tetano
Editor, Senior Moderator
Intensive Care Med. 2016 Oct 5. [Epub ahead of print]
[h=1]Increased incidence of co-infection in critically ill patients with influenza.[/h] Martin-Loeches I[SUP]1,[/SUP][SUP]2[/SUP], J Schultz M[SUP]3[/SUP], Vincent JL[SUP]4[/SUP], Alvarez-Lerma F[SUP]5[/SUP], Bos LD[SUP]3[/SUP], Sol?-Viol?n J[SUP]6[/SUP], Torres A[SUP]7[/SUP], Rodriguez A[SUP]8,[/SUP][SUP]9[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] Co-infection is frequently seen in critically ill patients with influenza, although the exact rate is unknown. We determined the rate of co-infection, the risk factors and the outcomes associated with co-infection in critically ill patients with influenza over a 7-year period in 148 Spanish intensive care units (ICUs).
[h=4]METHODS:[/h] This was a prospective, observational, multicentre study. Influenza was diagnosed using the polymerase chain reaction. Co-infection had to be confirmed using standard bacteriological tests. The primary endpoint of this analysis was the presence of community-acquired co-infection, with secondary endpoints including ICU, 28-day and hospital mortality.
[h=4]RESULTS:[/h] Of 2901 ICU patients diagnosed with influenza, 482 (16.6 %) had a co-infection. The proportion of cases of co-infection increased from 11.4 % (110/968) in 2009 to 23.4 % (80/342) in 2015 (P < 0.001). Compared with patients without co-infection, patients with co-infection were older [adjusted odds ratio (aOR) 1.1, 95 % confidence interval 1.1-1.2; P < 0.001] and were more frequently immunosuppressed due to existing HIV infection (aOR 2.6 [1.5-4.5]; P < 0.001) or preceding medication (aOR 1.4 [1.1-1.9]; P = 0.03). Co-infection was an independent risk factor for ICU mortality (aOR 1.4 [1.1-1.8]; P < 0.02), 28-day mortality (aOR 1.3 [1.1-1.7]; P = 0.04) and hospital mortality (aOR 1.9 [1.5-2.5]; P < 0.001).
[h=4]CONCLUSIONS:[/h] Co-infection in critically ill patients with influenza has increased in recent years. In this Spanish cohort, age and immunosuppression were risk factors for co-infection, and co-infection was an independent risk factor for ICU, 28-day and hospital mortality.
[h=4]KEYWORDS:[/h] Co-infection; Influenza; Intensive care; Outcome; Risk factors
PMID: 27709265 DOI: 10.1007/s00134-016-4578-y
[PubMed - as supplied by publisher]
[h=1]Increased incidence of co-infection in critically ill patients with influenza.[/h] Martin-Loeches I[SUP]1,[/SUP][SUP]2[/SUP], J Schultz M[SUP]3[/SUP], Vincent JL[SUP]4[/SUP], Alvarez-Lerma F[SUP]5[/SUP], Bos LD[SUP]3[/SUP], Sol?-Viol?n J[SUP]6[/SUP], Torres A[SUP]7[/SUP], Rodriguez A[SUP]8,[/SUP][SUP]9[/SUP].
[h=3]Author information[/h]
- [SUP]1[/SUP]Multidisciplinary Intensive Care Research Organization (MICRO), Wellcome Trust-HRB Clinical Research, Department of Clinical Medicine, Trinity Centre for Health Sciences, St James's University Hospital, Dublin, Ireland. drmartinloeches@gmail.com.
- [SUP]2[/SUP]CIBERes, Madrid, Spain. drmartinloeches@gmail.com.
- [SUP]3[/SUP]Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands.
- [SUP]4[/SUP]Department of Intensive Care, Erasme Hospital, Universit? libre de Bruxelles, Brussels, Belgium.
- [SUP]5[/SUP]Service of Intensive Care Medicine, Parc de Salut Mar, Universitat Autonoma de Barcelona, Barcelona, Spain.
- [SUP]6[/SUP]Intensive Care Unit, Hospital Universitario Dr. Negr?n, CIBERES, Las Palmas de Gran Canaria, Spain.
- [SUP]7[/SUP]Hospital Clinic Barcelona, Universidad Barcelona, CIBERES, Barcelona, Spain.
- [SUP]8[/SUP]Centro de Investigaci?n Biom?dica En Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
- [SUP]9[/SUP]Critical Care Department, Institut d'Investigaci? Sanit?ria Pere Virgili (IISPV), Joan XXIII University Hospital, Universitat Rovira i Virgili, Tarragona, Spain.
[h=3]Abstract[/h] [h=4]BACKGROUND:[/h] Co-infection is frequently seen in critically ill patients with influenza, although the exact rate is unknown. We determined the rate of co-infection, the risk factors and the outcomes associated with co-infection in critically ill patients with influenza over a 7-year period in 148 Spanish intensive care units (ICUs).
[h=4]METHODS:[/h] This was a prospective, observational, multicentre study. Influenza was diagnosed using the polymerase chain reaction. Co-infection had to be confirmed using standard bacteriological tests. The primary endpoint of this analysis was the presence of community-acquired co-infection, with secondary endpoints including ICU, 28-day and hospital mortality.
[h=4]RESULTS:[/h] Of 2901 ICU patients diagnosed with influenza, 482 (16.6 %) had a co-infection. The proportion of cases of co-infection increased from 11.4 % (110/968) in 2009 to 23.4 % (80/342) in 2015 (P < 0.001). Compared with patients without co-infection, patients with co-infection were older [adjusted odds ratio (aOR) 1.1, 95 % confidence interval 1.1-1.2; P < 0.001] and were more frequently immunosuppressed due to existing HIV infection (aOR 2.6 [1.5-4.5]; P < 0.001) or preceding medication (aOR 1.4 [1.1-1.9]; P = 0.03). Co-infection was an independent risk factor for ICU mortality (aOR 1.4 [1.1-1.8]; P < 0.02), 28-day mortality (aOR 1.3 [1.1-1.7]; P = 0.04) and hospital mortality (aOR 1.9 [1.5-2.5]; P < 0.001).
[h=4]CONCLUSIONS:[/h] Co-infection in critically ill patients with influenza has increased in recent years. In this Spanish cohort, age and immunosuppression were risk factors for co-infection, and co-infection was an independent risk factor for ICU, 28-day and hospital mortality.
[h=4]KEYWORDS:[/h] Co-infection; Influenza; Intensive care; Outcome; Risk factors
PMID: 27709265 DOI: 10.1007/s00134-016-4578-y
[PubMed - as supplied by publisher]