Infectious Disease

Hospitalized patients with the flu, CAP, often have a bacterial co-infection

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Bartley does not report any relevant financial information. In the study you will find all relevant financial information from all other authors.

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Around 10% of patients hospitalized for influenza and community-acquired pneumonia also had bacterial co-infection, which, according to a large US study, had worse outcomes and higher costs.

Patricia S. Bartley

“Little is known about the microbiology of bacterial co-infection in seasonal influenza pneumonia.” Patricia S. Bartley, MD, MSc, an infectious disease specialist at the Cleveland Clinic, said Healio. “We wanted to fill this gap in order to facilitate the empirical selection of antibiotics for patients with influenza pneumonia.”

According to Bartley, limited information for patients with pandemic influenza suggests that “influenza pneumonia leads to bacterial colonization, an increased risk of bacterial co-infection, and poor outcomes, including increased mortality.”

“We also wanted to provide this microbiological data that supports the latest Infectious Diseases Society of America guidelines for community-acquired pneumonia (CAP) and the CDC guidelines for influenza management. Both recommend that patients with influenza pneumonia receive empirical treatment with antibiotics that target the common pathogens in community-acquired pneumonia, ”said Bartley.

For the study, Bartley and colleagues used data from adults admitted with CAP and tested for influenza in 179 US hospitals between 2010 and 2015 to assess the relationships between co-infection and inpatient mortality, ICU admission, length of stay, and cost.

Of 38,665 patients hospitalized and tested for influenza with CAP and enrolled in the study, 4,313 (11.2%) were positive for influenza. Bartley and colleagues found that patients with influenza were less likely to have a positive culture in the first three days of hospital than patients without (10.3% versus 16.2%; P <0.001) and cultures were more likely to contain Staphylococcus aureus (34 , 2% versus 28.2%; P = 0.007) and less likely Streptococcus pneumoniae (24.9% versus 31%; P = 0.008).

The study showed that 42.8% of S. aureus isolates from patients with influenza were methicillin-resistant compared with 53.2% from patients without influenza (P = 0.01).

In addition, the researchers found that bacterial co-infection was associated with an increased likelihood of hospital mortality (adjusted OR = 3; 95% CI, 2.17-4.16), a late transfer in the intensive care unit (aOR = 2.83; 95% CI, 1.98-4.04) and an increased probability was associated with higher costs (risk-adjusted mean multiplier = 1.77; 95% CI, 1.59-1.96).

According to Bartley, the results can be used as a guide for empirical antibiotic decisions in patients with influenza pneumonia and suspected co-infection.

“Specifically, they support an antibiotic regimen that does not include coverage for MRSA, as recommended in the latest American Thoracic Society / IDSA CAP guidelines, and reserve MRSA coverage for patients with known risk factors for MRSA,” she said. “After a patient had been in the hospital for 4 days, we found no difference in bacterial pathogens between patients with influenza pneumonia and those without influenza. If a patient with influenza begins to worsen after 3 days, doctors should initiate treatment for hospital-acquired pneumonia, including coverage for MRSA and Pseudomonas. “

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