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McKelvey M, Uddin MB, Palani S, Shao S, Sun K. IL-10 Counteracts IFN-γ to Alleviate Acute Lung Injury in a Viral-Bacterial Superinfection Model. Am J Respir Cell Mol Biol 2024; 71:110-120. [PMID: 38574279 PMCID: PMC11225870 DOI: 10.1165/rcmb.2023-0437oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 04/03/2024] [Indexed: 04/06/2024] Open
Abstract
Immune activation is essential for lung control of viral and bacterial infection, but an overwhelming inflammatory response often leads to the onset of acute respiratory distress syndrome. IL-10 plays a crucial role in regulating the balance between antimicrobial immunity and immunopathology. In the present study, we investigated the role of IL-10 in acute lung injury induced by influenza A virus and methicillin-resistant Staphylococcus aureus coinfection. This unique coinfection model resembles patients with acute pneumonia undergoing appropriate antibiotic therapies. Using global IL-10 and IL-10 receptor gene-deficient mice, as well as in vivo neutralizing antibodies, we show that IL-10 deficiency promotes IFN-γ-dominant cytokine responses and triggers acute animal death. Interestingly, this extreme susceptibility is fully preventable by IFN-γ neutralization during coinfection. Further studies using mice with Il10ra deletion in selective myeloid subsets reveal that IL-10 primarily acts on mononuclear phagocytes to prevent IFN-γ/TNF-α hyperproduction and acute mortality. Importantly, this antiinflammatory IL-10 signaling is independent of its inhibitory effect on antiviral and antibacterial defense. Collectively, our results demonstrate a key mechanism of IL-10 in preventing hypercytokinemia and acute respiratory distress syndrome pathogenesis by counteracting the IFN-γ response.
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Affiliation(s)
| | - Md Bashir Uddin
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas
| | - Sunil Palani
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas
| | - Shengjun Shao
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas
| | - Keer Sun
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas
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Sul C, Nozik E, Malainou C. A Tale of Two Cytokines: IL-10 Blocks IFN-γ in Influenza A Virus- Staphylococcus aureus Coinfection. Am J Respir Cell Mol Biol 2024; 71:18-20. [PMID: 38701437 PMCID: PMC11225875 DOI: 10.1165/rcmb.2024-0154ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 05/02/2024] [Indexed: 05/05/2024] Open
Affiliation(s)
- Christina Sul
- Department of Pediatrics University of Colorado Anschutz Medical Campus Aurora, Colorado
| | - Eva Nozik
- Department of Pediatrics University of Colorado Anschutz Medical Campus Aurora, Colorado
| | - Christina Malainou
- University Hospital Giessen Justus Liebig University Giessen, Germany
- Member of the German Center for Lung Research Giessen, Germany
- Institute for Lung Health Justus Liebig University Giessen, Germany and
- Excellence Cluster Cardio-Pulmonary Institute Giessen, Germany
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Kwok WC, Lung DC, Tam TCC, Yap DYH, Ma TF, Tsui CK, Zhang R, Lam DCL, Ip MSM, Ho JCM. Protective Effects from Prior Pneumococcal Vaccination in Patients with Chronic Airway Diseases during Hospitalization for Influenza-A Territory-Wide Study. Vaccines (Basel) 2024; 12:704. [PMID: 39066342 PMCID: PMC11281690 DOI: 10.3390/vaccines12070704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/15/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024] Open
Abstract
Influenza is an important respiratory viral pathogen in adults, with secondary bacterial pneumonia being a common complication. While pneumococcal vaccines can prevent pneumococcal pneumonia and invasive pneumococcal disease, whether they can also prevent the severe in-hospital outcomes among patients hospitalized for influenza has not been examined. A territory-wide retrospective study was conducted in Hong Kong, which included all adult patients having chronic airway diseases (asthma, bronchiectasis, and chronic obstructive pulmonary disease) hospitalized for influenza and who had received seasonal influenza vaccine. The occurrence of secondary bacterial pneumonia, mortality, and other severe in-hospital outcomes were compared among subjects with or without pneumococcal vaccination. There was a total of 3066 eligible patients who were hospitalized for influenza in public hospitals in Hong Kong from 1 January 2016 to 30 June 2023. Completed pneumococcal vaccination with PSV23/PCV13 conferred protection against secondary bacterial pneumonia, all-cause mortality, and respiratory cause of mortality with adjusted odds ratios of 0.74 (95% CI = 0.57-0.95, p = 0.019), 0.12 (95% CI = 0.03-0.53, p = 0.005), and 0.04 (95% CI = 0.00-0.527, p = 0.0038), respectively.
