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Chest. 2011 Mar;139(3):555-562. doi: 10.1378/chest.10-1396. Epub 2010 Oct 7.

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

Author information

1
Critical Care Department, Joan XXIII University Hospital, University Rovira i Virgili, IISPV, CIBER Enfermedades Respiratorias (CIBERes), Tarragona, Spain. Electronic address: drmartinloeches@gmail.com.
2
Critical Care Department, Vall d'Hebron University Hospital, Barcelona, Spain.
3
Critical Care Department, Joan XXIII University Hospital, University Rovira i Virgili, IISPV, CIBER Enfermedades Respiratorias (CIBERes), Tarragona, Spain.
4
Critical Care Department, Hospital Universitario de Bellvitge, Barcelona, Spain.
5
Critical Care Department, Hospital Universitario Dr. Peset, Valencia, Spain.
6
Critical Care Department, Hospital Universitario de Guadalajara, Guadalajara, Spain.
7
Critical Care Department, Hospital Infanta Cristina, Madrid, Spain.
8
Critical Care Department, Hospital General de Vic, Consorci Hospitalari de Vic, Vic, Spain.
9
Critical Care Department, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain.
10
Critical Care Department, Hospital Sur de Alcorcón, Madrid, Spain.
11
Critical Care Department, Hospital Universitario Virgen de las Nieves, Granada, Spain.
12
Critical Care Department, Vall d'Hebron University Hospital, Institut de Recerca Vall d'Hebron, CIBER Enfermedades Respiratorias (CIBERes), Universitat Autónoma de Barcelona, Barcelona, Spain.

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.

PMID:
20930007
DOI:
10.1378/chest.10-1396
[Indexed for MEDLINE]

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