The occurrence and impact of bacterial organisms complicating critical care illness associated with 2009 influenza A(H1N1) infection.
Abstract
Background Although secondary infections are recognized as a cause of morbidity and mortality in seasonal influenza, their frequency, characteristics, and associated clinical outcomes in 2009 influenza A(H1N1) (A[H1N1])-related critical illness are unknown.Methods In a prospective cohort of adult patients admitted to Canadian ICUs with influenza A(H1N1) infection, the frequency and associated clinical outcomes of prevalent (culture taken within 72 h of ICU admission) and ICU-acquired (culture taken after 72 h from ICU admission) positive bacterial cultures were determined.Results Among 681 patients, the mean age was 47.9 years (SD, 15.1), APACHE (Acute Physiology and Chronic Health Examination) II score was 21.0 (9.9), and 573 patients (84.0%) were invasively mechanically ventilated. Positive cultures were obtained in 259 patients (38.0%): 77 (29.7%) had prevalent, 115 (44.4%) had ICU-acquired, and 40 (15.4%) had both; culture date was unavailable in 27 (10.4%). The most common bacterial organisms isolated were coagulase-negative staphylococci, Staphylococcus aureus, Pseudomonas species, and Streptococcus pneumoniae. Antibiotics were prescribed in 661 (97.1%), with 3.8 (1.9) prescriptions per patient. Patients with any positive culture had longer days of mechanical ventilation (mean [SD], 15.2 [10.7] vs 10.7 [9.0]; P<.0001), ICU stay (median [interquartile range (IQR)], 18.2 [12.5] days vs 10.8 [9.0] days, P<.0001), and hospitalization (median [IQR], 30.7 [20.7] days vs 19.2 [17.4] days, P<.0001) and a trend toward increased hospital mortality (25.1% vs 19.9%, P=.15). Patients with ICU-acquired positive cultures had worse outcomes compared with those with positive prevalent cultures or who were culture-negative.Conclusion Culture-based evidence of secondary infections commonly complicates A(H1N1)-related critical illness and is associated with worse clinical outcomes despite nearly ubiquitous antibiotic administration.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Among undifferentiated patients with pneumonia or sepsis, broad-spectrum regimens including agents active against MRSA were associated with higher mortality, particularly among patients without MRSA.
“Among undifferentiated patients with pneumonia or sepsis, broad-spectrum regimens including agents active against MRSA were associated with higher mortality, particularly among patients without MRSA (137,151,155,156).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [156]
Similar to SARS, conditional pathogens were the most common infectious microbes in influenza.
“Similar to SARS, conditional pathogens were the most common infectious microbes (Muscedere et al., 2013; MacIntyre et al., 2018).”
From Oral Microbiome and SARS-CoV-2: Beware of Lung Co-infection (2020) · cites this paper as Muscedere et al., 2013
The citation lists haven’t been fetched yet
References 29 · Cited by 40
- Authors
- Muscedere, J., Ofner, M., Kumar, A., Long, J., Lamontagne, F., Cook, D., McGeer, A., Chant, C., Marshall, J., Jouvet, P., & Fowler, R.
- Affiliations
- Queen's University (CA)
- Public Health Agency of Canada (CA)
- St. Boniface Hospital (CA)
- Sunnybrook Health Science Centre (CA)
- McMaster University (CA)
- Mount Sinai Hospital (CA)
- St. Michael's Hospital (CA)
- Université de Montréal (CA)
- Corresponding author
- Muscedere, John
- ORCID
- Venue
- Chest
- Publisher
- Elsevier BV
- Published
- 2013-07
- Volume
- 144
- Issue
- 1
- Pages
- 39-47
- ISSN
- 0012-3692 (ISSN-L)
- OpenAlex
- W2127473167
- Cited by
- 40
- References
- 29
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 1 · 2022: 3 · 2021: 5 · 2020: 4 · 2019: 1 · 2018: 4 · 2017: 2 · 2016: 7 · 2015: 3 · 2014: 5 · 2013: 3
- FWCI
- 4.37
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- CHEST Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Keywords
- secondary bacterial infection, intensive care unit infections, critical illness, intensive care unit, mechanical ventilation, coagulase-negative staphylococci, Staphylococcus aureus, Pseudomonas, Streptococcus pneumoniae, length of hospital stay, in-hospital mortality, antibiotic prescribing, bacterial co-infection
- MeSH terms
- Adult, Canada, Female, Humans, Influenza, Human, Intensive Care Units, Length of Stay, Male, Middle Aged, Prognosis, Prospective Studies, Pseudomonas Infections, Respiration, Artificial, Staphylococcal Infections, Streptococcal Infections, Cohort Studies, Incidence, Critical Illness, Influenza A Virus, H1N1 Subtype
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
