Objectives

We aimed to describe bacterial co-infections and acute respiratory distress (ARDS) outcomes according to influenza type and subtype.

Methods

A retrospective observational study was conducted from 2012 to 2016 in patients admitted to the respiratory intensive care unit (ICU) of Marseille university hospital for influenza-induced ARDS. Microbiological investigations, including multiplex molecular respiratory panel testing and conventional bacteriological cultures, were performed as part of the routine ICU care on the bronchoalveloar lavage collected at admission. Bacterial co-infections, ICU mortality and respiratory function were investigated according to virus type and subtype.

Results

Among the 45 ARDS patients included, A(H1N1)pdm09 was the most frequent influenza virus identified (28/45 A(H1N1)pdm09, eight out of 45 A(H3N2) and nine out of 45 influenza B). Bacterial co-infections involving a total of 23 bacteria were diagnosed in 16/45 patients (36%). A(H1N1)pdm09 patients presented fewer bacterial co-infections (17.9% vs. 50.0% for A(H3N2) patients and 77.8% for B patients; p < 0.01). Overall, mortality at 90 days post admission was 33.3% (15/45), and there was no significant difference between influenza type and subtype. The need for extracorporeal membrane oxygenation was more frequent for A(H1N1)pdm2009 (20/28, 71.4%) and B patients (7/9, 77.8%) than the A(H3N2) subtype (1/8, 12.5%; p < 0.01). A(H1N1)pdm09-ARDS patients were associated with fewer ventilation-free days at day 28 (median (IQR): 0 (0–8) days) compared with other influenza–ARDS patients (15 (0–25) days, p < 0.05).

Discussion

In a population of influenza-induced ARDS, A(H1N1)pdm09 was associated with fewer bacterial co-infections but poorer respiratory outcomes. These data underline the major role of A(H1N1)pdm09 subtype on influenza disease severity.

中文翻译：

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在2010-2016季节，流行性感冒引起的急性呼吸窘迫综合征：细菌共感染和结局的病毒类型和亚型。

目标

我们旨在描述根据流感类型和亚型的细菌共感染和急性呼吸窘迫（ARDS）结果。

方法

从2012年至2016年，对因流感引起的ARDS入马赛大学医院呼吸重症监护病房（ICU）的患者进行了一项回顾性观察研究。作为入院时收集的支气管肺泡灌洗常规ICU护理的一部分，进行了微生物学研究，包括多重分子呼吸板检测和常规细菌培养。根据病毒类型和亚型，调查细菌共感染，ICU死亡率和呼吸功能。

结果

在包括的45名ARDS患者中，A（H1N1）pdm09是最常见的流感病毒（28/45 A（H1N1）pdm09，45 A（H3N2）中有8名，B 45流感中有9名）。在16/45位患者中诊断出细菌共感染，共感染23种细菌（36％）。A（H1N1）pdm09患者的细菌合并感染较少（A（H3N2）患者为17.9％，而B（B3）患者为50.0％； p <0.01）。总体而言，入院后90天的死亡率为33.3％（15/45），流感类型与亚型之间无显着差异。A（H1N1）pdm2009（20/28，71.4％）和B患者（7/9，77.8％）比A（H3N2）亚型（1/8，12.5％; p <0.01）。A（H1N1）pdm09-ARDS患者在第28天的无通气天数减少（中位数（IQR）：

讨论区

在由流感引起的ARDS人群中，A（H1N1）pdm09与较少的细菌共感染相关，但呼吸效果较差。这些数据强调了A（H1N1）pdm09亚型对流感疾病严重性的重要作用。