Bacterial and viral co-infections complicating severe influenza

Incidence and impact among 507 U.S. patients, 2013-14

Nirav S. Shah, Jared A. Greenberg, Moira C. McNulty, Kevin S. Gregg, James Riddell, Julie E. Mangino, Devin M. Weber, Courtney L. Hebert, Natalie S. Marzec, Michelle A. Barron, Fredy Chaparro-Rojas, Alejandro Restrepo, Vagish Hemmige, Kunatum Prasidthrathsint, Sandra Cobb, Loreen Herwaldt, Vanessa Raabe, Christopher R. Cannavino, Andrea Green Hines, Sara H. Bares & 26 others Philip B. Antiporta, Tonya Scardina, Ursula Patel, Gail Reid, Parvin Mohazabnia, Suresh Kachhdiya, Binh Minh Le, Connie J. Park, Belinda Ostrowsky, Ari Robicsek, Becky A. Smith, Jeanmarie Schied, Micah M. Bhatti, Stockton Mayer, Monica Sikka, Ivette Murphy-Aguilu, Priti Patwari, Shira R. Abeles, Francesca J. Torriani, Zainab Abbas, Sophie Toya, Katherine Doktor, Anindita Chakrabarti, Susanne Doblecki-Lewis, David J. Looney, Michael Z. David

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Background: Influenza acts synergistically with bacterial co-pathogens. Few studies have described co-infection in a large cohort with severe influenza infection. Objectives: To describe the spectrum and clinical impact of co-infections. Study design: Retrospective cohort study of patients with severe influenza infection from September 2013 through April 2014 in intensive care units at 33 U.S. hospitals comparing characteristics of cases with and without co-infection in bivariable and multivariable analysis. Results: Of 507 adult and pediatric patients, 114 (22.5%) developed bacterial co-infection and 23 (4.5%) developed viral co-infection. Staphylococcus aureus was the most common cause of co-infection, isolated in 47 (9.3%) patients. Characteristics independently associated with the development of bacterial co-infection of adult patients in a logistic regression model included the absence of cardiovascular disease (OR 0.41 [0.23-0.73], p = 0.003), leukocytosis (>11 K/μl, OR 3.7 [2.2-6.2], p < 0.001; reference: normal WBC 3.5-11 K/μl) at ICU admission and a higher ICU admission SOFA score (for each increase by 1 in SOFA score, OR 1.1 [1.0-1.2], p = 0.001). Bacterial co-infections (OR 2.2 [1.4-3.6], p = 0.001) and viral co-infections (OR 3.1 [1.3-7.4], p = 0.010) were both associated with death in bivariable analysis. Patients with a bacterial co-infection had a longer hospital stay, a longer ICU stay and were likely to have had a greater delay in the initiation of antiviral administration than patients without co-infection (p < 0.05) in bivariable analysis. Conclusions: Bacterial co-infections were common, resulted in delay of antiviral therapy and were associated with increased resource allocation and higher mortality.

Original languageEnglish (US)
Pages (from-to)12-19
Number of pages8
JournalJournal of Clinical Virology
Volume80
DOIs
StatePublished - Jul 1 2016
Externally publishedYes

Fingerprint

Virus Diseases
Coinfection
Human Influenza
Incidence
Bacterial Infections
Antiviral Agents
Logistic Models
Resource Allocation
Leukocytosis
Infection
Intensive Care Units
Staphylococcus aureus
Length of Stay
Cohort Studies
Cardiovascular Diseases
Retrospective Studies
Pediatrics

Keywords

  • Co-infection
  • ICU
  • Influenza A (H1N1) pdm09
  • MRSA
  • Severe influenza
  • Staphylococcus aureus

