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Volume 3 Supplement 1


  • Poster presentation
  • Open Access

Pneumococcal pneumonia coinfection in critically ill patients with influenza a (h1n1) primary viral pneumonia

  • 1,
  • 2,
  • 3,
  • 4,
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  • 6,
  • 7,
  • 8,
  • 9,
  • 10,
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  • 12 and
Intensive Care Medicine Experimental20153 (Suppl 1) :A829

  • Published:


  • Pneumonia
  • Influenza
  • Renal Replacement Therapy
  • Acute Kidney Injury
  • Influenza Season


It has been generally believed that influenza virus infection increase susceptibility to invasive pneumococcal pneumonia. However, information regarding the impact of S. pneumoniae respiratory coinfection (SpCoI) in patients affected with A(H1N1) primary viral pneumonia is scarce.


Our aim was to analyse the demographic and clinical differences between patients admitted to ICU due to A(H1N1) pneumonia with and without SpCoI.


Prospective, observational, multicenter study conducted in 148 Spanish ICUs. Individuals with A(H1N1) confirmed using RT-PCR during the 2009 to 2014 influenza seasons were included and compared with those patients with SpCoI. Patients´ demographic, clinical, radiologic features, laboratory values, ICU and hospital length of stay (LOS) and outcomes were recorded. Discrete variables are expressed as counts (percentage) and continuous variables as medians with 25th to 75th interquartile range (IQR). Differences between groups were assessed using the x2 test and the Fisher exact test for categoric variables and Mann-Whitney U test for continuous variables.


Of 2343 patients with confirmed A(H1N1) pneumonia, 208 were excluded due to respiratory coinfection by non-pneumococal microorganism. At all, 1949 patients with A(H1N1) pneumonia were compared to 186 patients with documented SpCoI (incidence= 8.7%). Patients SpCoI presented a higher APACHE II score (14 [10-19] vs 17 [12-21.5], P = 0.001) and SOFA score (5 [3-8] vs 6 [4-9], P = 0.002). Patient with SpCoI were less obese (36.8% vs 22.2%, P < 0.001). HIV presented SpCoI more frequently (2.0% vs 4.3%, P = 0.036). No other differences in comorbidities were observed. Patients who had coinfection developed acute kidney injury more frequently (22.8% vs 32.4%, P = 0.004) but no difference in renal replacement therapy was observed (10.8% vs 11.5%, P= 0.773). Shock requiring vasopressors were more frequently in those patients with SpCoI (49.7% vs 61.1%, P = 0.003). No differences were observed in invasive mechanical ventilation (68.8% vs 65.0%, P = 0.211), prone positioning (18% vs 15.1%, P = 0.331) or LOS. Coinfection was not associated with increased ICU mortality (19.5% v 21.0%, P = 0.627).


Incidence of SpCoI among Influenza virus infection admitted to ICU was low. There was no difference in LOS or mortality for patients with SpCoI despite their greater severity and organ dysfunction at ICU admission.

Authors’ Affiliations

Mutua Terrassa University Hospital, Terrassa, Spain
Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
Hospital General de Cataluña, Sant Cugat del Valles, Spain
ParcTaulí Hospital, Sabadell, Spain
Hospital Dr. Negrín, Las Palmas, de Gran Canaria, Spain
Hospital Son Llatzer, Mallorca, Spain
Hospital de Cruces, Vizcaya, Spain
Hospital Dr. Peset, Valencia, Spain
Hospital Universitario de Santander, Santander, Spain
Hospital de Donostia, San Sebastián, Spain
Mútua Terrassa University Hospital, Intensive Care, Terrassa, Spain
St James's University Hospital, Dublin, Ireland


  1. Hament JM, Kimpen JL, Fleer A, Wolfs TF: Respiratory viral infection predisposing for bacterial disease: a concise review. FEMS Immunol Med Microbiol. 1999, 26: 189-95. 10.1111/j.1574-695X.1999.tb01389.x.PubMedView ArticleGoogle Scholar
  2. Martín-Loeches I, Sanchez-Corral A, Diaz E, Granada RM, Zaragoza R, Villavicencio C, Albaya A, Cerdá E, Catalán RM, Luque P, Paredes A, Navarrete I, Rello J, Rodríguez A, H1N1 SEMICYUC Working Group: Community-acquired respiratory co-infection (CARC) in critically ill patients infected with pandemic 2009 influenza A (H1N1) virus infection. Chest. 2011, 139: 555-562. 10.1378/chest.10-1396.PubMedView ArticleGoogle Scholar


© González De Molina et al.; 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.