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Published in: Intensive Care Medicine 1/2017

01-01-2017 | Original

Increased incidence of co-infection in critically ill patients with influenza

Authors: Ignacio Martin-Loeches, Marcus J Schultz, Jean-Louis Vincent, Francisco Alvarez-Lerma, Lieuwe D. Bos, Jordi Solé-Violán, Antoni Torres, Alejandro Rodriguez

Published in: Intensive Care Medicine | Issue 1/2017

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Abstract

Background

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).

Methods

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.

Results

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).

Conclusions

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.
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Metadata
Title
Increased incidence of co-infection in critically ill patients with influenza
Authors
Ignacio Martin-Loeches
Marcus J Schultz
Jean-Louis Vincent
Francisco Alvarez-Lerma
Lieuwe D. Bos
Jordi Solé-Violán
Antoni Torres
Alejandro Rodriguez
Publication date
01-01-2017
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 1/2017
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-016-4578-y

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