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Affiliation(s)
- Wang-Chun Kwok
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China; (W.-C.K.); (T.C.-C.T.); (D.Y.-H.Y.); (C.-K.T.); (R.Z.); (D.C.-L.L.); (M.S.-M.I.)
| | - David Christopher Lung
- Department of Pathology, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong SAR, China;
| | - Terence Chi-Chun Tam
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China; (W.-C.K.); (T.C.-C.T.); (D.Y.-H.Y.); (C.-K.T.); (R.Z.); (D.C.-L.L.); (M.S.-M.I.)
| | - Desmond Yat-Hin Yap
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China; (W.-C.K.); (T.C.-C.T.); (D.Y.-H.Y.); (C.-K.T.); (R.Z.); (D.C.-L.L.); (M.S.-M.I.)
| | - Ting-Fung Ma
- Department of Statistics, University of South Carolina, Columbia, SC 29208, USA;
| | - Chung-Ki Tsui
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China; (W.-C.K.); (T.C.-C.T.); (D.Y.-H.Y.); (C.-K.T.); (R.Z.); (D.C.-L.L.); (M.S.-M.I.)
| | - Ru Zhang
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China; (W.-C.K.); (T.C.-C.T.); (D.Y.-H.Y.); (C.-K.T.); (R.Z.); (D.C.-L.L.); (M.S.-M.I.)
| | - David Chi-Leung Lam
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China; (W.-C.K.); (T.C.-C.T.); (D.Y.-H.Y.); (C.-K.T.); (R.Z.); (D.C.-L.L.); (M.S.-M.I.)
| | - Mary Sau-Man Ip
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China; (W.-C.K.); (T.C.-C.T.); (D.Y.-H.Y.); (C.-K.T.); (R.Z.); (D.C.-L.L.); (M.S.-M.I.)
| | - James Chung-Man Ho
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China; (W.-C.K.); (T.C.-C.T.); (D.Y.-H.Y.); (C.-K.T.); (R.Z.); (D.C.-L.L.); (M.S.-M.I.)
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4
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Fullana Barceló MI, Artigues Serra F, Millan Pons AR, Asensio Rodriguez J, Ferre Beltran A, Del Carmen Lopez Bilbao M, Reina Prieto J, Riera Jaume M. Analysis of viral pneumonia and risk factors associated with severity of influenza virus infection in hospitalized patients from 2012 to 2016. BMC Infect Dis 2024; 24:302. [PMID: 38475703 DOI: 10.1186/s12879-024-09173-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 02/24/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Influenza viruses cause pneumonia in approximately one-third of cases, and pneumonia is an important cause of death. The aim was to identify risk factors associated with severity and those that could predict the development of pneumonia. METHODS This retrospective, observational study included all adult patients with confirmed influenza virus infection admitted to Son Espases University Hospital during four influenza seasons in Spain (October to May) from to 2012-2016. RESULTS Overall, 666 patients with laboratory-confirmed influenza were included, 93 (14%) of which were severe; 73 (10.9%) were admitted to Intensive Care Unit (ICU), 39 (5.8%) died, and 185 (27.7%) developed pneumonia. Compared to less severe cases, patients with severe disease: were less vaccinated (40% vs. 28%, p = 0.021); presented with more confusion (26.9% vs. 6.8%), were more hypoxemic (Horowitz index (PaO2/FiO2) 261 vs. 280), had higher C-reactive protein (CRP) (12.3 vs. 4.0), had more coinfections (26.8% vs. 6.3%) and had more pleural effusion (14% vs. 2.6%) (last six all p < 0.001). Risk factors significantly associated with severity were pneumonia [OR (95% CI) = 4.14 (2.4-7.16)], history of heart disease (1.84, 1.03-3.28), and confusion at admission (4.99, 2.55-9.74). Influenza vaccination was protective (0.53, 0.28-0.98). Compared to those without pneumonia, the pneumonia group had higher CRP (11.3 vs. 4.0, p < 0.001), lower oxygen saturation (92% vs. 94%, p < 0.001), were more hypoxic (PaO2/FiO2 266 vs. 281, p < 0.001), and incurred more mechanical ventilation, septic shock, admission to the ICU, and deaths (all four p < 0.001). Higher CRP and lower oxygen saturation were independent variables for predicting the development of pneumonia. CONCLUSIONS Pneumonia, history of heart disease, confusion and no influenza vaccination were independent variables to present complications in patients admitted with influenza infection.
