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Clin Microbiol Infect. 2011 Apr 5. doi: 10.1111/j.1469-0691.2011.03537.x. [Epub ahead of print]
Pandemic influenza A(H1N1) virus infection in solid organ transplant recipients: impact of viral and non-viral co-infection.
Cordero E, P?rez-Romero P, Moreno A, Len O, Montejo M, Vidal E, Mart?n-D?vila P, Fari?as MC, Fern?ndez-Sab? N, Giannella M, Pach?n J; The Novel influenza A(H1N1) Study Group of the Spanish Network for Research in Infectious Diseases (REIPI).
Source
Infectious Diseases Unit, Hospital Universitario Virgen del Roc?o, Instituto de Biomedicina Sevilla (IBiS), Sevilla, Spain Infectious Diseases Unit, Hospital Clinic, Barcelona, Spain Infectious Diseases Unit, Hospital Vall d'Hebron, Barcelona, Spain Infectious Diseases Unit, Hospital Universitario de Cruces, Bilbao, Spain Infectious Diseases Unit, Hospital Universitario Reina Sof?a-IMIBIC, Universidad de C?rdoba, C?rdaba, Spain Infectious Diseases Unit, Hospital Ram?n y Cajal, Madrid, Spain Infectious Diseases Unit, Hospital Universitario Marqu?s de Valdecilla, Santander, Spain Infectious Diseases Unit, Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain Infectious Diseases Unit, Hospital General Universitario Gregorio Mara??n, Madrid, Spain.
Abstract
Clin Microbiol Infect ABSTRACT: Solid organ transplant recipients (SOTR) are at risk of serious influenza-related complications. The impact of respiratory co-infection in SOTR with 2009 pandemic influenza A(H1N1) is unknown. A multicentre prospective study of consecutive cases of pandemic influenza A(H1N1) in SOTR was carried out to assess the clinical characteristics and outcome and the risk factors for co-infection. Overall, 51 patients were included. Median time from transplant was 3.7 years, 5.9% of the cases occurred perioperatively and 7.8% were hospital-acquired. Pneumonia was diagnosed in 15 (29.4%) patients. Ten cases were severe (19.6%): 13.7% were admitted to intensive care units, 5.9% suffered septic shock, 5.9% developed acute graft rejection and 7.8% died. Co-infection was detected in 15 patients (29.4%): eight viral, six bacterial and one fungal. Viral co-infection did not affect the outcome. Patients with non-viral co-infection had a worse outcome: longer hospital stay (26.2 ? 20.7 vs. 5.5 ? 10.2) and higher rate of severe diseases (85.7% vs. 2.3%) and mortality (42.8% vs. 2.3%). Independent risk factors for non-viral co-infection were: diabetes mellitus and septic shock. Other factors associated with severe influenza were: delayed antiviral therapy, diabetes mellitus, time since transplantation <90 days and pneumonia. In conclusion, pandemic influenza A can cause significant direct and indirect effects in SOTR, especially in the early post-transplant period, and should be treated early. Clinicians should be aware of the possibility of non-viral co-infection, mainly in diabetic patients and severe cases. An effort should be made to prevent influenza with immunization of the patient and the environment.
? 2011 The Authors. Clinical Microbiology and Infection ? 2011 European Society of Clinical Microbiology and Infectious Diseases.
PMID:
21790857
[PubMed - as supplied by publisher]
Pandemic influenza A(H1N1) virus infection in solid organ transplant recipients: impact of viral and non-viral co-infection.
Cordero E, P?rez-Romero P, Moreno A, Len O, Montejo M, Vidal E, Mart?n-D?vila P, Fari?as MC, Fern?ndez-Sab? N, Giannella M, Pach?n J; The Novel influenza A(H1N1) Study Group of the Spanish Network for Research in Infectious Diseases (REIPI).
Source
Infectious Diseases Unit, Hospital Universitario Virgen del Roc?o, Instituto de Biomedicina Sevilla (IBiS), Sevilla, Spain Infectious Diseases Unit, Hospital Clinic, Barcelona, Spain Infectious Diseases Unit, Hospital Vall d'Hebron, Barcelona, Spain Infectious Diseases Unit, Hospital Universitario de Cruces, Bilbao, Spain Infectious Diseases Unit, Hospital Universitario Reina Sof?a-IMIBIC, Universidad de C?rdoba, C?rdaba, Spain Infectious Diseases Unit, Hospital Ram?n y Cajal, Madrid, Spain Infectious Diseases Unit, Hospital Universitario Marqu?s de Valdecilla, Santander, Spain Infectious Diseases Unit, Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain Infectious Diseases Unit, Hospital General Universitario Gregorio Mara??n, Madrid, Spain.
Abstract
Clin Microbiol Infect ABSTRACT: Solid organ transplant recipients (SOTR) are at risk of serious influenza-related complications. The impact of respiratory co-infection in SOTR with 2009 pandemic influenza A(H1N1) is unknown. A multicentre prospective study of consecutive cases of pandemic influenza A(H1N1) in SOTR was carried out to assess the clinical characteristics and outcome and the risk factors for co-infection. Overall, 51 patients were included. Median time from transplant was 3.7 years, 5.9% of the cases occurred perioperatively and 7.8% were hospital-acquired. Pneumonia was diagnosed in 15 (29.4%) patients. Ten cases were severe (19.6%): 13.7% were admitted to intensive care units, 5.9% suffered septic shock, 5.9% developed acute graft rejection and 7.8% died. Co-infection was detected in 15 patients (29.4%): eight viral, six bacterial and one fungal. Viral co-infection did not affect the outcome. Patients with non-viral co-infection had a worse outcome: longer hospital stay (26.2 ? 20.7 vs. 5.5 ? 10.2) and higher rate of severe diseases (85.7% vs. 2.3%) and mortality (42.8% vs. 2.3%). Independent risk factors for non-viral co-infection were: diabetes mellitus and septic shock. Other factors associated with severe influenza were: delayed antiviral therapy, diabetes mellitus, time since transplantation <90 days and pneumonia. In conclusion, pandemic influenza A can cause significant direct and indirect effects in SOTR, especially in the early post-transplant period, and should be treated early. Clinicians should be aware of the possibility of non-viral co-infection, mainly in diabetic patients and severe cases. An effort should be made to prevent influenza with immunization of the patient and the environment.
? 2011 The Authors. Clinical Microbiology and Infection ? 2011 European Society of Clinical Microbiology and Infectious Diseases.
PMID:
21790857
[PubMed - as supplied by publisher]
