Table 1 Bacterial co-infection among the fatal cases of A(H1N1)2009pdm (n = 11)
Author (year) Study location/ period | Study type | Study population | N (%) autopsied | N (%) hospitalised prior to death | Requirement for | Antiviralsa n/N (%) any n/N (%) 48 h | Antibioticsb n/N (%) pre n/N (%) on n/N (%) during admission | Positive bacterial growth | N (%) bacterial pneumonia | N (%) with S.pneumoniae Site of isolation | |
|---|---|---|---|---|---|---|---|---|---|---|---|
ICU | Mechanical Ventilation | ||||||||||
Fajardo-Dolci (2009) [14] Mexico 16/3/09–16/5/09 | Medical record review | N = 100 Consecutive notified hospitalized fatal cases | 0/100 (0) | 100/100 (100) | NR | 84/100 (84.0) | 56/100 (56) NR | 94/100 (94) | 2/100 (2%) (Site not mentioned) | 77/82 (94.0) CXR suggestive of pneumonia. | NR |
Lee (2010) [1] USA 4/09–7/09 | Enhanced surveillance/confirmed cases in New York City. | N = 47 | 31/47 (66) | 47/47 (100.0) | All 28 cases who died after > 24 in hospital were admitted to ICU | 25/47 (80.6) | 32/47 (68.0) NR | NR | NR | 13/47 (27.6) By immunohistochemical analysis or PCR 21/28 with abnormal CXR and multilobar infiltrates. | 8/47 (17.0) Lung/airway tissue By immunohistochemical analysis or PCR |
Lucas (2010) [19] UK 4/09–1/10 | Case series. 15% of reported H1N1 deaths | N = 68 Autopsied fatal cases | 68/68 (100) | 68/68 (100) | NR | NR | NR | NR | 20/68 (29.4) (Culture of lung/ blood) | 28/68 (41.2) - Autopsy findings - Culture and histopathology | 7/68 (10.3) (6 confirmed and 1 possible through histology) isolation site Lung/ and or blood |
Gill (2010) [2] USA 5/09–7/09 | Case series. Autopsy request New York City (NYC) Office of chief medical examiner (n = 32), family requests (n = 10), deaths outside of NYC (n = 2) | N = 34 Autopsied fatal cases | 34/34 (100) | 21/34 (61.8) | NR | 12/21 (57.1) | NR | NR | 10/30 (33.3) Positive bacteria by culture, immunohistochemistry, and/or PCR | 18/33 (54.4) have evidence of bacterial co-infection by tissue Gram stain. | 6/30 (20) Positive for streptococcus by culture, immunohistochemistry, and/or PCR 16/33 (55) have evidence of bacterial co-infection by tissue Gram stain morphologically compatible with streptococcus. |
CDC (2009) [15] USA 4/09–8/09 | Multicenter case series. 100% of reported deaths | N = 36 Pediatric (< 18 yrs). Hospitalized fatal cases | NR | 28/33 (84.8) | 24/36 (66.7) | NR | 19/30 (63.3) Status unknown for 6 cases 4/30 (13%) | NR | NR | 10/23 (43.5) Based on culture and pathology results | 3/23 (13) from multiple sites in px (BC, lung tissue, pleural fluid, CSF) |
Shieh (2010) [18] USA 5/09–10/09 | Notified fatal case series/US CDC | N = 100 Autopsied fatal cases | 100/100 (100) | 58/87 (66.7) | NR | 42/57 (73.7) | 44/67 (65.7) NR | NR | NR | 29/100 (29) Bacterial co-infection positive through PCR and histopathology on lung tissue 38/64 (59) radiological diagnosis of pneumonia | 10/100 (10) Lung tissue through PCR |
CDC (2009) [16] USA 5/09–8/09 | Case series (US CDC), multiple (8) states | N = 77 Autopsied fatal cases | 77/77 (100) | 8/18 (44.0) | NR | 7/7 (100.0) | NR | 7/9 (77.8) | NR | 22/77 (28.6) Histopathology and positive PCR for bacteria | 10/77 (positive through immunohistochemical assays) respiratory tissue |
Mauad (2010) [17] Brazil 7/09–8/09 | Case series | N = 21 Autopsied fatal cases | 21 (100) | 21 (100.0) | 16/21 (76.2) | 21/21 (100.0) | 16/21 (76.2) NR | 13/21 (61.9) | 3/9 (33.3) | 8/21 (38.1) | 6/21 (28.6) diagnosed by culture of bronchial aspirate and/or tissue PCR |
Kim (2011) [20] Korea 8/09–11/09 | Active mortality inpatient surveillance | N = 115 Notified hospitalized fatal cases | 0/115 (0) | 115/115 (100%) | 63/115 (54.8) | NR | 100/115 (87%) 41/115 (35.6) | NR | 34/115 (29.6) positive on blood or sputum culture | 34/115 (29.6) positive on blood or sputum culture 97/113 (85.8) CXR suggestive of pneumonia | 3/115 (2.6) bronchoalveolar lavage (BAL) Streptococcus was also isolated from blood of one case |
Nakajima (2012) [21] Japan 8/09–2/10 | Multicenter (15), case series, Tokyo. | N = 20 Autopsied fatal cases | 20/20 (100) | 11/20 (55.0) | NR | 7/20 (35.0) | 14/20 (70%) 13/20 (65%) | 10/20 (50%) | 4/11 (36.4%) | 5/20 (25%) Based on histopathological finding (bacteria isolated in 4 of 5) | 2/10 (20%) sputum, blood cultures; lung tissue |
Tamme (2012) [22] Estonia 10/09–5/10 | Case series | N = 21 Autopsied fatal cases | 19/21 (90) | 17/21 (81.0) | 15/21(71.4) | NR | 3/21 (14.3) 1/21 (4.8%) | 16/21 (76.2) | 8/21 (38.1) (Culture performed on 14 samples) | 9/21 (42.8) Culture or Autopsy findings consistent with sepsis or bacterial infection | 2/21 (9.5) Blood and/or lung tissue culture |