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Affiliation(s)
- M I Fullana Barceló
- Internal Medicine Department, Infectious Diseases Section, Hospital Universitari Son Espases, Valldemossa Road 79, Palma de Mallorca, 07010, Spain.
| | - F Artigues Serra
- Internal Medicine Department, Infectious Diseases Section, Hospital Universitari Son Espases, Valldemossa Road 79, Palma de Mallorca, 07010, Spain
| | - A R Millan Pons
- IdISBa estadistic and methodological support, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - J Asensio Rodriguez
- Internal Medicine Department, Infectious Diseases Section, Hospital Universitari Son Espases, Valldemossa Road 79, Palma de Mallorca, 07010, Spain
| | - A Ferre Beltran
- Internal Medicine Department, Infectious Diseases Section, Hospital Universitari Son Espases, Valldemossa Road 79, Palma de Mallorca, 07010, Spain
| | | | - J Reina Prieto
- Microbiological Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - M Riera Jaume
- Internal Medicine Department, Infectious Diseases Section, Hospital Universitari Son Espases, Valldemossa Road 79, Palma de Mallorca, 07010, Spain
- IdISBa- Fundació Institut d'Investigació Sanitària Illes Balears, Palma de Mallorca, Spain
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Jia L, Luo H, Li L, Wang M, Liu J, Liang Y, Li S, Jiang Y, Yang J, Song H. Targeting complement hyperactivation: a novel therapeutic approach for severe pneumonia induced by influenza virus/staphylococcus aureus coinfection. Signal Transduct Target Ther 2023; 8:467. [PMID: 38155175 PMCID: PMC10754916 DOI: 10.1038/s41392-023-01714-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 10/16/2023] [Accepted: 11/15/2023] [Indexed: 12/30/2023] Open
Affiliation(s)
- Leili Jia
- Institute for Disease Control and Prevention of PLA, Beijing, China
| | - Haihua Luo
- Guangdong Provincial Key Laboratory of Proteomics, State Key Laboratory of Organ Failure Research, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Lizhong Li
- Institute for Disease Control and Prevention of PLA, Beijing, China
| | - Mingyao Wang
- State Key Laboratory of Common Mechanism Research for Major Diseases, Institute of Basic Medical Sciences, Chinese Academy of Medical Science and Peking Union Medical College, 100005, Beijing, China
| | - Jiangfeng Liu
- State Key Laboratory of Common Mechanism Research for Major Diseases, Institute of Basic Medical Sciences, Chinese Academy of Medical Science and Peking Union Medical College, 100005, Beijing, China
| | - Yuan Liang
- Institute for Disease Control and Prevention of PLA, Beijing, China
| | - Shan Li
- Guangdong Provincial Key Laboratory of Proteomics, State Key Laboratory of Organ Failure Research, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Yong Jiang
- Guangdong Provincial Key Laboratory of Proteomics, State Key Laboratory of Organ Failure Research, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China.
| | - Juntao Yang
- State Key Laboratory of Common Mechanism Research for Major Diseases, Institute of Basic Medical Sciences, Chinese Academy of Medical Science and Peking Union Medical College, 100005, Beijing, China.
| | - Hongbin Song
- Institute for Disease Control and Prevention of PLA, Beijing, China.
