Immunosuppressed patients with pandemic influenza A 2009 (H1N1) virus infection

• Published in: European journal of clinical microbiology & infectious diseases Vol. 31; no. 4; pp. 547 - 556
• Main Authors: Cordero, E., Aydillo, T., Fariñas, M. C., Paño-Pardo, J. R., Pachón, J., Viasus, D., Riera, M., López-Medrano, F., Payeras, A., Moreno, A., Rodríguez-Baño, J., Oteo, J. A., Martínez-Montauti, J., Torre-Cisneros, J., Segura, F., Carratalá, J.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.04.2012; Springer; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents - administration & dosage; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Body mass index; Cohort Studies; Coinfection - epidemiology; Corticoids; Female; Gram-negative bacilli; HIV; Hospitals; Human immunodeficiency virus; Human viral diseases; Humans; Immunocompromised Host; Immunosuppression; Immunosuppressive Agents - administration & dosage; Infection; Infections; Infectious diseases; Influenza; Influenza A; Influenza A Virus, H1N1 Subtype - isolation & purification; Influenza, Human - drug therapy; Influenza, Human - mortality; Influenza, Human - pathology; Influenza, Human - virology; Internal Medicine; Male; Malignancy; Medical Microbiology; Medical sciences; Middle Aged; Mortality; Pandemics; Pneumonia; Pneumonia, Bacterial - epidemiology; Prospective Studies; Public health; Risk factors; Spain; Staphylococcus aureus; Steroids; Survival Analysis; Treatment Outcome; Vaccines; Viral diseases; Viral diseases of the respiratory system and ent viral diseases; Young Adult; Spain; Majorca; Madrid Spain; Oseltamivir; Pandemic Influenza; Seasonal Influenza; Antiviral Therapy; Influenza; Human; Microbiology; Respiratory disease; H1N1 influenza; Orthomyxoviridae; Infection; Virus; Immunosuppression; Influenzavirus A; Influenza A virus; Viral disease; Influenza A (H1N1); Influenza A
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-011-1346-3

The purpose of this paper was to prospectively characterize the clinical manifestations and outcomes of confirmed influenza A 2009 (H1N1) virus infection in immunosuppressed patients with hospital admission and compare them with those of a general population. A multicenter prospective cohort study was carried out. All adult patients admitted to 13 hospitals in Spain with confirmed influenza A 2009 (H1N1) virus infection from June 12, 2009 to November 11, 2009 were included. Risk factors for complicated influenza infection were studied in immunosuppressed patients. Overall, 559 patients were included, of which 56 were immunosuppressed, nine with solid or hematological malignancies, 18 with solid-organ transplant recipients, 13 with corticosteroid therapy, and six with other types of immunosuppression. Clinical findings at diagnosis were similar in both groups. Nineteen immunosuppressed patients had pneumonia (33.9%). Immunosuppressed patients with pandemic influenza had bacterial co-infection more frequently (17.9% vs. 6.4%, p  = 0.02), specifically, gram-negative bacilli and Staphylococcus aureus infections. Mortality was higher in immunosuppressed patients (7.1% vs. 1.8%, p  < 0.05). The only modifiable risk factor of complicated influenza A 2009 (H1N1) was delayed antiviral therapy. In immunosuppressed patients, influenza A 2009 (H1N1) virus infection has higher mortality than in non-immunosuppressed individuals. Bacterial co-infection is common in complicated cases.