ASJC Scopus subject areas

  • Virology
  • Infectious Diseases

Cite this

Shah, N. S., Greenberg, J. A., McNulty, M. C., Gregg, K. S., Riddell, J., Mangino, J. E., ... David, M. Z. (2016). Bacterial and viral co-infections complicating severe influenza: Incidence and impact among 507 U.S. patients, 2013-14. Journal of Clinical Virology, 80, 12-19. https://doi.org/10.1016/j.jcv.2016.04.008

Bacterial and viral co-infections complicating severe influenza : Incidence and impact among 507 U.S. patients, 2013-14. / Shah, Nirav S.; Greenberg, Jared A.; McNulty, Moira C.; Gregg, Kevin S.; Riddell, James; Mangino, Julie E.; Weber, Devin M.; Hebert, Courtney L.; Marzec, Natalie S.; Barron, Michelle A.; Chaparro-Rojas, Fredy; Restrepo, Alejandro; Hemmige, Vagish; Prasidthrathsint, Kunatum; Cobb, Sandra; Herwaldt, Loreen; Raabe, Vanessa; Cannavino, Christopher R.; Hines, Andrea Green; Bares, Sara H.; Antiporta, Philip B.; Scardina, Tonya; Patel, Ursula; Reid, Gail; Mohazabnia, Parvin; Kachhdiya, Suresh; Le, Binh Minh; Park, Connie J.; Ostrowsky, Belinda; Robicsek, Ari; Smith, Becky A.; Schied, Jeanmarie; Bhatti, Micah M.; Mayer, Stockton; Sikka, Monica; Murphy-Aguilu, Ivette; Patwari, Priti; Abeles, Shira R.; Torriani, Francesca J.; Abbas, Zainab; Toya, Sophie; Doktor, Katherine; Chakrabarti, Anindita; Doblecki-Lewis, Susanne; Looney, David J.; David, Michael Z.

In: Journal of Clinical Virology, Vol. 80, 01.07.2016, p. 12-19.

