. It is likely that co‐infection contributed to a need for ICU admission in those without other risk factors for severe influenza disease. Empiric antibiotics with staphylococcal activity should be strongly considered in all patients with severe influenza A infection.

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  • In seasonal epidemics, influenza bacterial coinfection is associated with increases in hospital admissions, more severe symptoms, and increases in mortality.

    “In seasonal epidemics, influenza bacterial coinfection is associated with increases in hospital admissions,4, 5 more severe symptoms,6 and increases in mortality.7”

    From The frequency of influenza and bacterial coinfection: a systematic review and meta-analysis. (2016) · cites this paper as [5]

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  1. [27]Pandemic flu: clinical management of patients with an influenza‐like illness during an influenza pandemic. Provisional guidelines from the British Infection Society, British Thoracic Society, and Health Protection Agency in collaboration with the Department of Health. Thorax 2007; 62(Suppl 1): 1– 46. PMC2223144 17202446
  2. [28]Bradley JS, Englund JA, File TM et al. Influenza H1N1: Frontline Questions and Expert Opinion Answers; in America IDSo (ed.). Arlington, VA: Infectious Diseases Society of America, 2009 Accessed 7th February 2011 (http://www.idsociety.org/Content.aspx?id=15743).

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Authors
Blyth, C. C., Webb, S. A. R., Kok, J., Dwyer, D. E., van Hal, S. J., Foo, H., Ginn, A. N., Kesson, A. M., Seppelt, I., Iredell, J. R., & on behalf of the ANZIC Influenza Investigators and COSI Microbiological Investigators
Affiliations
  • The University of Western Australia (AU)
  • The University of Sydney (AU)
  • Wollongong Hospital (AU)
Corresponding author
Blyth, Christopher C.
ORCID
Venue
Influenza and Other Respiratory Viruses
Publisher
Wiley
Published
2012-04-06
Volume
7
Issue
2
Pages
168-176
ISSN
  • 1750-2640 (ISSN-L)
  • 1750-2659
DOI
10.1111/j.1750-2659.2012.00360.x
PMC
PMC5006004
OpenAlex
W1954785451
Cited by
117
References
34
Citations by year
2026: 5 · 2025: 10 · 2024: 8 · 2023: 4 · 2022: 10 · 2021: 14 · 2020: 11 · 2019: 4 · 2018: 8 · 2017: 9 · 2016: 7 · 2015: 10 · 2014: 7 · 2013: 9 · 2012: 1
FWCI
6.47
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Influenza and Other Respiratory Viruses (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
  • UWA Profiles and Research Repository (UWA) (submittedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
  • Health Sciences › Medicine › Epidemiology › Respiratory viral infections research
  • Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
Keywords
influenza A virus, severe influenza, bacterial co-infection, viral coinfection, 2009 H1N1 pandemic, intensive care unit, Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, risk factors, comorbidities, obesity, empirical antibiotic therapy, respiratory pathogens
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Bacterial Infections, Child, Child, Preschool, Critical Care, Female, Humans, Infant, Infant, Newborn, Influenza, Human, Male, Middle Aged, Pregnancy, Cohort Studies, Young Adult, Coinfection

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