Objective H1N1 influenza with coinfections has been implicated to have high morbidity and mortality. We hypothesized that critically ill children with 2009 H1N1 and coinfections are at a higher risk for developing disseminated intravascular coagulation (DIC). Design The chart review included demographics, length-of-stay (LOS), severity of illness score (PRISM III), clinical labs, and outcomes at hospital day 90 (D-90) data. Patients were classified as having methicillin-sensitive or -resistant Staphylococcus aureus (MSSA/MRSA), other, or no coinfections. Patients 66 consecutive patients with 2009 H1N1 and influenza A infection Setting Single-center Pediatric Intensive Care Unit Main Results There were 12, 22, and 32 patients with MSSA/MRSA, other, and no coinfections respectively. PICU LOS was 11, 10, and 5.5 days (median), and survival at D-90 was 83, 96, and 91 % in patients with MSSA/MRSA, other, and no coinfections. Patients with MSSA/MRSA coinfections compared to patients with other, and no coinfections had higher PRISM III scores (14 [ 6 – 25 ], vs 7 [ 2 – 10 ], p = 0.052 and 6 [2.5–10] p = 0.008, (Median [Interquartile Range])), higher D-dimer (16.1 [7.9–19.3], vs 1.6 [1.1–4], p = 0.02 and 2.3 [0.8–8.7] mcg/ml, p = 0.05), longer prothrombin time (19.3 [15.4–25.9] vs 15.3 [14.8–17.1], p = 0.04 and 16.6 [14.7–20.4] seconds, p<0.39) on admission, and lower day-7 platelet counts (90K [26–161K] vs 277K [98–314], p = 0.03 and 256K [152–339]/mm3, p<0.07). Patients with MSSA/MRSA coinfections compared to patients without coinfections were more likely to be sicker with PRISM III score >10 vs <10 (RR 2.4; CI 1.2–4.7, p =0.035) (Relative Risk; 95% Confidence Interval), and have overt DIC (RR 4.4; CI 1.3–15.8, p =0.025) Conclusions During the 2009–2010 H1N1 pandemic, pediatric patients with influenza A and MSSA/MRSA coinfections were sicker and more likely to develop DIC than patients with other or no coinfections.
【저자키워드】 influenza A, Coinfection, H1N1, Disseminated intravascular coagulation, DIC, Staphylococcal aureus,