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Newell K, Fischer M, Massey S, Orell L, Steinberg J, Tompkins M, Castrodale L, McLaughlin J. Temporally Associated Invasive Pneumococcal Disease and SARS-CoV-2 Infection, Alaska, USA, 2020-2021. Emerg Infect Dis 2023; 29:1765-1771. [PMID: 37506683 PMCID: PMC10461657 DOI: 10.3201/eid2909.230080] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023] Open
Abstract
Streptococcus pneumoniae can co-infect persons who have viral respiratory tract infections. However, research on S. pneumoniae infections that are temporally associated with SARS-CoV-2 infections is limited. We described the epidemiology and clinical course of patients who had invasive pneumococcal disease (IPD) and temporally associated SARS-CoV-2 infections in Alaska, USA, during January 1, 2020-December 23, 2021. Of 271 patients who had laboratory-confirmed IPD, 55 (20%) had a positive SARS-CoV-2 test result. We observed no major differences in age, race, sex, or underlying medical conditions among IPD patients with and without SARS-CoV-2. However, a larger proportion of IPD patients with SARS-CoV-2 died (16%, n = 9) than for those with IPD alone (4%, n = 9) (p<0.01). IPD patients with SARS-CoV-2 were also more likely to be experiencing homelessness (adjusted OR 3.5; 95% CI 1.7-7.5). Our study highlights the risk for dual infection and ongoing benefits of pneumococcal and COVID-19 vaccination, especially among vulnerable populations.
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Le J, Kulatheepan Y, Jeyaseelan S. Role of toll-like receptors and nod-like receptors in acute lung infection. Front Immunol 2023; 14:1249098. [PMID: 37662905 PMCID: PMC10469605 DOI: 10.3389/fimmu.2023.1249098] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/28/2023] [Indexed: 09/05/2023] Open
Abstract
The respiratory system exposed to microorganisms continuously, and the pathogenicity of these microbes not only contingent on their virulence factors, but also the host's immunity. A multifaceted innate immune mechanism exists in the respiratory tract to cope with microbial infections and to decrease tissue damage. The key cell types of the innate immune response are macrophages, neutrophils, dendritic cells, epithelial cells, and endothelial cells. Both the myeloid and structural cells of the respiratory system sense invading microorganisms through binding or activation of pathogen-associated molecular patterns (PAMPs) to pattern recognition receptors (PRRs), including Toll-like receptors (TLRs) and NOD-like receptors (NLRs). The recognition of microbes and subsequent activation of PRRs triggers a signaling cascade that leads to the activation of transcription factors, induction of cytokines/5chemokines, upregulation of cell adhesion molecules, recruitment of immune cells, and subsequent microbe clearance. Since numerous microbes resist antimicrobial agents and escape innate immune defenses, in the future, a comprehensive strategy consisting of newer vaccines and novel antimicrobials will be required to control microbial infections. This review summarizes key findings in the area of innate immune defense in response to acute microbial infections in the lung. Understanding the innate immune mechanisms is critical to design host-targeted immunotherapies to mitigate excessive inflammation while controlling microbial burden in tissues following lung infection.
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Affiliation(s)
- John Le
- Laboratory of Lung Biology, Department of Pathobiological Sciences and Center for Lung Biology and Disease, School of Veterinary Medicine, Louisiana State University (LSU) and Agricultural & Mechanical College, Baton Rouge, LA, United States
| | - Yathushigan Kulatheepan
- Laboratory of Lung Biology, Department of Pathobiological Sciences and Center for Lung Biology and Disease, School of Veterinary Medicine, Louisiana State University (LSU) and Agricultural & Mechanical College, Baton Rouge, LA, United States
| | - Samithamby Jeyaseelan
- Laboratory of Lung Biology, Department of Pathobiological Sciences and Center for Lung Biology and Disease, School of Veterinary Medicine, Louisiana State University (LSU) and Agricultural & Mechanical College, Baton Rouge, LA, United States
- Section of Pulmonary and Critical Care Department of Medicine, LSU Health Sciences Center, New Orleans, LA, United States
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Hu C, Wei KC, Wang WH, Chang YC, Huang YT. Association of Influenza Vaccination With Risk of Bell Palsy Among Older Adults in Taiwan. JAMA Otolaryngol Head Neck Surg 2023; 149:726-734. [PMID: 37347468 PMCID: PMC10288376 DOI: 10.1001/jamaoto.2023.1392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/28/2023] [Indexed: 06/23/2023]
Abstract
