Table 2 Bacterial co-infection among hospitalised cases of A(H1N1)2009pdm with confirmed pneumonia (n = 11)
Author and year | Study type | Study population | Case severity | Antivirals* n/N (%) any n/N (%) 48 h | Antibiotics† n/N (%) pre n/N (%) on n/N (%) during admission | Any positive bacterial growth | n/N (%) S.pneumoniae [Site of isolation] | N (%)pneumonia Method Diff/no diff | ||
|---|---|---|---|---|---|---|---|---|---|---|
ICU | Mechanical Ventilation | Deaths | ||||||||
Perez-Padilla (2009) [23] Mexico 3/09–4/09 | Single-centre case series (retrospective medical record review) of patients admitted to hospital with pneumonia and A(H1N1)pdm09 (N = 18) | N = 18 | 12/18 (66.7) | 12/18 (66.7) | 7/18 (38.9) | 14/18 (77.7) | 12/18 pre (66.7) 17/18 post (94.4) | 0/6 (0) BC 0/2 (0) BA 0/1 (0) pleural fluid 4/18 (22.2) Ventilator Associated pneumonia | 0/18 [NR] NP swab and bronchial aspirates | 18 (100) CXR No diff |
Chien (2010) [3] Taiwan 07/09–8/09 | Nation-wide notified cases (retrospective medical record review) New pulmonary infiltrates consistent with pneumonia, compatible clinical presentations. Identification of clinicalyl significant bacteria in respiratory secretion or specimens from sterile compartments was recorded as secondary bacterial infection. | N = 96 | 35/96 (36.5) | NR | 10/96 (10.4) | 96/96 (100.0) - NR | NR | 13/96 (13.2) pulmonary NFI (13.5) | 2/99 (2) [Respiratory secretions] | 13 (13.5) CXR positive |
Champunot (2010) [53] Thailand 7/09–10/09 | Single-centre case series (prospective); Community acquired, new pulmonary infiltrate (CXR) within 24 h of admission, clinical symptoms | N = 24 | 13/24 (54.2) | 11/24 (45.8) | 5/24 (8.3) | 24/24 (100%) - NR | 21/24 (87.5) - Pre = 6 | Blood culture 0/24 (0) Sputum culture 2/24(8.3) 1/24 (4.2) [urine pneumococcal Ag TOTAL 3/24 (12.5) | 1/24 (4.2) [urine pneumococcal Ag] | 24 (100.0) CXR No diff |
Cui (2010) [24] China 11/09–12/09 | Single-centre case series (retrospective medical record review) of patients admitted to a tertiary hospital with pneumonia and H1N1(N = 68) Blood cultures (BC) - Any patient with high fever > 38.0 °C for ≥3 days or repeated fever. Sputum cultures (SC) - patients with symptoms of expectoration especially with yellowish/purulent sputum. | N = 68 | 30/68 (44) | 13/68 (19.1) | 10/68 (14.7) | 68/68 (100.0) 50/68 (74%) | All received antibiotics 65/68 (95.6) received preadmission antibiotics | 5/11 (45.5) [BC] 9/29 (31.0) [SC] Total 11/29 (37.9) | 0/11 (0.0) [BC] 0/29 (0.0) [SC] | 68/68 (100.0) CXR No diff |
Cuquemelle [54] (2011) France 11/09–4/10 | Multicenter (24) case series (retrospective)/ not having received prior antibiotics (N = 103) Microbiological investigations and biomarker levels were obtained as part of the routine clinical management of patients, at the discretion of the treating physician | N = 103 | 103/103 (100) | 62/103 (60.2) | 18/103 (17.5) | NR | 0/103 (0) | 48/103 (46.6) Isolation of bacteria | 26/103 (25.2) [NS] | Infiltrates on all CXR |
Choi [55] | Definition: the presence of an infiltrate on plain chest radiograph. | N = 17 | 17/17 (100) All in acute care unit | 1/17 (5.9) | 1/17 (5.9) | 17/17 (100) | 17/17 (100) | 0/17 (0) BC 0/17 (0) SC 2/17 (11.8) urine Ag test (Legionella) 1/17 (5.9) PCR (TB) | 0/17 (100) Testing for S. pneumo | 16/17 (94.1) CXR No diff |
Viasus [56] | Pneumonia was defined as the presence of a new infiltrate on a chest radiograph plus fever (temperature 38.0-C) and/or respiratory symptoms | N = 234 (210 tested for microbiologic studies) | 53/234 (22.6) | 42/234 (17.9) | 12/234 (5.1) | 229/234 (97.9) 50/234 (22.4) | 228/234 (97.9) | 36/210 (17.1) Specimens included: culture of blood, normally sterile fluids, or sputum and/or a positive urinary antigen test | 26/210 (12.4) | All CXR positive |
Piacentini [57] | Compares H1N1 with pneumonia in ICU and community acquired | N = 10 | 10/10 (100) | 5/10 (50) | 0/10 (0) | 10/10 (100) | 10/10 (100) | 2/10 (20.0) Pre-treatment BC, SC, and urinary Ag for S. pneumoniae and Legionella sp. | 2/10 (20) Specimen type NR | CXR positive (multilobar infiltrates) all except 2 (single lobe infiltrates) |
Mulrennan [58] | New pulmonary infiltrates on imaging + clinical symptoms Compared with non-pneumonia H1N1 | N = 35 | 11/35 (31.4) | 10/35 (28.6) | 2/35 (5.7) | 35/35 (100) | NR | 5/35 (14.3) NP, lower resp. tarct | NR | 35/35 (100) CXR no diff |
Ugarte (2010) [25] Chile 5/09–9/09 Adults | Multicenter (11) case series (retrospective) / adult ICU admissions Definition: positive culture from a sterile site (e.g. blood) and/or lower respiratory tract specimens, or seroconversion to atypical bacterial pathogens. LRT specimens included expectorated sputum, ET aspirated sputum and BAL | N = 75 | 75/75 (100.0)) | 56/75 (74.7) - | 19/75 (25.3) | NR | NR | 7/75 (9.3) Specimens NR | 4/75 (5.3) on admission. Site NR 1/5 (20) empyema patients BC | 74 (98.7) CXR No diff |
Busi [4] | N = 40 | NR | NR | 1/40 (2.5) | NR | NR | 0/40 (0) Specimen NR | 40/40 (100) 40 had findings consistent with pneumonia. These 28/40 (70 bilaterial) Non-Diff | ||