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Original Research: CRITICAL CARE |

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

Ignacio Martín-Loeches, MD, PhD; Ana Sanchez-Corral, MD; Emili Diaz, MD, PhD; Rosa María Granada, MD; Rafael Zaragoza, MD; Christian Villavicencio, MD; Antonio Albaya, MD; Enrique Cerdá, MD; Rosa María Catalán, MD; Pilar Luque, MD; Amparo Paredes, MD; Inés Navarrete, MD; Jordi Rello, MD, PhD; Alejandro Rodríguez, MD, PhD; H1N1 SEMICYUC Working Group
Author and Funding Information

From the Critical Care Department (Drs Martín-Loeches, Diaz, Villavicencio, and Rodríguez), 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 Cerdá), Hospital Infanta Cristina, Madrid; the Critical Care Department (Dr Catalán), 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 Alcorcón, 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 Autónoma de Barcelona, Barcelona, Spain.

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


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).


© 2011 American College of Chest Physicians


Chest. 2011;139(3):555-562. doi:10.1378/chest.10-1396
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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. Streptococcuspneumoniae (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.

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