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Table 4 Bacterial co-infection reported among hospitalised cases of influenza A(H1N1)pdm09, not requiring ICU (n = 22)

From: The role of pneumonia and secondary bacterial infection in fatal and serious outcomes of pandemic influenza a(H1N1)pdm09

Author and year Study type Study population Case severity n (%) Antiviral agents
- Number (%) started ≤48 h of symptoms
Antibiotics†
n/N (%) pre
n/N (%) on
n/N (%) during admission
Any positive bacterial growth Number (%) patients with S.pneumoniae and site of isolation Number (%) with bacterial pneumonia
- Method
- Diff/no diff
ICU
N
MV
- type
Deaths
CDC (2009) [59]
California, USA
4/09–5/09
State-wide passive surveillance of notified cases / Hospitalized cases for > 24 h N = 30 6/30 (20) 4/30 (13.3) 0/23 (0)
7 were still hospitalised
15/30 (50)
5/30 (16.7)
0 0/100 (0) 0/100 (0) 15/25 (60)
CXR Non diff
Jain [60] (2009)
USA
4/09–6/09
Notified cases from 24 state health departments to CDC / Hospitalized ≥24 h N = 272 67/272 (24.6) 42/272 (15.4) 19/272 (7.0) 200/268 (74.6)
78 (29.1)
206/260 (79.2)
- Pre: 30/198
- on: 117/198
3/182 (1.6) 2/182 (1.1) 1 had positive lung tissue culture)
1/n urinary antigen test
1/n BAL fluid
0/n ET aspirate
- CXR 100/249 (40)
(66 patients with bilateral infiltrates)
26 limited to 1 lobe, 6 limited to multiple lobes
- not diff
Louie [61] (2009)
California, USA
4/09–8/09
State-wide enhanced surveillance /Hospitalized or fatal all ages cases N = 1088 340/1088 (31.3) 193/297 (64.9) 118/1088 (10.8) 701/884 (79.3)
- 357 (40.4)
NR 46/1088 (4.2) NR 547/833 (65.7)
- CXR/CT + pos bacterial culture(s) 46
- No diff
Dhanoa [62] (2011)
Malaysia
9/09–5/10
Single-centre case series (retrospective)/ Hospitalised patients all ages N = 50 9/50 (18.0) 6/50 (12.0) 2/50 (4.0) 50/50 (100) 49 (98.0)
- Pre = 8
- On =41
14/45 (31.1)
total 45 culture samples sent
2/45 (4.4) site NR 25/50 (50)
-CXR + clinical opinion
- No diff
To [63] (2010)
China
6/09–10/09
Single-centre case series (retrospective)/ Hospitalized adult patients N = 69 28/69 (40.6) 26/69 (37.7)
- NS
13/69 (18.8) 69/69 (100) 37/69 (53.6)
- On = 37
0/69 (0) 0/69 (0) 25/69 (36.2)
CXR Non-diff
Viasus [64] (2011)
Spain
6/09–11/09
Multicentre (13) case series (prospective)/ Hospitalized ≥24 h and had a chest radiograph done N = 585 71/585 (12.1) 52/585 (8.9) 13/585 (2.2) 545/585 (93.3) 416/585 (71.7) 45/585 (7.7) 28/585 (4.8) 234/585 (40)
CXR non diff
Palacios (2009) [42]
Argentina
6/09–7/09
Random sample specimens N = 199 19/199 (9.5) NR 20/199 (10) 96/120 (80) 14/120 (11.7) 152/199 (76.3) 62/199 (31.1) 152//199 (76)
Culture pos
Chitnis [6] Wisconsin, hospital acute care
PCR + cases
N = 252 59/252 (23.4) 34/59 (58)
Of tho9se cases admitted to ICU
11/252 (4.3) 215/250 (86) 204/249 (81.9) 19/241 (7.9) NR 123/229 (53.7)
CXR non diff
Riera [65] 13 Hospitals in Spain N = 585 71/585 (12.1) 52/585 (8.9) 13/585 (2.2) 545/585 (93.1)
202/585 (34.5)
316/585 (54) 45/585 (7.7) (Sputum) 2/585 (0.3)
(1 sputum and 1 antigenuria positive
CXR infil 234/585 (40)
Multilobarl infilt 135/585 (23.1)
