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Chest. 2013 Feb 7. doi: 10.1378/chest.12-1861. [Epub ahead of print]
The Occurrence and Impact of Bacterial Organisms Complicating Critical Care Illness Associated with Influenza A(H1N1) infection.
Muscedere J, Ofner M, Kumar A, Long J, Lamontagne F, Cook D, McGeer A, Chant C, Marshall J, Jouvet P, Fowler R.
Abstract
ABSTRACT PURPOSE:
Although secondary infections are recognized as a cause of morbidity and mortality in seasonal influenza, their frequency, characteristics and associated clinical outcomes in Influenza A (H1N1)-related critical illness are unknown.
METHODS:
In a prospective cohort of adult patients admitted to Canadian Intensive Care Units (ICUs) with H1N1 infection, the frequency and associated clinical outcomes of prevalent (culture taken within 72 hours of ICU admission) and ICU-acquired (culture taken after 72 hours from ICU admission) positive bacterial cultures were determined.
RESULTS:
Among 681 patients the mean age was 47.9 years (standard deviation [SD] 15.1), APACHE II was 21.0 (9.9) and 573 (84.0%) were invasively mechanical ventilated (MV). Positive cultures were obtained in 259 (38.0 %): 77 (29.7%) prevalent; 115 (44.4%) ICU-acquired; 40 (15.4%) had both; culture date was unavailable in 27 (10.4%). The most common bacterial organisms isolated were coagulase negative staphylococci, Staphylococcus aureus, Pseudomonas sp. and Streptococcus pneumoniae. Antibiotics were prescribed in 661 (97.1%) with 3.8 (1.9) prescriptions per patient. Patients with any positive culture had longer days of MV [mean(SD); 15.2 (10.7) vs. 10.7 (9.0), p< 0.0001], ICU stay [median(IQR);18.2 (12.5) vs. 10.8 (9.0) days, p< 0.0001], hospitalization [median(IQR); 30.7 (20.7) vs. 19.2 (17.4) days, p< 0.0001] and a trend towards increased hospital mortality (25.1% vs. 19.9%, p = 0.15). Patients with ICU-acquired positive cultures had worse outcomes compared to those with positive prevalent cultures or who were culture negative.
CONCLUSION:
Culture-based evidence of secondary infections commonly complicates Influenza A(H1N1)-related critical illness and is associated with worse clinical outcomes despite nearly ubiquitous antibiotic administration.
PMID:
23392627
[PubMed - as supplied by publisher]
The Occurrence and Impact of Bacterial Organisms Complicating Critical Care Illness Associated with Influenza A(H1N1) infection.
Muscedere J, Ofner M, Kumar A, Long J, Lamontagne F, Cook D, McGeer A, Chant C, Marshall J, Jouvet P, Fowler R.
Abstract
ABSTRACT PURPOSE:
Although secondary infections are recognized as a cause of morbidity and mortality in seasonal influenza, their frequency, characteristics and associated clinical outcomes in Influenza A (H1N1)-related critical illness are unknown.
METHODS:
In a prospective cohort of adult patients admitted to Canadian Intensive Care Units (ICUs) with H1N1 infection, the frequency and associated clinical outcomes of prevalent (culture taken within 72 hours of ICU admission) and ICU-acquired (culture taken after 72 hours from ICU admission) positive bacterial cultures were determined.
RESULTS:
Among 681 patients the mean age was 47.9 years (standard deviation [SD] 15.1), APACHE II was 21.0 (9.9) and 573 (84.0%) were invasively mechanical ventilated (MV). Positive cultures were obtained in 259 (38.0 %): 77 (29.7%) prevalent; 115 (44.4%) ICU-acquired; 40 (15.4%) had both; culture date was unavailable in 27 (10.4%). The most common bacterial organisms isolated were coagulase negative staphylococci, Staphylococcus aureus, Pseudomonas sp. and Streptococcus pneumoniae. Antibiotics were prescribed in 661 (97.1%) with 3.8 (1.9) prescriptions per patient. Patients with any positive culture had longer days of MV [mean(SD); 15.2 (10.7) vs. 10.7 (9.0), p< 0.0001], ICU stay [median(IQR);18.2 (12.5) vs. 10.8 (9.0) days, p< 0.0001], hospitalization [median(IQR); 30.7 (20.7) vs. 19.2 (17.4) days, p< 0.0001] and a trend towards increased hospital mortality (25.1% vs. 19.9%, p = 0.15). Patients with ICU-acquired positive cultures had worse outcomes compared to those with positive prevalent cultures or who were culture negative.
CONCLUSION:
Culture-based evidence of secondary infections commonly complicates Influenza A(H1N1)-related critical illness and is associated with worse clinical outcomes despite nearly ubiquitous antibiotic administration.
PMID:
23392627
[PubMed - as supplied by publisher]
