Bloodstream Infections in Children Hospitalized for Influenza, the Canadian Immunization Monitoring Program Active (IMPACT)

Abstract

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.