Semionov [66] 147 cases with CXR results available in Montreal N = 147 8/147 (5.4) 6/147 (4.1) 4/147 (2.7) NR NR 21/42 (50)
(of 42 radiological positive cases)
5/21 (23.8)
(of 21 positive bacterial cases)
42/147 (28.6)
cases positive CXR
Non diff
To [67] 74 cases in Hong Kong N = 74 28/74 (37.8) 26/74 (35.1) 2/74 (2.7) 69/74 (93.2) 52/74 (70.3) 9/74 (12.2) bacterial positive
8 sputum
1 blood
0/74 (0) 9/74 (12.2) bacterial positive
8 sputum
1 blood
Diff
Masia [68] Complicated hospital admitted cases in Spain > 18 years, out patients N = 100 4/100 (4) NR 0/100 (0) NR NR 14/100 (14) 14/100 (14)
Diff
8 urinary antigen pos, 2 isolated from blood and 4 from sputum
14/100 (14)
Diff
Pecavar [69] Hospitalized cases N = 66 7/66 (10.6) NR NR 62/64 (96.9) 35/61 (57.4) 5/63 (7.9) 2/63 (3.2) 29/57 (50.9)
CXR Non diff
Liu [70] One hospital in China N = 46 NR NR NR 46/46 (100) 9/46 (19.6) 9/15 (60) NR 44/46 (95.6)
CXR or CT scan abnormal
Non diff
Nguyen (2010) [71]
UK
4/09–9/09
Multicentre (55) case series (retrospective)/ Hospitalized cases N = 631 53/631 (8.4) NR
- IV = 21/631 (3.3)
29/631 (4.6) 474/631 (75.1)
- NS
366/631 (58) 4/102 (3.9%) of cases with radiological pneumonia 1/102 (0.9) sputum culture
0/102 (0) BC
102/349 (29.2)
- CXR
- No diff
Santa-Olalla Peralta [72] (2010)
Spain
4/09–12/09
National surveillance of severe cases (retrospective) / Hospitalized patients all ages (, in Spain N = 3025 852/3025 (28.2) 438/3.25 (14.5) 200/3025 (6.6) 2521/2779 (90.7)
- 711/2020 (35.2)
NR 292/957 (30.5, bacteria isolated not reported) NR NR
Venkata [73] (2010)
USA
5/09–12/09
Single-centre case series (retrospective)/ Electronic medical records of hospitalized adult patients N = 66 29/66 (43.9) 23/66 (34.8)
- IV = 17 (73.9)
- NIV = 6 (26.1)
5/66 (7.6)
4 more died after discharge from hospital
60/66 (90.9)
- NR
  14/ 29 (48.2)
Bac culture pos
3/29 (10.3), site NS 14/29 (48.2) confirmed and 10/29 (34.5) probable bacterial pneumonia
- NR
- Diff
Jartti [74] Cases with severe cases and CXR finding available, I hospital in Finland N = 135 18/135 (13%) 18/135 (13.3) 3/135 (2.2) NR NR 5/135 (3.7)
Site not mentioned
1 /135 (0.7)
Isolated from Plural Fluid
84/135 (62.2)
Rizzo [75] Sentinel sites, Italy N = 1278 NR NR NR NR NR 33/1278 (2.6) 0/1278 (0) 271/1278 (21.2)
Non-diff
Kopel [76] Til Aviv, cases in ICU and PICU N = 17 17/17 (100) NR 7/17 (41.2) NR NR 9/17 cases (52.9)
(but likely nosocomial infection, so not included)
0/17 (0) NR
D’Ortenzio [41] ReUnion Island, all sites, included 785 reported cases, 282 hospitalized cases included here N = 282 24/282 (8.5) 15/282 (5.3) 7/282 (2.5) 92/171 (53.8)
39/163 (23.9)
(within 48 h)
NR NR NR 24/83 (28.9)
(Confirmed and suspected)
Sample not reported
Dominguez-Cherit [77] Critically ill, hospitalized in 6 hospital in Maxico N = 58 58/58 (100) 54/58 (93.1) 24/ 58 (41.4) 57/58 (98.3) 52/58 (89.6) 4/58 (6.9) 0/58 (0) NR
  1. Antibiotics: time started – “Pre” = started prior admission, “On” = started on admission, “During” = started during admission
  2. Diff Differentiated between bacterial pneumonia, viral pneumonia and ARDS
  3. No diff Did not differentiate between aetiology of abnormal chest imaging