Importance Annual administration of the influenza vaccine (fluVc) is currently the most effective method of preventing the influenza virus in older adults. However, half of adults older than 65 years remain unvaccinated in Taiwan, possibly because of concern about adverse events, such as Bell palsy (BP). Currently, studies on the association between fluVc and risk of BP are inconsistent. Objective To determine whether the incidence of BP increases following fluVc in older adults. Design, Setting, and Participants A self-controlled case series study design was used. Days 1 through 7, days 8 through 14, days 15 through 30, and days 31 through 60 following fluVc were identified as risk intervals, and days 61 through 180 were considered the control interval. A total of 4367 vaccinated individuals aged 65 years or older who developed BP within 6 months following fluVc were enrolled. Population-based retrospective claims data were obtained between 2010 and 2017; data were analyzed from April 2022 through September 2022. Exposure Government-funded seasonal fluVc. Main Outcomes and Measures The outcome of interest was BP onset in risk intervals compared with control intervals. Three or more consecutive diagnoses of BP within 60 days following fluVc were used as the definition of a patient with BP. Poisson regression was used to analyze the incidence rate ratio (IRR) of risk intervals compared with control intervals. Results In total, 13 261 521 patients who received the fluVc were extracted from the National Health Insurance Research Database in Taiwan from January 1, 2010, to December 31, 2017. Of those, 7 581 205 patients older than 65 years old met the inclusion criteria. The number of patients with BP diagnosed within 6 months following fluVc enrolled for risk analysis was 4367 (mean [SD] age, 74.19 [5.97] years; 2349 [53.79%] female patients). The incidence rate of BP among all observed fluVc older adults was 57.87 per 100 000 person-years. The IRRs for BP on days 1 through 7, days 8 through 14, and days 15 through 30 were 4.18 (95% CI, 3.82-4.59), 2.73 (95% CI, 2.45-3.05), and 1.67 (95% CI, 1.52-1.84), respectively. However, there was no increase during days 31 through 60 (IRR, 1.06; 95% CI, 0.97-1.16). The postvaccination risk of BP was consistent across all subgroups stratified by sex, age group, and baseline conditions. Conclusions and Relevance The present self-controlled case series indicated that the risk of BP in individuals older than 65 years increased within the first month, especially within the first week, following fluVc. But overall, the adverse event rate of BP was low, and considering the morbidity and mortality of influenza infection, the benefits of fluVc still outweigh the risks.
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Affiliation(s)
- Chin Hu
- Department of Nuclear Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Kai-Che Wei
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Hwa Wang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Health Management Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Yu-Chia Chang
- Department of Long Term Care, College of Health and Nursing, National Quemoy University, Kinmen County, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Yu-Tung Huang
- Center for Big Data Analytics and Statistics, Department of Medical Research & Development, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
- Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan
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Schwerdtner M, Skalik A, Limburg H, Bierwagen J, Jung AL, Dorna J, Kaufmann A, Bauer S, Schmeck B, Böttcher-Friebertshäuser E. Expression of TMPRSS2 is up-regulated by bacterial flagellin, LPS, and Pam3Cys in human airway cells. Life Sci Alliance 2023; 6:e202201813. [PMID: 37208193 PMCID: PMC10200810 DOI: 10.26508/lsa.202201813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/21/2023] Open
Abstract
Many viruses require proteolytic activation of their envelope proteins for infectivity, and relevant host proteases provide promising drug targets. The transmembrane serine protease 2 (TMPRSS2) has been identified as a major activating protease of influenza A virus (IAV) and various coronaviruses (CoV). Increased TMPRSS2 expression has been associated with a higher risk of severe influenza infection and enhanced susceptibility to SARS-CoV-2. Here, we found that Legionella pneumophila stimulates the increased expression of TMPRSS2-mRNA in Calu-3 human airway cells. We identified flagellin as the dominant structural component inducing TMPRSS2 expression. The flagellin-induced increase was not observed at this magnitude for other virus-activating host proteases. TMPRSS2-mRNA expression was also significantly increased by LPS, Pam3Cys, and Streptococcus pneumoniae, although less pronounced. Multicycle replication of H1N1pdm and H3N2 IAV but not SARS-CoV-2 and SARS-CoV was enhanced by flagellin treatment. Our data suggest that bacteria, particularly flagellated bacteria, up-regulate the expression of TMPRSS2 in human airway cells and, thereby, may support enhanced activation and replication of IAV upon co-infections. In addition, our data indicate a physiological role of TMPRSS2 in antimicrobial host response.
