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Grand Rounds | National Institutes of Health| Clinician's Corner

Bacterial Coinfection in Influenza:  A Grand Rounds Review

Daniel S. Chertow, MD, MPH; Matthew J. Memoli, MD, MS
JAMA. 2013;309(3):275-282. doi:10.1001/jama.2012.194139.
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Bacterial coinfection complicated nearly all influenza deaths in the 1918 influenza pandemic and up to 34% of 2009 pandemic influenza A(H1N1) infections managed in intensive care units worldwide. More than 65 000 deaths attributable to influenza and pneumonia occur annually in the United States. Data from 683 critically ill patients with 2009 pandemic influenza A(H1N1) infection admitted to 35 intensive care units in the United States reveal that bacterial coinfection commonly occurs within the first 6 days of influenza infection, presents similarly to influenza infection occurring alone, and is associated with an increased risk of death. Pathogens that colonize the nasopharynx, including Staphylococcus aureus, Streptococcus pneumoniae, and Streptococcus pyogenes, are most commonly isolated. Complex viral, bacterial, and host factors contribute to the pathogenesis of coinfection. Reductions in morbidity and mortality are dependent on prevention with available vaccines as well as early diagnosis and treatment.

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Figure 1. Case Patient's Chest Radiograph Showing Diffuse Bilateral Infiltrates
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Figure 2. Influenza and Pneumonia Death Rates by Age Group, United States, 1976-2009
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Based on data from the National Vital Statistics System.13

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Figure 3. Model of Severe Influenza and Bacterial Copathogenesis
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