PMID- 23392627
OWN - NLM
STAT- MEDLINE
DCOM- 20130930
LR  - 20220318
IS  - 1931-3543 (Electronic)
IS  - 0012-3692 (Linking)
VI  - 144
IP  - 1
DP  - 2013 Jul
TI  - The occurrence and impact of bacterial organisms complicating critical care 
      illness associated with 2009 influenza A(H1N1) infection.
PG  - 39-47
LID - S0012-3692(13)60448-1 [pii]
LID - 10.1378/chest.12-1861 [doi]
AB  - BACKGROUND: Although secondary infections are recognized as a cause of morbidity 
      and mortality in seasonal influenza, their frequency, characteristics, and 
      associated clinical outcomes in 2009 influenza A(H1N1) (A[H1N1])-related critical 
      illness are unknown. METHODS: In a prospective cohort of adult patients admitted 
      to Canadian ICUs with influenza A(H1N1) infection, the frequency and associated 
      clinical outcomes of prevalent (culture taken within 72 h of ICU admission) and 
      ICU-acquired (culture taken after 72 h from ICU admission) positive bacterial 
      cultures were determined. RESULTS: Among 681 patients, the mean age was 47.9 
      years (SD, 15.1), APACHE (Acute Physiology and Chronic Health Examination) II 
      score was 21.0 (9.9), and 573 patients (84.0%) were invasively mechanically 
      ventilated. Positive cultures were obtained in 259 patients (38.0%): 77 (29.7%) 
      had prevalent, 115 (44.4%) had ICU-acquired, and 40 (15.4%) had both; culture 
      date was unavailable in 27 (10.4%). The most common bacterial organisms isolated 
      were coagulase-negative staphylococci, Staphylococcus aureus, Pseudomonas 
      species, and Streptococcus pneumoniae. Antibiotics were prescribed in 661 
      (97.1%), with 3.8 (1.9) prescriptions per patient. Patients with any positive 
      culture had longer days of mechanical ventilation (mean [SD], 15.2 [10.7] vs 10.7 
      [9.0]; P<.0001), ICU stay (median [interquartile range (IQR)], 18.2 [12.5] days 
      vs 10.8 [9.0] days, P<.0001), and hospitalization (median [IQR], 30.7 [20.7] days 
      vs 19.2 [17.4] days, P<.0001) and a trend toward increased hospital mortality 
      (25.1% vs 19.9%, P=.15). Patients with ICU-acquired positive cultures had worse 
      outcomes compared with those with positive prevalent cultures or who were 
      culture-negative. CONCLUSION: Culture-based evidence of secondary infections 
      commonly complicates A(H1N1)-related critical illness and is associated with 
      worse clinical outcomes despite nearly ubiquitous antibiotic administration.
FAU - Muscedere, John
AU  - Muscedere J
AD  - Department of Medicine, Queen's University, Kingston, ON. Electronic address: 
      muscedej@kgh.kari.net.
FAU - Ofner, Marianna
AU  - Ofner M
AD  - Public Health Agency of Canada, Ottawa, ON and Winnipeg, MB.
FAU - Kumar, Anand
AU  - Kumar A
AD  - Winnipeg Health Sciences Centre and St. Boniface Hospital, University of 
      Manitoba, Winnipeg, MB.
FAU - Long, Jennifer
AU  - Long J
AD  - Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON.
FAU - Lamontagne, Francois
AU  - Lamontagne F
AD  - Clinical Research Centre Etienne Le Bel and Department of Medicine, Universite de 
      Sherbrooke, Sherbrooke, QC.
FAU - Cook, Deborah
AU  - Cook D
AD  - Faculty of Health Sciences, McMaster University, Hamilton, ON.
FAU - McGeer, Allison
AU  - McGeer A
AD  - Mt. Sinai Hospital, University of Toronto, Toronto, ON.
FAU - Chant, Clarence
AU  - Chant C
AD  - St. Michael's Hospital, Toronto, ON.
FAU - Marshall, John
AU  - Marshall J
AD  - St. Michael's Hospital, Toronto, ON.
FAU - Jouvet, Philippe
AU  - Jouvet P
AD  - Sainte-Justine Research Center, Universite de Montreal, QC, Canada.
FAU - Fowler, Robert
AU  - Fowler R
AD  - Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON.
CN  - ICU-FLU Group and the Canadian Critical Care Trials Group
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
SB  - IM
MH  - Adult
MH  - Canada
MH  - Cohort Studies
MH  - Critical Illness/*epidemiology
MH  - Female
MH  - Humans
MH  - Incidence
MH  - *Influenza A Virus, H1N1 Subtype
MH  - Influenza, Human/*complications
MH  - Intensive Care Units
MH  - Length of Stay
MH  - Male
MH  - Middle Aged
MH  - Prognosis
MH  - Prospective Studies
MH  - Pseudomonas Infections/diagnosis/*epidemiology
MH  - Respiration, Artificial
MH  - Staphylococcal Infections/diagnosis/*epidemiology
MH  - Streptococcal Infections/diagnosis/*epidemiology
EDAT- 2013/02/09 06:00
MHDA- 2013/10/01 06:00
CRDT- 2013/02/09 06:00
PHST- 2013/02/09 06:00 [entrez]
PHST- 2013/02/09 06:00 [pubmed]
PHST- 2013/10/01 06:00 [medline]
AID - S0012-3692(13)60448-1 [pii]
AID - 10.1378/chest.12-1861 [doi]
PST - ppublish
SO  - Chest. 2013 Jul;144(1):39-47. doi: 10.1378/chest.12-1861.