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Affiliation(s)
- Marie Schwerdtner
- Institute of Virology, Philipps-University Marburg, Marburg, Germany
| | - Annika Skalik
- Institute of Virology, Philipps-University Marburg, Marburg, Germany
| | - Hannah Limburg
- Institute of Virology, Philipps-University Marburg, Marburg, Germany
| | - Jeff Bierwagen
- Institute for Lung Research, Universities of Giessen and Marburg Lung Center, Philipps-University Marburg, German Center for Lung Research (DZL), Marburg, Germany
| | - Anna Lena Jung
- Institute for Lung Research, Universities of Giessen and Marburg Lung Center, Philipps-University Marburg, German Center for Lung Research (DZL), Marburg, Germany
| | - Jens Dorna
- Institute of Immunology, Philipps-University Marburg, Marburg, Germany
| | - Andreas Kaufmann
- Institute of Immunology, Philipps-University Marburg, Marburg, Germany
| | - Stefan Bauer
- Institute of Immunology, Philipps-University Marburg, Marburg, Germany
| | - Bernd Schmeck
- Institute for Lung Research, Universities of Giessen and Marburg Lung Center, Philipps-University Marburg, German Center for Lung Research (DZL), Marburg, Germany
- Department of Pulmonary and Critical Care Medicine, Philipps-University Marburg, Marburg, Germany, Member of the German Center for Infectious Disease Research (DZIF), Marburg, Germany
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10
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Falces-Romero I, Bloise I, García-Rodríguez J, Cendejas-Bueno E. Staphylococcus aureus bacteremia in patients with SARS-CoV-2 infection. MEDICINA CLINICA (ENGLISH ED.) 2023; 160:495-498. [PMID: 37311167 PMCID: PMC10250598 DOI: 10.1016/j.medcle.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 01/18/2023] [Indexed: 06/15/2023]
Abstract
Objectives The aim was to compare the incidence of Staphylococcus aureus bacteremia in COVID-19 and non-COVID-19 adult patients during the pandemic period versus the previous two years. Also, we described the characteristics of both cohorts of patients in pandemic period to find differences. Material and methods Retrospective study in our tertiary-care centre reviewing S. aureus bacteremia episodes in COVID-19 and non-COVID-19 patients through clinical records and the Microbiology Department database. Results In 2018 and 2019, the incidence of S. aureus bacteremia episodes was 1.95 and 1.63 per 1000 admissions respectively. In the pandemic period, global incidence was 1.96 episodes per 1000 non-COVID-19 admissions and 10.59 episodes per 1000 COVID-19 admissions. A total of 241 bacteremia was registered during this pandemic period in 74 COVID-19 patients and in 167 non-COVID-19 patients. Methicillin resistance was detected in 32.4% and 13.8% of isolates from COVID-19 and non-COVID-19 patients respectively. In COVID-19 patients, mortality rates were significantly higher. Conclusions We showed a significantly high rates of S. aureus bacteremia incidence in COVID-19 patients and higher methicillin resistance and 15-day mortality rates than in non-COVID-19 patients.
