tetano
Editor, Senior Moderator
Chest. 2010 Oct 7. [Epub ahead of print]
Community-Acquired Respiratory Co-infection (CARC) in Critically Ill Patients Infected With Pandemic 2009 Influenza A (H1N1) Virus Infection.
Mart?n-Loeches I, Sanchez-Corral A, Diaz E, Granada R, Zaragoza R, Villavicencio C, Albaya A, Cerd? E, Catal?n R, Luque P, Paredes A, Navarrete I, Rello J, Rodr?guez A; H1N1 SEMICYUC Working Group.
(1)Critical Care Department. Joan XXIII University Hospital, University Rovira i Virgili, IISPV, CIBER Enfermedades Respiratorias (CIBERes) Tarragona, Spain.
Abstract
ABSTRACT
BACKGROUND: Little is known about the impact of Community-Acquired Respiratory Co-infection in patients with Pandemic 2009 Influenza A (H1N1) Virus Infection.
METHODS: Prospective, observational, multi-center study conducted in 148 Spanish ICU.
RESULTS: Severe respiratory syndrome was present in 645 ICU patients. Co-infection occurred in 113 (17.5%) of patients. S. pneumoniae 62 (54.8%) was identified as the most prevalent bacteria. Patients with co-infection were older (47.5 +/- 15.7 vs. 43.8 +/- 14.2 years, P < 0.05), presented a higher APACHE II score (16.1 +/- 7.3 vs. 13.3+/- 7.1, P < 0.05) and SOFA score (7.0 +/- 3.8 vs. 5.2+/- 3.5, P < 0.05) at ICU admission. No differences in comorbidities were observed. Patients who had co-infection required vasopressors (63.7% vs.39.3%, p<0.05) and invasive mechanical ventilation (69% vs.58.5%, p<0.05) more frequently. ICU-LOS was 3 days longer in patients who had co-infection compared to patients who did not (11 (IQR ,5-23) vs 8(IQR 4-17), p = 0.01). Co-infection 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 co-infection and ICU-mortality.
CONCLUSIONS: During 2009 pandemics, the role of bacterial coinfection in bringing patients to the ICU has not been clear, being S. pneumoniae the most common pathogen. This work clearly evidences that bacterial coinfection is a contributor for increased consumption of health resources in critical patients infected with the virus, but is the virus the cause of critical illness in the vast majority of the cases.
PMID: 20930007 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/20930007
Community-Acquired Respiratory Co-infection (CARC) in Critically Ill Patients Infected With Pandemic 2009 Influenza A (H1N1) Virus Infection.
Mart?n-Loeches I, Sanchez-Corral A, Diaz E, Granada R, Zaragoza R, Villavicencio C, Albaya A, Cerd? E, Catal?n R, Luque P, Paredes A, Navarrete I, Rello J, Rodr?guez A; H1N1 SEMICYUC Working Group.
(1)Critical Care Department. Joan XXIII University Hospital, University Rovira i Virgili, IISPV, CIBER Enfermedades Respiratorias (CIBERes) Tarragona, Spain.
Abstract
ABSTRACT
BACKGROUND: Little is known about the impact of Community-Acquired Respiratory Co-infection in patients with Pandemic 2009 Influenza A (H1N1) Virus Infection.
METHODS: Prospective, observational, multi-center study conducted in 148 Spanish ICU.
RESULTS: Severe respiratory syndrome was present in 645 ICU patients. Co-infection occurred in 113 (17.5%) of patients. S. pneumoniae 62 (54.8%) was identified as the most prevalent bacteria. Patients with co-infection were older (47.5 +/- 15.7 vs. 43.8 +/- 14.2 years, P < 0.05), presented a higher APACHE II score (16.1 +/- 7.3 vs. 13.3+/- 7.1, P < 0.05) and SOFA score (7.0 +/- 3.8 vs. 5.2+/- 3.5, P < 0.05) at ICU admission. No differences in comorbidities were observed. Patients who had co-infection required vasopressors (63.7% vs.39.3%, p<0.05) and invasive mechanical ventilation (69% vs.58.5%, p<0.05) more frequently. ICU-LOS was 3 days longer in patients who had co-infection compared to patients who did not (11 (IQR ,5-23) vs 8(IQR 4-17), p = 0.01). Co-infection 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 co-infection and ICU-mortality.
CONCLUSIONS: During 2009 pandemics, the role of bacterial coinfection in bringing patients to the ICU has not been clear, being S. pneumoniae the most common pathogen. This work clearly evidences that bacterial coinfection is a contributor for increased consumption of health resources in critical patients infected with the virus, but is the virus the cause of critical illness in the vast majority of the cases.
PMID: 20930007 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/20930007