Research output: Contribution to journalArticle

Shah, NS, Greenberg, JA, McNulty, MC, Gregg, KS, Riddell, J, Mangino, JE, Weber, DM, Hebert, CL, Marzec, NS, Barron, MA, Chaparro-Rojas, F, Restrepo, A, Hemmige, V, Prasidthrathsint, K, Cobb, S, Herwaldt, L, Raabe, V, Cannavino, CR, Hines, AG, Bares, SH, Antiporta, PB, Scardina, T, Patel, U, Reid, G, Mohazabnia, P, Kachhdiya, S, Le, BM, Park, CJ, Ostrowsky, B, Robicsek, A, Smith, BA, Schied, J, Bhatti, MM, Mayer, S, Sikka, M, Murphy-Aguilu, I, Patwari, P, Abeles, SR, Torriani, FJ, Abbas, Z, Toya, S, Doktor, K, Chakrabarti, A, Doblecki-Lewis, S, Looney, DJ & David, MZ 2016, 'Bacterial and viral co-infections complicating severe influenza: Incidence and impact among 507 U.S. patients, 2013-14', Journal of Clinical Virology, vol. 80, pp. 12-19. https://doi.org/10.1016/j.jcv.2016.04.008
Shah, Nirav S. ; Greenberg, Jared A. ; McNulty, Moira C. ; Gregg, Kevin S. ; Riddell, James ; Mangino, Julie E. ; Weber, Devin M. ; Hebert, Courtney L. ; Marzec, Natalie S. ; Barron, Michelle A. ; Chaparro-Rojas, Fredy ; Restrepo, Alejandro ; Hemmige, Vagish ; Prasidthrathsint, Kunatum ; Cobb, Sandra ; Herwaldt, Loreen ; Raabe, Vanessa ; Cannavino, Christopher R. ; Hines, Andrea Green ; Bares, Sara H. ; Antiporta, Philip B. ; Scardina, Tonya ; Patel, Ursula ; Reid, Gail ; Mohazabnia, Parvin ; Kachhdiya, Suresh ; Le, Binh Minh ; Park, Connie J. ; Ostrowsky, Belinda ; Robicsek, Ari ; Smith, Becky A. ; Schied, Jeanmarie ; Bhatti, Micah M. ; Mayer, Stockton ; Sikka, Monica ; Murphy-Aguilu, Ivette ; Patwari, Priti ; Abeles, Shira R. ; Torriani, Francesca J. ; Abbas, Zainab ; Toya, Sophie ; Doktor, Katherine ; Chakrabarti, Anindita ; Doblecki-Lewis, Susanne ; Looney, David J. ; David, Michael Z. / Bacterial and viral co-infections complicating severe influenza : Incidence and impact among 507 U.S. patients, 2013-14. In: Journal of Clinical Virology. 2016 ; Vol. 80. pp. 12-19.
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abstract = "Background: Influenza acts synergistically with bacterial co-pathogens. Few studies have described co-infection in a large cohort with severe influenza infection. Objectives: To describe the spectrum and clinical impact of co-infections. Study design: Retrospective cohort study of patients with severe influenza infection from September 2013 through April 2014 in intensive care units at 33 U.S. hospitals comparing characteristics of cases with and without co-infection in bivariable and multivariable analysis. Results: Of 507 adult and pediatric patients, 114 (22.5{\%}) developed bacterial co-infection and 23 (4.5{\%}) developed viral co-infection. Staphylococcus aureus was the most common cause of co-infection, isolated in 47 (9.3{\%}) patients. Characteristics independently associated with the development of bacterial co-infection of adult patients in a logistic regression model included the absence of cardiovascular disease (OR 0.41 [0.23-0.73], p = 0.003), leukocytosis (>11 K/μl, OR 3.7 [2.2-6.2], p < 0.001; reference: normal WBC 3.5-11 K/μl) at ICU admission and a higher ICU admission SOFA score (for each increase by 1 in SOFA score, OR 1.1 [1.0-1.2], p = 0.001). Bacterial co-infections (OR 2.2 [1.4-3.6], p = 0.001) and viral co-infections (OR 3.1 [1.3-7.4], p = 0.010) were both associated with death in bivariable analysis. Patients with a bacterial co-infection had a longer hospital stay, a longer ICU stay and were likely to have had a greater delay in the initiation of antiviral administration than patients without co-infection (p < 0.05) in bivariable analysis. Conclusions: Bacterial co-infections were common, resulted in delay of antiviral therapy and were associated with increased resource allocation and higher mortality.",
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TY - JOUR

T1 - Bacterial and viral co-infections complicating severe influenza

T2 - Incidence and impact among 507 U.S. patients, 2013-14

AU - Shah, Nirav S.

AU - Greenberg, Jared A.

AU - McNulty, Moira C.

AU - Gregg, Kevin S.

AU - Riddell, James

AU - Mangino, Julie E.

AU - Weber, Devin M.

AU - Hebert, Courtney L.

AU - Marzec, Natalie S.

AU - Barron, Michelle A.

AU - Chaparro-Rojas, Fredy

AU - Restrepo, Alejandro

AU - Hemmige, Vagish

AU - Prasidthrathsint, Kunatum

AU - Cobb, Sandra

AU - Herwaldt, Loreen

AU - Raabe, Vanessa

AU - Cannavino, Christopher R.

AU - Hines, Andrea Green

AU - Bares, Sara H.

AU - Antiporta, Philip B.

AU - Scardina, Tonya

AU - Patel, Ursula

AU - Reid, Gail

AU - Mohazabnia, Parvin

AU - Kachhdiya, Suresh

AU - Le, Binh Minh

AU - Park, Connie J.

AU - Ostrowsky, Belinda

AU - Robicsek, Ari

AU - Smith, Becky A.

AU - Schied, Jeanmarie

AU - Bhatti, Micah M.

AU - Mayer, Stockton

AU - Sikka, Monica

AU - Murphy-Aguilu, Ivette

AU - Patwari, Priti

AU - Abeles, Shira R.