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Affiliation(s)
- Iker Falces-Romero
- Clinical Microbiology and Parasitology Department, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Iván Bloise
- Clinical Microbiology and Parasitology Department, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - Julio García-Rodríguez
- Clinical Microbiology and Parasitology Department, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Emilio Cendejas-Bueno
- Clinical Microbiology and Parasitology Department, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
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11
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Susan M, Susan R, Lazar V, Bagiu IC, Mihu AG, Bagiu RV, Ionescu A, Iana AN, Dehelean CA, Lighezan D, Marti DT. COVID-19 association with multidrug-resistant bacteria superinfections: Lessons for future challenges. Exp Ther Med 2023; 25:254. [PMID: 37153889 PMCID: PMC10161190 DOI: 10.3892/etm.2023.11953] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 03/07/2023] [Indexed: 05/10/2023] Open
Abstract
The future waves of COVID 19 infections will continue to raise serious problems in patients with severe forms of the disease. Bacterial infections associated with SARS-CoV-2 disease may complicate the progress of hospitalized patients with COVID-19. The present study aimed to evaluate the etiological spectrum of superinfection in adult patients with COVID-19 and to investigate the correlation between superinfection with multidrug-resistant (MDR) bacteria and serum procalcitonin (PCT). A total of 82 COVID-19 hospitalized patients with COVID-19 and bacterial superinfection were included. The superinfections were classified into early infections (3-7 days from admission) and late infections (>7 days from admission). Bacterial superinfection etiological spectrum, MDR bacteria profile and levels of serum PCT were studied. The most frequently isolated bacteria were Klebsiella pneumoniae, Acinetobacter baumannii and Enterococcus spp. MDR bacteria were involved in 73.17% of COVID-19 patients with bacterial superinfections. Most MDR bacteria superinfections (73.52%) occurred in the late infection period. Klebsiella pneumoniae, Enterococcus spp. and Methicillin-resistant Staphylococcus aureus were the most common MDR bacteria identified in late infections after hospitalization in 20.43, 4.30 and 4.30% of all infections, respectively. Serum PCT values were significantly higher in patients with MDR bacteria superinfection compared with patients with sensitive bacteria superinfection (P=0.009). The principal findings of the present study were the high prevalence of superinfection with MDR bacteria among the COVID-19 patients with bacterial superinfections and the presence of a statistically significant association between serum PCT levels and the presence of superinfection with MDR bacteria. The most effective way to fight against microbial resistance to antibiotics, whether it occurs independently or overlaps with viral infections, is to pursue a national policy for the rational use of antibiotics.
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Affiliation(s)
- Monica Susan
- Department of Internal Medicine, Centre for Preventive Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara 300041, Romania
| | - Razvan Susan
- Department of Family Medicine, Centre for Preventive Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara 300041, Romania
- Correspondence to: Dr Razvan Susan, Department of Family Medicine, Centre for Preventive Medicine, Victor Babes University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., Timisoara 300041, Romania
| | - Viorica Lazar
- Department of General Medicine, Vasile Goldis University of Medicine, Arad 310048, Romania
- Pediatric Clinic II, Clinical Hospital Emergency of Arad County, Arad 310037, Romania
| | - Iulia-Cristina Bagiu
- Department of Microbiology, Multidisciplinary Research Center on Antimicrobial Resistance, Victor Babes University of Medicine and Pharmacy, Timisoara 300041, Romania
| | - Alin Gabriel Mihu
- Bioclinica Medical Analysis Laboratory, Arad 310300, Romania
- Department of Biology and Life Sciences, Vasile Goldis University of Medicine, Arad 310048, Romania
| | - Radu Vasile Bagiu
- Department of Hygiene, Preventive Medicine Study Center, Victor Babes University of Medicine and Pharmacy, Timisoara 300041, Romania
| | - Alin Ionescu
- Department of Family Medicine, Centre for Preventive Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara 300041, Romania
| | - Andreea Narcisa Iana
- Department of Family Medicine, Centre for Preventive Medicine, Victor Babes University of Medicine and Pharmacy, Timisoara 300041, Romania
| | - Cristina Adriana Dehelean
- Department of Toxicology, Research Center for Pharmaco-Toxicological Evaluations, Victor Babes University of Medicine and Pharmacy, Timisoara 300041, Romania
| | - Daniel Lighezan
- Department of Internal Medicine, Advanced Research Center for Cardiovascular Pathology and Haemostaseology, Victor Babes University of Medicine and Pharmacy, Timisoara 300041, Romania
| | - Daniela Teodora Marti
- Department of Biology and Life Sciences, Vasile Goldis University of Medicine, Arad 310048, Romania
- Clinical Analysis Laboratory, Clinical Hospital Emergency of Arad County, Arad 310037, Romania
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Ozbay S, Ayan M, Ozsoy O, Akman C, Karcioglu O. Diagnostic and Prognostic Roles of Procalcitonin and Other Tools in Community-Acquired Pneumonia: A Narrative Review. