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Table 5 Bacterial co-infection reported among paediatric hospitalised cases (including PICU) of influenza A(H1N1)pdm09 (n = 15)

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 Diagnosis of influenza/ cases Antiviral agents
- Number (%) started ≤48 h of symptoms
Number (%) patients with S.pneumoniae and site of isolation Any bacteria positive Number (%) with bacterial pneumonia
- Method
- Diff/no diff
Antibiotics used (Pre, on, during) Required
ICU - ECMO MV Deaths
Hospitalised
Louie (2010) [7]
California USA
4/09–8/09
State-wide surveillance (California) / Hospitalized or died cases (< 18 years) PCR/345 221/345 (64.1)
88/ 345 (25.5) with in 48 h
3/345 (0.9)
isolation site NR
15/345 (4.3) 138/229 (60.3)
(F: 4/5; H: 134/224)
163/278 (CT + CXR pos)
- No diff
NR 94/345 (27.4) 35/94 (37) in text 9/345 (2.6)
Libster [78] (2010)
Argentina
5/09–7/09
Multicentre (6) case series (retrospective)/ Hospitalized cases (< 18 years) PCR/ 251 - 22/ 171(12.9) with in 48 h
(4/34 PICU Px, 18/137 ward px)
2/121 (1.7) BC
1/4 (25.0) empyema
10 /121 (8)
Blood culture
25/251 (10.0) bacterial confirm
- Among 92 CXR, 78% diagnosis was pneumonia
-NonDiff
186/251 (74.1)
- On = 82
47/251 (18.7) 42/251 (16.7) 13/251 (5.2)
Okada [43] 2011
Japan
7/09–1/10
Single-centre case series (retrospective) / Pneumonia, pharyngitis or bronchitis cases (< 15 years) (n = unclear). PCR/46 44/46 (95.6)
- NR
28/46 (60.9)
NP
40/46 (86.9)
NP positive swab
40/46 (86.9%)
NP swab
Bac pneumonia
21/46 (45.6%) unilateral infiltrates
- CXR
- No diff
32/46 (69.6)
- NS
NR NR 0/46 (0)
Kumar [79] (2010)
Wisconsin, USA
4/09–8/09
Single-centre case series (retrospective record review)/ Hospitalized (> = 24 h) cases (< 19 years) PCR/75 74/75 (98.7)
- NR
0 /75 (0) 0/75 (0) 23/75 (34.3)
- CXR
- Diff
60/75 (80.0)
- Pre = 12
- On/during = 48
14/75 (18.7) 4/75 (5.3) 2/75 (2.7)
Miroballi [80] (2010)
New York, USA
05/09–07/09
Multicentre (2) case series (retrospective) / Hospitalized cases (< 18) PCR (54), EIA, DFA, viral culture/ 115 97/115 (84.3)
- NR
2/115 (1.7) BC
1/115 (0.9) respiratory secretions
4/115 (3.5) Total NR (11/35 in PICU)
- NR
- Diff NS
89/115 (77.4)
- NS
35/115 (30.4) 11/115 (9.6) in PICU 1/115 (0.9)
O’Riordan [81] Retrospective case review/hospitalised cases (< 18 yrs) PCR/ 58 12/58 (20.7)
- NR
1/58 (1.7)
BC
1/58 (1.7)
bacterial culture positive
17/58 (29.3)
- CXR
- No diff
56/58 (96.6)
- NS
12/58 (20.7) 7/58 (12.1) 0/58 (0)
Bettinger [82] (2010)
Canada
5/09–8/09
National active surveillance / hospitalized cases (< 17 years) PCR/235 107/235 (45.5)
- NR
3/235 (1.3) isolation site NR 8/235 (3.4) culture positive 8/235 (3.4) culture positive 203/235 (86.4)
- NS
39/235 (16.6) 15/235 (6.4) 2/235 (0.9)
Lockman [83] 2010 Retrospective case review (notes)/cases admitted to ICU PCR/ 13 11/13 (84.6)
- 5 (45.5)
0/13 (0) 0/13 (0) 3/13 (23%)
Nondiff CXR
3/13 (23.1)
- NS
13/13 (100) 6/13 (46.2)
- IV =4 (66.7)
- NIV = 2 (33.3)
0/13 (0)
 Stein [84] < 18 year, ARI cases, hospitalized in 7 medical centers in Israel PCR/ 478 413/478 (87.1) 2/478 (0.4) 4/478 (0.8) 172/478 (35.9) CXR non-diff 215/478 (45) 42/478 (8.8) 15/478 (3.1) 3/478 (0.6%)
 Tamma [85] 1 hospital, lab confirm US, <  18 years, retrospective cohot in US PCR/ 133 106/133 (79.7)
51/133 < 48 h
0/133 (0) 0/133 (0) 28/122 (22.9)
CXR nondiff
61/85 (72%) 27 (20.3) 11/133 (8%) 0
 Parakh [86] 1 hospital, retrospective record review, India PICU and ICU, cases with age < 18 with ILI PCR/ 25 25/25 (100) 0/25 (0) 0/25 (0) 8/25 (32)
CXR nondiff
NR 7/25 (28) 4/25 (16) 3/25 (12)
PICU
 Farias [87] Prospective multicentred study/includes nosocomial cases in Argentina(n = 147) PCR/ 147 135/147 (91.8)
- 116/147 (85.9)
6/147 (4) isolation site NR 50/147 (34) NR 143/147 (97.3) 147/147 (100) 139/147 (94.6)
- IV = 117 (84.2)
- NIV = 22 (15.8)
57/147 (38.8)
 Randolph (2011) [88]
USA
4/09–4/10
Multicentre (35) case series (retrospective & prospective). Probable 293/838 (35%) cases
PICU cases (< 21 years)
Confirmed- PCR, viral culture
Probable- direct fluorescent antibody, rapid influenza diagnostic test (n = 838)
751/838 (89.6)
- NR (before ICU admission =49)
0/38 (0) BC
15/274 (5.5) respiratory secretions
BC: 0
274/838 (32.7) had pneumonia/other bacterial co-infection
From resp. secretions
274/838 (32.7) had pneumonia/other bacterial co-infection
From resp. secretions
NR 838/838 (100)
- 33 (3.9)
546/838 (67.3) 75/838 (8.9)
 Shin [89] South Korea, critically ill cases PCR/30 29/30 (96.7) 0/30 (0) 4/30 (13.3)
Blood c/s positive
22/29 (75.9)
CXR non diff
NR 30/30 (0) 16/30 (53.3) 14//30 (46.7)
 Jouvet [8] Canada PICUs, PCR or culture positive /57 44/57 (77.2) 5/27 (18.5)
Lower resp. samples
12/57 (21.1)
Lower resp. samples
12/57 (21.1)
Lower resp. samples
54/57 (94.7) 2/57 (3.5) 39/57 (68.4) 4/57 (7)
  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