AU - Torriani, Francesca J.

AU - Abbas, Zainab

AU - Toya, Sophie

AU - Doktor, Katherine

AU - Chakrabarti, Anindita

AU - Doblecki-Lewis, Susanne

AU - Looney, David J.

AU - David, Michael Z.

PY - 2016/7/1

Y1 - 2016/7/1

N2 - Background: Influenza acts synergistically with bacterial co-pathogens. Few studies have described co-infection in a large cohort with severe influenza infection. Objectives: To describe the spectrum and clinical impact of co-infections. Study design: Retrospective cohort study of patients with severe influenza infection from September 2013 through April 2014 in intensive care units at 33 U.S. hospitals comparing characteristics of cases with and without co-infection in bivariable and multivariable analysis. Results: Of 507 adult and pediatric patients, 114 (22.5%) developed bacterial co-infection and 23 (4.5%) developed viral co-infection. Staphylococcus aureus was the most common cause of co-infection, isolated in 47 (9.3%) patients. Characteristics independently associated with the development of bacterial co-infection of adult patients in a logistic regression model included the absence of cardiovascular disease (OR 0.41 [0.23-0.73], p = 0.003), leukocytosis (>11 K/μl, OR 3.7 [2.2-6.2], p < 0.001; reference: normal WBC 3.5-11 K/μl) at ICU admission and a higher ICU admission SOFA score (for each increase by 1 in SOFA score, OR 1.1 [1.0-1.2], p = 0.001). Bacterial co-infections (OR 2.2 [1.4-3.6], p = 0.001) and viral co-infections (OR 3.1 [1.3-7.4], p = 0.010) were both associated with death in bivariable analysis. Patients with a bacterial co-infection had a longer hospital stay, a longer ICU stay and were likely to have had a greater delay in the initiation of antiviral administration than patients without co-infection (p < 0.05) in bivariable analysis. Conclusions: Bacterial co-infections were common, resulted in delay of antiviral therapy and were associated with increased resource allocation and higher mortality.

AB - Background: Influenza acts synergistically with bacterial co-pathogens. Few studies have described co-infection in a large cohort with severe influenza infection. Objectives: To describe the spectrum and clinical impact of co-infections. Study design: Retrospective cohort study of patients with severe influenza infection from September 2013 through April 2014 in intensive care units at 33 U.S. hospitals comparing characteristics of cases with and without co-infection in bivariable and multivariable analysis. Results: Of 507 adult and pediatric patients, 114 (22.5%) developed bacterial co-infection and 23 (4.5%) developed viral co-infection. Staphylococcus aureus was the most common cause of co-infection, isolated in 47 (9.3%) patients. Characteristics independently associated with the development of bacterial co-infection of adult patients in a logistic regression model included the absence of cardiovascular disease (OR 0.41 [0.23-0.73], p = 0.003), leukocytosis (>11 K/μl, OR 3.7 [2.2-6.2], p < 0.001; reference: normal WBC 3.5-11 K/μl) at ICU admission and a higher ICU admission SOFA score (for each increase by 1 in SOFA score, OR 1.1 [1.0-1.2], p = 0.001). Bacterial co-infections (OR 2.2 [1.4-3.6], p = 0.001) and viral co-infections (OR 3.1 [1.3-7.4], p = 0.010) were both associated with death in bivariable analysis. Patients with a bacterial co-infection had a longer hospital stay, a longer ICU stay and were likely to have had a greater delay in the initiation of antiviral administration than patients without co-infection (p < 0.05) in bivariable analysis. Conclusions: Bacterial co-infections were common, resulted in delay of antiviral therapy and were associated with increased resource allocation and higher mortality.

KW - Co-infection

KW - ICU

KW - Influenza A (H1N1) pdm09

KW - MRSA

KW - Severe influenza

KW - Staphylococcus aureus

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