Bloodstream Infections in Children Hospitalized for Influenza, the Canadian Immunization Monitoring Program Active
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Rapid Molecular Detection and Differentiation of Influenza Viruses A and B
Published on: January 30, 2017
Jacqueline Modler1, Shaun K Morris2, Julie A Bettinger3
1From the Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montréal, Quebec, Canada.
Insights
Bloodstream infections (BSI) complicate pediatric influenza hospitalizations in 0.9% of cases. BSIs significantly increase the risk of severe outcomes, including death, necessitating heightened medical care.
Area of Science:
- Pediatric Infectious Diseases
- Critical Care Medicine
- Epidemiology
Background:
- Influenza hospitalizations in children can lead to serious complications.
- Bloodstream infections (BSI) are a significant concern in pediatric respiratory illnesses.
Purpose of the Study:
- To determine the incidence of BSI in children hospitalized with influenza.
- To describe the clinical characteristics of these infections.
- To identify risk factors for BSI in pediatric influenza patients.
Main Methods:
- Active surveillance of laboratory-confirmed influenza hospitalizations in children (≤16 years) across 12 Canadian hospitals (2010-2021).
- Multivariable logistic regression was used to identify factors associated with BSI.
- Analysis included clinical course and outcomes, including mortality.
Main Results:
- BSIs occurred in 0.9% (87/9179) of pediatric influenza hospitalizations.
- Common pathogens included Streptococcus pyogenes, Staphylococcus aureus, and Streptococcus pneumoniae.
- Risk factors for BSI included cancer, non-BSI bacterial infections, pneumonia, ICU admission, mechanical ventilation, and longer hospital stays.
- Children with chronic lung disorders had a lower likelihood of BSI.
Conclusions:
- While infrequent, BSIs significantly increase the severity of pediatric influenza, correlating with ICU admission, mechanical ventilation, and prolonged hospitalization.
- BSI is associated with a substantially higher risk of in-hospital mortality among children hospitalized with influenza.
- These findings underscore the importance of vigilant BSI monitoring and management in pediatric influenza cases.
Background:
We aimed to estimate the proportion of children hospitalized for influenza whose illness was complicated by bloodstream infection, describe their clinical course, and identify the factors associated with bloodstream infection.
Methods:
We performed active surveillance for laboratory-confirmed influenza hospitalizations among children ≤16 years old at the 12 Canadian Immunization Monitoring Program Active hospitals, from the 2010-2011 to 2020-2021 influenza seasons. Factors associated with bloodstream infection were identified using multivariable logistic regression analyses.
Results:
Among 9179 laboratory-confirmed influenza hospital admissions, bloodstream infection occurred in 87 children (0.9%). Streptococcus pyogenes (22%), Staphylococcus aureus (18%) and Streptococcus pneumoniae (17%) were the most common bloodstream infection pathogens identified. Children with cancer [adjusted odds ratio (aOR): 2.78; 95% confidence interval (CI): 1.23-5.63], a laboratory-confirmed nonbloodstream bacterial infection (aOR: 14.1; 95% CI: 8.04-24.3) or radiographically-confirmed pneumonia (aOR: 1.87; 95% CI: 1.17-2.97) were more likely to experience a bloodstream infection, whereas children with chronic lung disorders were less likely (aOR: 0.41; 95% CI: 0.19-0.80). Disease severity markers such as intensive care unit admission (aOR: 2.11; 95% CI: 1.27-3.46), mechanical ventilation (aOR: 2.84; 95% CI: 1.63-4.80) and longer hospital length of stay (aOR: 1.02; 95% CI: 1.01-1.03) were associated with bloodstream infection. Bloodstream infection also increased the odds of death (aOR: 13.0; 95% CI: 4.84-29.1) after adjustment for age, influenza virus type and the presence of any at-risk chronic condition.
Conclusions:
Bloodstream infections, although infrequent, are associated with intensive care unit admission, mechanical ventilation, increased hospital length of stay and in-hospital mortality, thus requiring increased levels of care among pediatric influenza hospitalizations.
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