Influenza and Bacterial Coinfection in Adults With Community-Acquired Pneumonia Admitted to Conventional Wards: Risk Factors, Clinical Features, and Outcomes

Author:

Abelenda-Alonso Gabriela123,Rombauts Alexander123,Gudiol Carlota1234,Meije Yolanda5,Ortega Lucía5,Clemente Mercedes5,Ardanuy Carmen6ORCID,Niubó Jordi6,Carratalà Jordi1234

Affiliation:

1. Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain

2. Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain

3. University of Barcelona, Barcelona, Spain

4. Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain

5. Department Internal Medicine, Infectious Diseases Unit, Hospital de Barcelona, Societat, Cooperativa d’Installacions Assistencials Sanitàries (SCIAS), Barcelona, Spain

6. Department Clinical Microbiology, Hospital Universitari de Bellvitge, Barcelona, Spain

Abstract

Abstract Background Relevance of viral and bacterial coinfection (VBC) in non-intensive care unit (ICU) hospitalized adults with community-acquired pneumonia (CAP) is poorly characterized. We aim to determine risk factors, features, and outcomes of VBC-CAP in this setting. Methods This is a prospective cohort of adults admitted to conventional wards with CAP. Patients were divided into VBC-CAP, viral CAP (V-CAP), and bacterial CAP (B-CAP) groups. Independent risk and prognostic factors for VBC-CAP were identified. Results We documented 1123 episodes: 57 (5.1%) VBC-CAP, 98 (8.7%) V-CAP, and 968 (86.1%) B-CAP. Patients with VBC-CAP were younger than those with B-CAP (54 vs 71 years; P < .001). Chronic respiratory disease was more frequent in patients with VBC-CAP than in those with V-CAP (26.3% vs 14.3%%; P = .001). Among those with influenza (n = 153), the VBC-CAP group received empirical oseltamivir less often (56.1% vs 73.5%; P < .001). Patients with VBC-CAP also had more respiratory distress (21.1% VBC-CAP; 19.4% V-CAP, and 9.8% B-CAP; P < .001) and required ICU admission more often (31.6% VBC-CAP, 31.6% V-CAP, and 12.8% B-CAP; P < .001). The 30-day case-fatality rate was 3.5% in the VBC-CAP group, 3.1% in the V-CAP group, and 6.3% in the B-CAP group (P = .232). Furthermore, VBC-CAP was associated with severity criteria (odds ratio [OR], 5.219; P < .001) and lack of empirical oseltamivir therapy in influenza cases (OR, 0.401; P < .043). Conclusions Viral and bacterial coinfection-CAP involved younger patients with comorbidities and with poor influenza vaccination rate. Patients with VBC-CAP presented more respiratory complications and more often required ICU admission. Nevertheless, 30-day mortality rate was low and related either to severity criteria or to delayed initiation of oseltamivir therapy.

Funder

La Marató de TV3

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Oncology

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