Community-acquired pneumonia during the first post-pandemic influenza season: A prospective, multicentre cohort study - 01/08/13

Doi : 10.1016/j.jinf.2013.05.006

Diego Viasus ^a,^⁎ , Carmen Marinescu ^b, Aroa Villoslada ^c, Elisa Cordero ^d, Juan Gálvez-Acebal ^e, María C. Fariñas ^f, Irene Gracia-Ahufinger ^g, Anabel Fernández-Navarro ^a, Jordi Niubó ^a, Lucia Ortega ^h, Elena Muñez-Rubio ⁱ, María P. Romero-Gómez ^j, Jordi Carratalà ^a
the Influenza A (H1N1) Study Group of the Spanish Network for Research in Infectious Diseases (REIPI)^{^k}
The collaborators of “Influenza A (H1N1) Study Group” listed in Appendix section.
^a Hospital Universitari de Bellvitge – IDIBELL, University of Barcelona, Feixa Llarga s/n, 08907 Barcelona, Spain
^b Hospital Universitario Son Dureta – Son Espases, Calle Andrea Doria 55, 07014 Palma de Mallorca, Spain
^c Hospital Son Llàtzer, Carretera Manacorkm4, 07198 Palma de Mallorca, Spain
^d Hospital Universitario Virgen del Rocío, Avenida Manuel Siurot s/n, 41013 Sevilla, Spain
^e Hospital Universitario Virgen Macarena, Avenida Doctor Fedriani 3, 41007 Sevilla, Spain
^f Hospital Universitario Marqués de Valdecilla, Avenida Valdecilla 25, 39008 Santander, Spain
^g Hospital Universitario Reina Sofía – IMIBIC, University of Córdoba, Avenida Menendez Pidal s/n, 14004 Córdoba, Spain
^h SCIAS – Hospital de Barcelona, Avenida Diagonal 660, 08034 Barcelona, Spain
ⁱ Hospital Universitario Puerta de Hierro, Calle Manuel de Falla 1, 28222 Madrid, Spain
^j Hospital Universitario La Paz – IDIPAZ, Paseo de la Castellana 26, 28046 Madrid, Spain

^∗Corresponding author. Department of Infectious Diseases, Hospital Universitari de Bellvitge, Feixa Llarga s/n, L'Hospitalet de Llobregat, 08907 Barcelona, Spain. Tel.: +34 932607625; fax: +34 932607637.

Summary

Objectives

To determine the aetiology, clinical features and prognosis of CAP during the first post-pandemic influenza season. We also assessed the factors associated with severe disease and tested the ability of a scoring system for identifying influenza A (H1N1)pdm09-related pneumonia.

Methods

Prospective cohort study carried out at 10 tertiary hospitals of Spain. All adults hospitalised with CAP from December 01, 2010 to March 31, 2011 were analysed.

Results

A total of 747 adults with CAP required hospitalisation. The aetiology was determined in 315 (42.2%) patients, in whom 154 (21.9%) were due to bacteria, 125 (16.7%) were due to viruses and 36 (4.8%) were mixed (due to viruses and bacteria). The most frequently isolated bacteria were Streptococccus pneumoniae. Among patients with viral pneumonia, the most common organism identified were influenza A (H1N1)pdm09. Independent factors associated with severe disease were impaired consciousness, septic shock, tachypnea, hyponatremia, hypoxemia, influenza B, and influenza A (H1N1)pdm09. The scoring system evaluated did not differentiate reliably between patients with influenza A (H1N1)pdm09-related pneumonia and those with other aetiologies.

Conclusions

The frequency of bacterial and viral pneumonia during the first post-pandemic influenza season was similar. The main identified virus was influenza A (H1N1)pdm09, which was associated with severe disease. Although certain presenting clinical features may allow recognition of influenza A (H1N1)pdm09-related pneumonia, it is difficult to express them in a reliable scoring system.

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Keywords : Clinical features, Community-acquired pneumonia, Influenza A (H1N1)pdm09, Mortality, Post-pandemic period

Plan

Introduction

Patients and methods

Setting, patients and study design

Clinical assessment and follow-up

Definitions

Microbiological studies

Statistical analysis

Results

Aetiology, clinical features and outcomes of CAP

Predictors of severe disease

Validation of a clinical model for identifying patients with influenza A (H1N1)pdm09-related pneumonia

Discussion

Role of the funding sources

Competing interests

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Vol 67 - N° 3

P. 185-193 - septembre 2013 Retour au numéro

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Community-acquired pneumonia during the first post-pandemic influenza season: A prospective, multicentre cohort study - 01/08/13

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