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Highlights • 22.5% of adult patients with H1N1 developed bacterial co-infection. • Staphylococcus aureus was the most common cause of co-infection. • Bacterial and viral co-infections were associated with death in bivariate. • Patients with a bacterial co-infection had greater use of resources., Background Influenza acts synergistically with bacterial co-pathogens. Few studies have described co-infection in a large cohort with severe influenza infection. Objectives To describe the spectrum and clinical impact of co-infections. Study design Retrospective cohort study of patients with severe influenza infection from September 2013 through April 2014 in intensive care units at 33 U.S. hospitals comparing characteristics of cases with and without co-infection in bivariable and multivariable analysis. Results Of 507 adult and pediatric patients, 114 (22.5%) developed bacterial co-infection and 23 (4.5%) developed viral co-infection. Staphylococcus aureus was the most common cause of co-infection, isolated in 47 (9.3%) patients. Characteristics independently associated with the development of bacterial co-infection of adult patients in a logistic regression model included the absence of cardiovascular disease (OR 0.41 [0.23–0.73], p = 0.003), leukocytosis (>11 K/μl, OR 3.7 [2.2–6.2], p

Author(s): Shah, Nirav S; Greenberg, Jared A; McNulty, Moira C; Gregg, Kevin S; Riddell, James; Mangino, Julie E; Weber, Devin M; Hebert, Courtney L; Marzec, Natalie S; Barron, Michelle A; Chaparro-Rojas, Fredy; Restrepo, Alejandro; Hemmige, Vagish; Prasidthrathsint, Kunatum; Cobb, Sandra; Herwaldt, Loreen; Raabe, Vanessa; Cannavino, Christopher R; Hines, Andrea Green; Bares, Sara H; Antiporta, Philip B; Scardina, Tonya; Patel, Ursula; Reid, Gail; Mohazabnia, Parvin; Kachhdiya, Suresh; Le, Binh-Minh; Park, Connie J; Ostrowsky, Belinda; Robicsek, Ari; Smith, Becky A; Schied, Jeanmarie; Bhatti, Micah M; Mayer, Stockton; Sikka, Monica; Murphy-Aguilu, Ivette; Patwari, Priti; Abeles, Shira R; Torriani, Francesca J; Abbas, Zainab; Toya, Sophie; Doktor, Katherine; Chakrabarti, Anindita; Doblecki-Lewis, Susanne; Looney, David J; David, Michael Z | Abstract: BackgroundInfluenza A (H1N1) pdm09 became the predominant circulating strain in the United States during the 2013-2014 influenza season. Little is known about the epidemiology of severe influenza during this season.MethodsA retrospective cohort study of severely ill patients with influenza infection in intensive care units in 33 US hospitals from September 1, 2013, through April 1, 2014, was conducted to determine risk factors for mortality present on intensive care unit admission and to describe patient characteristics, spectrum of disease, management, and outcomes.ResultsA total of 444 adults and 63 children were admitted to an intensive care unit in a study hospital; 93 adults (20.9%) and 4 children (6.3%) died. By logistic regression analysis, the following factors were significantly associated with mortality among adult patients: older age (g65 years, odds ratio, 3.1 [95% CI, 1.4-6.9], P=.006 and 50-64 years, 2.5 [1.3-4.9], P=.007; reference age 18-49 years), male sex (1.9 [1.1-3.3], P=.031), history of malignant tumor with chemotherapy administered within the prior 6 months (12.1 [3.9-37.0], Pl.001), and a higher Sequential Organ Failure Assessment score (for each increase by 1 in score, 1.3 [1.2-1.4], Pl.001).ConclusionRisk factors for death among US patients with severe influenza during the 2013-2014 season, when influenza A (H1N1) pdm09 was the predominant circulating strain type, shifted in the first postpandemic season in which it predominated toward those of a more typical epidemic influenza season.