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Cited by 203Influenza Virus Research StudiesPneumonia and Respiratory InfectionsRespiratory viral infections research

Community-acquired respiratory coinfection in critically ill patients with pandemic 2009 influenza A(H1N1) virus

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Martín-Loeches, Ignacio, Sanchez-Corral, Ana, Diaz, Emili, Granada, Rosa María, Zaragoza, Rafael, Villavicencio, Christian, Albaya, Antonio, Cerdá, Enrique +6 more·2011·Chest
DOI 10.1378/chest.10-1396
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Abstract

Background Little is known about the impact of community-acquired respiratory coinfection in patients with pandemic 2009 influenza A(H1N1) virus infection.Methods This was a prospective, observational, multicenter study conducted in 148 Spanish ICUs.Results Severe respiratory syndrome was present in 645 ICU patients. Coinfection occurred in 113 (17.5%) of patients. Streptococcus pneumoniae (in 62 patients [54.8%]) was identified as the most prevalent bacteria. Patients with coinfection at ICU admission were older (47.5±15.7 vs 43.8±14.2 years, P<.05) and presented a higher APACHE (Acute Physiology and Chronic Health Evaluation) II score (16.1±7.3 vs 13.3±7.1, P<.05) and Sequential Organ Failure Assessment (SOFA) score (7.0±3.8 vs 5.2±3.5, P<.05). No differences in comorbidities were observed. Patients who had coinfection required vasopressors (63.7% vs 39.3%, P<.05) and invasive mechanical ventilation (69% vs 58.5%, P<.05) more frequently. ICU length of stay was 3 days longer in patients who had coinfection than in patients who did not (11 [interquartile range, 5-23] vs 8 [interquartile range 4-17], P=.01). Coinfection was associated with increased ICU mortality (26.2% vs 15.5%; OR, 1.94; 95% CI, 1.21-3.09), but Cox regression analysis adjusted by potential confounders did not confirm a significant association between coinfection and ICU mortality.Conclusions During the 2009 pandemics, the role played by bacterial coinfection in bringing patients to the ICU was not clear, S pneumoniae being the most common pathogen. This work provides clear evidence that bacterial coinfection is a contributor to increased consumption of health resources by critical patients infected with the virus and is the virus that causes critical illness in the vast majority of cases.

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Crossref · 10.1378/chest.10-1396

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  • Bacterial co-infection was detected in ~30% of cases in the 2009 H1N1 pandemic, with high mortality rates despite administration of appropriate antibiotics.

    “Bacterial co-infection was also detected in ~30% of cases in the 2009 H1N1 pandemic, with high mortality rates despite administration of appropriate antibiotics”

    From Respiratory viral infection-induced microbiome alterations and secondary bacterial pneumonia. (2018) · cites this paper as [15]

  • In the Spanish ICU study, S pneumoniae was identified as the most prevalent bacteria (54·8%).

    “S pneumoniae was identified as the most prevalent bacteria (54·8%).”

    From Bacterial and viral infections associated with influenza (2013) · cites this paper as [36]

  • In a prospective observational multicenter study of 645 patients with confirmed H1N1 pandemic influenza in 148 Spanish ICUs, co-infection occurred in 113 (17·5%) of patients.

    “A prospective, observational, multicenter study conducted in 148 Spanish intensive care units (ICU) and with 645 patients, all of whom had confirmed H1N1 pandemic influenza infection showed that co‐infection occurred in 113 (17·5%) of patients.”

    From Bacterial and viral infections associated with influenza (2013) · cites this paper as [36]

  • In the Spanish ICU study, Cox regression analysis adjusted by potential confounders did not confirm a significant association between co-infection and ICU mortality.

    “but Cox regression analysis adjusted by potential confounders did not confirm a significant association between co‐infection and ICU mortality.”

    From Bacterial and viral infections associated with influenza (2013) · cites this paper as [36]

  • In the Spanish ICU study, co-infection was associated with increased ICU mortality (26·2% versus 15·5%).

    “Co‐infection was associated with increased ICU mortality (26·2% versus 15·5%)”

    From Bacterial and viral infections associated with influenza (2013) · cites this paper as [36]

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Authors
Martín-Loeches, I., Sanchez-Corral, A., Diaz, E., Granada, R. M., Zaragoza, R., Villavicencio, C., Albaya, A., Cerdá, E., Catalán, R. M., Luque, P., Paredes, A., Navarrete, I., Rello, J., & Rodríguez, A.
Affiliations
  • Vall d'Hebron Hospital Universitari (ES)
  • Bellvitge University Hospital (ES)
  • Hospital Universitario Doctor Peset (ES)
  • Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (ES)
  • Hospital Universitario de Guadalajara (ES)
  • Hospital Clínico Universitario Lozano Blesa (ES)
  • Hospital Universitario Virgen de las Nieves (ES)
  • Universitat Autònoma de Barcelona (ES)
ORCID
Venue
Chest
Publisher
Elsevier BV
Published
2011-03
Volume
139
Issue
3
Pages
555-562
ISSN
0012-3692 (ISSN-L)
DOI
10.1378/chest.10-1396
OpenAlex
W2166978186
Semantic Scholar
194814586299f696be1cd83ce20b3464f6763f3e
Cited by
203
References
37
Citations by year
2026: 1 · 2025: 12 · 2024: 11 · 2023: 28 · 2022: 20 · 2021: 30 · 2020: 8 · 2019: 4 · 2018: 10 · 2017: 7 · 2016: 11 · 2015: 11 · 2014: 4 · 2013: 13 · 2012: 16
FWCI
10.71
Type
journal article
Language
en
Open access
Licence
Locations
  • CHEST Journal (publishedVersion)
  • PubMed (publishedVersion)
  • Acceda (Universidad de Las Palmas de Gran Canaria) (submittedVersion)
  • RUNA. Repositorio Institucional del Sergas (Servicio Gallego de Salud (SERGAS)) (submittedVersion, other-oa)
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
2009 H1N1 pandemic, influenza A (H1N1) virus, bacterial co-infection, Streptococcus pneumoniae, community-acquired respiratory tract infections, critically ill patients, intensive care unit, ICU mortality, mechanical ventilation, vasopressors, ICU length of stay, health resource utilization
MeSH terms
Adult, Female, Humans, Influenza, Human, Intensive Care Units, Male, Middle Aged, Prospective Studies, Regression Analysis, Respiration, Artificial, Respiratory Tract Infections, Retrospective Studies, Spain, Comorbidity, Prevalence, Critical Illness, Community-Acquired Infections, Influenza A Virus, H1N1 Subtype

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