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Bacterial coinfection in influenza: a grand rounds review

Daniel S Chertow1, Matthew J Memoli

  • 1Critical Care Medicine Department, Clinical Center, National Institutes of Health, 10 Center Dr, Room 2C145, Bethesda, MD 20892-1662, USA. chertowd@cc.nih.gov

JAMA
|January 17, 2013
PubMed

Insights

Bacterial coinfection is a significant threat during influenza pandemics, increasing the risk of death. Early diagnosis and treatment are crucial for managing these complex infections.

Area of Science:

  • Infectious Diseases
  • Microbiology
  • Critical Care Medicine

Background:

  • Bacterial coinfection historically complicates influenza deaths, notably in the 1918 pandemic.
  • Influenza and pneumonia cause over 65,000 annual deaths in the US.
  • Bacterial coinfection affects up to 34% of severe pandemic influenza A(H1N1) cases.

Observation:

  • In a study of 683 ICU patients with pandemic influenza A(H1N1), bacterial coinfection was common.
  • Coinfection typically emerged within 6 days of initial influenza symptoms.
  • Clinical presentation of coinfection mimicked uncomplicated influenza.

Findings:

  • Bacterial coinfection was associated with a significantly increased risk of mortality.
  • Commonly isolated pathogens included Staphylococcus aureus, Streptococcus pneumoniae, and Streptococcus pyogenes.
  • Pathogenesis involves complex interactions between viral, bacterial, and host factors.

Implications:

  • Effective prevention strategies, including vaccination, are vital.
  • Prompt diagnosis and appropriate antimicrobial treatment are essential for reducing influenza-associated morbidity and mortality.
  • Further research into the complex interplay of factors driving coinfection is warranted.

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