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Chest. Community-Acquired Respiratory Coinfection in Critically Ill Patients With Pandemic 2009 Influenza A(H1N1) Virus

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  • Chest. Community-Acquired Respiratory Coinfection in Critically Ill Patients With Pandemic 2009 Influenza A(H1N1) Virus

    Community-Acquired Respiratory Coinfection in Critically Ill Patients With Pandemic 2009 Influenza A(H1N1) Virus (Chest, abstract, edited)

    [Source: Chest, full text: <cite cite="http://chestjournal.chestpubs.org/content/139/3/555.short?rss=1">Community-Acquired Respiratory Coinfection in Critically Ill Patients With Pandemic 2009 Influenza A(H1N1) Virus</cite>. Abstract, edited.]

    Community-Acquired Respiratory Coinfection in Critically Ill Patients With Pandemic 2009 Influenza A(H1N1) Virus

    1. Ignacio Mart?n-Loeches, MD, PhD, 2. Ana Sanchez-Corral, MD, 3. Emili Diaz, MD, PhD, 4. Rosa Mar?a Granada, MD, 5. Rafael Zaragoza, MD, 6. Christian Villavicencio, MD, 7. Antonio Albaya, MD, 8. Enrique Cerd?, MD, 9. Rosa Mar?a Catal?n, MD, 10. Pilar Luque, MD, 11. Amparo Paredes, MD, 12. In?s Navarrete, MD, 13. Jordi Rello, MD, PhD, 14. Alejandro Rodr?guez, MD, PhD and 15. H1N1 SEMICYUC Working Group

    Author Affiliations
    1. From the Critical Care Department (Drs Mart?n-Loeches, Diaz, Villavicencio, and Rodr?guez), Joan XXIII University Hospital, University Rovira i Virgili, IISPV, CIBER Enfermedades Respiratorias (CIBERes), Tarragona; the Critical Care Department (Dr Sanchez-Corral), Vall d?Hebron University Hospital, Barcelona; the Critical Care Department (Dr Granada), Hospital Universitario de Bellvitge, Barcelona; the Critical Care Department (Dr Zaragoza), Hospital Universitario Dr. Peset, Valencia; the Critical Care Department (Dr Albaya), Hospital Universitario de Guadalajara, Guadalajara; the Critical Care Department (Dr Cerd?), Hospital Infanta Cristina, Madrid; the Critical Care Department (Dr Catal?n), Hospital General de Vic, Consorci Hospitalari de Vic, Vic; the Critical Care Department (Dr Luque), Hospital Clinico Universitario Lozano Blesa, Zaragoza; the Critical Care Department (Dr Paredes), Hospital Sur de Alcorc?n, Madrid; the Critical Care Department (Dr Navarrete), Hospital Universitario Virgen de las Nieves, Granada; and the Critical Care Department (Dr Rello), Vall d?Hebron University Hospital, Institut de Recerca Vall d?Hebron, CIBER Enfermedades Respiratorias (CIBERes), Universitat Aut?noma de Barcelona, Barcelona, Spain.

    1. Correspondence to: Ignacio Mart?n-Loeches, MD, PhD, Critical Care Department, Joan XXIII University Hospital, Mallafr? Guasch 4, 43007 Tarragona, Spain; e-mail: drmartinloeches@gmail.com


    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.


    Footnotes

    * A complete list of the H1N1 SEMICYUC Working Group authors can be found in the e-Appendix 1.
    * Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

    #Abbreviations: A(H1N1) pandemic 2009 influenza A(H1N1) - APACHE Acute Physiology and Chronic Health Evaluation - CARC community-acquired respiratory coinfection - HR hazard ratio - IQR interquartile range - MRSA methicillin-resistant Staphylococcus aureus - PCR polymerase chain reaction - SOFA Sequential Organ Failure Assessment

    * Received June 2, 2010.
    * Accepted September 15, 2010.
    * ? 2011 American College of Chest Physicians

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