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Cited by 222Influenza Virus Research StudiesRespiratory viral infections researchInfectious Encephalopathies and Encephalitis

Critically Ill Children During the 2009–2010 Influenza Pandemic in the United States

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Randolph, Adrienne G., Vaughn, Frances, Sullivan, Ryan, Rubinson, Lewis, Thompson, B. Taylor, Yoon, Grace, Smoot, Elizabeth, Rice, Todd W. +13 more·2011·Pediatrics
DOI 10.1542/peds.2011-0774PMC PMC3387899
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Abstract

BACKGROUND: The 2009 pandemic influenza A (H1N1) (pH1N1) virus continues to circulate worldwide. Determining the roles of chronic conditions and bacterial coinfection in mortality is difficult because of the limited data for children with pH1N1-related critical illness. METHODS: We identified children (<21 years old) with confirmed or probable pH1N1 admitted to 35 US PICUs from April 15, 2009, through April 15, 2010. We collected data on demographics, baseline health, laboratory results, treatments, and outcomes. RESULTS: Of 838 children with pH1N1 admitted to a PICU, the median age was 6 years, 58% were male, 70% had ≥1 chronic health condition, and 88.2% received oseltamivir (5.8% started before PICU admission). Most patients had respiratory failure with 564 (67.3%) receiving mechanical ventilation; 162 (19.3%) received vasopressors, and 75 (8.9%) died. Overall, 71 (8.5%) of the patients had a presumed diagnosis of early (within 72 hours after PICU admission) Staphylococcus aureus coinfection of the lung with 48% methicillin-resistant S aureus (MRSA). In multivariable analyses, preexisting neurologic conditions or immunosuppression, encephalitis (1.7% of cases), myocarditis (1.4% of cases), early presumed MRSA lung coinfection, and female gender were mortality risk factors. Among 251 previously healthy children, only early presumed MRSA coinfection of the lung (relative risk: 8 [95% confidence interval: 3.1–20.6]; P < .0001) remained a mortality risk factor. CONCLUSIONS: Children with preexisting neurologic conditions and immune compromise were at increased risk of pH1N1-associated death after PICU admission. Secondary complications of pH1N1, including myocarditis, encephalitis, and clinical diagnosis of early presumed MRSA coinfection of the lung, were mortality risk factors.

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  • The frequency of overall bacterial coinfection in influenza patients is still poorly characterized.

    “While prior studies have examined the frequency of select bacterial species in influenza cases,13, 14 particularly the presence of methicillin‐resistant S. aureus (MRSA),15, 16, 17, 18 the frequency of overall coinfection in influenza patients is still poorly characterized.”

    From The frequency of influenza and bacterial coinfection: a systematic review and meta-analysis. (2016) · cites this paper as [17]

  • Bacteraemia was observed in 5% of admissions in the pediatric ICU study, for which S. aureus was the main cause.

    “Bacteraemia was observed in 5% of admissions, for which S. aureus was the main cause (Randolph et al., 2011).”

    From Secondary bacterial infections associated with influenza pandemics (2017) · cites this paper as Randolph et al., 2011

  • In 838 critically ill children infected with pandemic influenza in US pediatric intensive care units, within 72 h of admission 33% exhibited bacterial co-infection; in 26% of these cases S. aureus was identified (48% MRSA), 5.5% were positive for S. pneumoniae, and 5% for H. influenzae.

    “investigated 838 critically ill children who were infected with pandemic influenza. Within 72 h of admission to the intensive care unit 33% exhibited bacterial co-infection; in 26% of these cases S. aureus was identified as the cause (48% of which were MRSA), 5.5% were positive for S. pneumoniae and 5% were positive for H. influenzae.”

    From Secondary bacterial infections associated with influenza pandemics (2017) · cites this paper as Randolph et al., 2011

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  1. [21]21. Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated Pediatric Risk of Mortality score. Crit Care Med. 1996;24(5):743–752 [DOI] [PubMed] [Google Scholar]
  2. [30]30. Shieh WJ, Blau DM, Denison AM, et al. 2009 pandemic influenza A (H1N1): pathology and pathogenesis of 100 fatal cases in the United States. Am J Pathol. 2010;177(1):166–175 [DOI] [PMC free article] [PubMed] [Google Scholar]

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Authors
Randolph, A. G., Vaughn, F., Sullivan, R., Rubinson, L., Thompson, B. T., Yoon, G., Smoot, E., Rice, T. W., Loftis, L. L., Helfaer, M., Doctor, A., Paden, M., Flori, H., Babbitt, C., Graciano, A. L., Gedeit, R., Sanders, R. C., Giuliano, J. S., Zimmerman, J., Uyeki, T. M., & for the Pediatric Acute Lung Injury and Sepsis Investigator's Network and the National Heart, L.
Affiliations
  • Boston Children's Hospital (US)
  • United States Department of Health and Human Services (US)
  • Harvard University (US)
  • Vanderbilt University (US)
  • Baylor College of Medicine (US)
  • Children's Hospital of Philadelphia (US)
  • St. Louis Children's Hospital (US)
  • Henrietta Egleston Hospital for Children (US)
  • Department of Pediatrics, Children's Hospital Oakland, Oakland, California;
  • Miller Children's & Women's Hospital (US)
  • Department of Pediatrics, Children's Hospital of Central California, Madera, California;
  • Children's Hospital of Wisconsin (US)
  • Arkansas Children's Hospital (US)
  • Yale University (US)
  • Seattle Children's Hospital (US)
  • Centers for Disease Control and Prevention (US)
ORCID
Venue
Pediatrics
Publisher
American Academy of Pediatrics (AAP)
Published
2011-12-01
Volume
128
Issue
6
Pages
e1450-e1458
ISSN
  • 0031-4005 (ISSN-L)
  • 1098-4275
DOI
10.1542/peds.2011-0774
PMC
PMC3387899
OpenAlex
W2169416010
Cited by
222
References
61
Citations by year
2026: 5 · 2025: 8 · 2024: 2 · 2023: 6 · 2022: 17 · 2021: 6 · 2020: 14 · 2019: 20 · 2018: 21 · 2017: 18 · 2016: 11 · 2015: 22 · 2014: 15 · 2013: 35 · 2012: 21
FWCI
17.28
Type
journal article
Language
en
Open access
Locations
  • PEDIATRICS (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • U.S. Department of Health and Human Services
  • National Institutes of Health (n01hr56179-17-0-1)
  • National Heart, Lung, and Blood Institute (N01 HR 56179, N01 HR056179)
  • National Institute of Allergy and Infectious Diseases (R56AI084011)
Topics
  • Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
  • Health Sciences › Medicine › Epidemiology › Respiratory viral infections research
  • Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
Keywords
2009 H1N1 pandemic, pediatric intensive care, critically ill children, mortality risk factors, methicillin-resistant Staphylococcus aureus, bacterial co-infection, respiratory failure, mechanical ventilation, vasopressors, neurologic conditions, immunosuppression, encephalitis, myocarditis, oseltamivir, chronic disease
MeSH terms
Adolescent, Child, Child, Preschool, Female, Humans, Infant, Influenza, Human, Male, Retrospective Studies, United States, Critical Illness, Influenza A Virus, H1N1 Subtype, Young Adult, Pandemics

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