Community-acquired pneumonia due to pandemic A(H1N1)2009 influenzavirus and methicillin resistant Staphylococcus aureus co-infection.
Open accessAbstract
BACKGROUND: Bacterial pneumonia is a well described complication of influenza. In recent years, community-onset methicillin-resistant Staphylococcus aureus (cMRSA) infection has emerged as a contributor to morbidity and mortality in patients with influenza. Since the emergence and rapid dissemination of pandemic A(H1N1)2009 influenzavirus in April 2009, initial descriptions of the clinical features of patients hospitalized with pneumonia have contained few details of patients with bacterial co-infection. METHODOLOGY/PRINCIPAL FINDINGS: Patients with community-acquired pneumonia (CAP) caused by co-infection with pandemic A(H1N1)2009 influenzavirus and cMRSA were prospectively identified at two tertiary hospitals in one Australian city during July to September 2009, the period of intense influenza activity in our region. Detailed characterization of the cMRSA isolates was performed. 252 patients with pandemic A(H1N1)2009 influenzavirus infection were admitted at the two sites during the period of study. Three cases of CAP due to pandemic A(H1N1)2009/cMRSA co-infection were identified. The clinical features of these patients were typical of those with S. aureus co-infection or sequential infection following influenza. The 3 patients received appropriate empiric therapy for influenza, but inappropriate empiric therapy for cMRSA infection; all 3 survived. In addition, 2 fatal cases of CAP caused by pandemic A(H1N1)2009/cMRSA co-infection were identified on post-mortem examination. The cMRSA infections were caused by three different cMRSA clones, only one of which contained genes for Panton-Valentine Leukocidin (PVL). CONCLUSIONS/SIGNIFICANCE: Clinicians managing patients with pandemic A(H1N1)2009 influenzavirus infection should be alert to the possibility of co-infection or sequential infection with virulent, antimicrobial-resistant bacterial pathogens such as cMRSA. PVL toxin is not necessary for the development of cMRSA pneumonia in the setting of pandemic A( H1N1) 2009 influenzavirus co-infection.
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Community-acquired MRSA causes necrotising pneumonia with a 30% mortality rate.
“specifically necrotising pneumonia that is caused by community acquired Methicillin-resistant Staphylococcus aureus (MRSA) and has a 30% mortality rate (Murray et al., 2010).”
From Secondary bacterial infections associated with influenza pandemics (2017) · cites this paper as Murray et al., 2010
In studies examining severe or fatal cases, the pathogenesis of influenza-associated S. aureus pneumonia seems to be distinct from that of typical community-acquired pneumonia.
“In studies examining severe or fatal cases, however, the pathogenesis of influenza-associated S. aureus pneumonia seems to be distinct from that of typical community-acquired pneumonia.”
From Influenza virus primes mice for pneumonia from Staphylococcus aureus. (2011) · cites this paper as [12]
Influenza-associated S. aureus pneumonia is characterized as fulminant, with short intervals between onset of illness and diagnosis of pneumonia (<7 days) and rapid (often within <24 h) progression to severe disease with multilobar involvement.
“The disease is characterized as fulminant, with short intervals between onset of illness and diagnosis of pneumonia (,7 days) and rapid (often within ,24 h) progression to severe disease with multilobar involvement [6,7,9,11,12].”
From Influenza virus primes mice for pneumonia from Staphylococcus aureus. (2011) · cites this paper as [12]
Although few data are available, bacterial pneumonia is complicating around 30% of fatal cases of the 2009 novel pandemic H1N1 influenza, with S. aureus the most commonly recognized pathogen.
“Although few data are available, it seems that bacterial pneumonia is complicating around 30% of fatal cases, with S. aureus the most commonly recognized pathogen [12,15,16].”
From Influenza virus primes mice for pneumonia from Staphylococcus aureus. (2011) · cites this paper as [12]
Influenza-staphylococcal coinfections have increased following the emergence of the USA300 and USA400 lineages, and S. aureus has been identified as a common cause of death during the recent H1N1 influenza pandemic.
“Influenza-staphylococcal coinfections have increased following the emergence of the USA300 and USA400 lineages [9,11,30,31], and S. aureus has been identified as a common cause of death during the recent H1N1 influenza pandemic [12,15].”
From Influenza virus primes mice for pneumonia from Staphylococcus aureus. (2011) · cites this paper as [12]
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References 44 · Cited by 84
- Authors
- Murray, R. J., Robinson, J. O., White, J. N., Hughes, F., Coombs, G. W., Pearson, J. C., Tan, H.-L., Chidlow, G., Williams, S., Christiansen, K. J., & Smith, D. W.
- Affiliations
- Queen Elizabeth II Medical Centre (AU)
- Royal Perth Hospital (AU)
- Corresponding author
- Murray, Ronan J.
- ORCID
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2010-01-14
- Volume
- 5
- Issue
- 1
- Pages
- e8705
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC2806836
- OpenAlex
- W1993746671
- Cited by
- 84
- References
- 44
- Citations by year
- 2024: 1 · 2023: 3 · 2022: 7 · 2021: 4 · 2020: 3 · 2019: 4 · 2018: 9 · 2017: 3 · 2016: 6 · 2015: 7 · 2014: 6 · 2013: 7 · 2012: 10
- FWCI
- 7.21
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Murdoch University Research Portal (submittedVersion, cc-by)
- UWA Profiles and Research Repository (UWA) (submittedVersion, other-oa)
- Murdoch University Research Portal (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- eSpace (Curtin University) (submittedVersion, cc-by)
- Figshare (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
- Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
- Health Sciences › Medicine › Infectious Diseases › Antimicrobial Resistance in Staphylococcus
- Keywords
- community-acquired pneumonia, methicillin-resistant Staphylococcus aureus, bacterial co-infection, sequential infection, Panton-Valentine leukocidin, antimicrobial resistance, empirical treatment, influenza complications, fatal pneumonia
- MeSH terms
- Australia, Humans, Influenza, Human, Staphylococcal Infections, Community-Acquired Infections, Pneumonia, Bacterial, Influenza A Virus, H1N1 Subtype, Methicillin-Resistant Staphylococcus aureus
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