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

Ignacio Martín-Loeches, Ana Sanchez-Corral, Emili Diaz, Rosa María Granada, Rafael Zaragoza, Christian Villavicencio, Antonio Albaya, Enrique Cerdá, Rosa María Catalán, Pilar Luque, Amparo Paredes, Inés Navarrete, Jordi Rello, Alejandro Rodríguez, Pedro Cobo, Javier Martins, Cecilia Carbayo, Emilio Robles-Musso, Antonio Cárdenas, Javier FierroOcaña Fernández, Rafael Sierra, Ma Jesús Huertos, Juan Carlos Pozo, Rafael Guerrero, Enrique Márquez, Manuel Rodríguez-Carvajal, Antonio Jareño, José Pomares, José Luis Ballesteros, Yolanda Fernández, Francisco Lobato, José F. Prieto, José Albofedo-Sánchez, Pilar Martínez, Miguel Angel Díaz Castellanos, Guillermo Sevilla, José Garnacho-Montero, Rafael Hinojosa, Esteban Fernández, Ana Loza, Cristóbal León, Angel Arenzana, Dolores Ocaña, Manuel Luis Avellanas, Arantxa Lander, S. Garrido Ramírez De Arellano, M. I.Marquina Lacueva, Ignacio González, Jose Ma Montón, Jose Ma Díaz, Pilar López-Reina, Sergio Sáez, Lisardo Iglesias, Carmen Pascual González, Quiroga, Águeda García-Rodríguez, Lorenzo Socias, Pedro Ibánez, Marcío Borges-Sa, A. Socias, A. Del Castillo, Ricard Jordà Marcos, José M. Bonell, Ignacio Amestarán, Sergio Ruiz-Santana, Juan José Díaz, Sisón, David Hernández, Ana Trujillo, Luis Regalado, Leonardo Lorente, Mar Martín, Sergio Martínez, J. J. Cáceres, Borja Suberviola, P. Ugarte, Fernando García-López, Angel Álvaro Alonso, Antonio Pasilla, Ma Luisa Gómez Grande, Alfonso Canabal, Luis Marina, Juan B.López Messa, Ma Jesús López Pueyo, Zulema Ferreras, Santiago Macias, José Ángel Berezo, Jesús Blanco Varela, Ojeda A. Andaluz, Antonio Álvarez Terrero, Fabiola Tena Ezpeleta, Miquel Ferrer, Antoni Torres, Sandra Barbadillo, Lluís Cabré, Assumpta Rovira, Francisco Álvarez-Lerma, Antonia Vázquez, Joan Nolla

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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. ©2011 American College of Chest Physicians.
Original languageEnglish
Pages (from-to)555-562
JournalChest
Volume139
Issue number3
DOIs
Publication statusPublished - 1 Mar 2011

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    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., Cobo, P., Martins, J., Carbayo, C., Robles-Musso, E., Cárdenas, A., ... Nolla, J. (2011). Community-acquired respiratory coinfection in critically III patients with pandemic 2009 influenza A(H1N1) virus. Chest, 139(3), 555-562. https://doi.org/10.1378/chest.10-1396