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Published on: April 14, 2011
Influenza coinfection and outcomes in children with complicated pneumonia
Derek J Williams1, Matthew Hall, Thomas V Brogan
1Division of Pediatric Hospital Medicine, Vanderbilt University School of Medicine and the Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee, USA.
Insights
Influenza coinfection in children with complicated pneumonia leads to more severe outcomes, including increased intensive care unit admissions and longer hospital stays. This study highlights the significant impact of influenza coinfection on pediatric pneumonia severity.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Respiratory medicine
Background:
- Complicated pneumonia in children often requires invasive procedures like pleural drainage.
- The impact of concurrent influenza infection on the severity of pediatric complicated pneumonia is not well-defined.
Purpose of the Study:
- To investigate the association between influenza coinfection and clinical outcomes in children hospitalized with complicated pneumonia requiring pleural drainage.
Main Methods:
- Retrospective cohort study involving 9680 children with complicated pneumonia from 40 children's hospitals (2004-2009).
- Identified 3382 children who underwent pleural fluid drainage, with 105 (3.1%) having influenza coinfection.
- Analyzed outcomes including ICU admission, mechanical ventilation, vasoactive infusions, blood transfusions, mortality, readmission, length of stay, and hospitalization costs.
Main Results:
- Influenza coinfection was associated with significantly higher odds of ICU admission, mechanical ventilation, vasoactive infusions, and blood product transfusions.
- Coinfected children experienced longer hospital stays and higher hospitalization costs.
- While readmission rates were lower, there was a trend towards increased mortality in coinfected children, particularly those with Staphylococcus aureus coinfection.
Conclusions:
- Influenza coinfection is present in 3.1% of pediatric complicated pneumonia cases requiring pleural drainage.
- Clinical outcomes are demonstrably more severe for children with complicated pneumonia when coinfected with influenza.
Objective:
To determine the impact of influenza coinfection on outcomes for children with complicated pneumonia.
Design:
Retrospective cohort study.
Setting:
Forty children's hospitals that contribute data to the Pediatric Health Information System.
Participants:
Children discharged from participating hospitals between January 1, 2004, and June 30, 2009, with complicated pneumonia requiring a pleural drainage procedure.
Main Exposure:
Influenza coinfection.
Main Outcome Measures:
Intensive care unit admission, receipt of mechanical ventilation, receipt of vasoactive infusions, receipt of blood product transfusions, in-hospital death, readmission within 14 days of hospital discharge, hospital length of stay, and cost of hospitalization.
Results:
Overall, 3382 of 9680 children with complicated pneumonia underwent pleural fluid drainage; 105 patients (3.1%) undergoing pleural drainage had influenza coinfection. A bacterial pathogen was identified in 1201 cases (35.5%); the most commonly identified bacteria were Staphylococcus aureus in children with influenza coinfection (22.9% of cases) and Streptococcus pneumoniae in children without coinfection (20.0% of cases). In multivariable analysis, influenza coinfection was associated with higher odds of intensive care unit admission and receipt of mechanical ventilation, vasoactive infusions, and blood product transfusions as well as higher costs and a longer hospital stay. Children with influenza coinfection were less likely to require readmission, although there was a trend toward higher odds of mortality for patients with coinfection. In a subanalysis stratified by bacteria, outcomes remained worse for coinfected children in the subgroups of children with S aureus and with no specified bacteria.
Conclusions:
Influenza coinfection occurred in 3.1% of children with complicated pneumonia. Clinical outcomes for children with complicated pneumonia and influenza coinfection were more severe than for children without documented influenza coinfection.
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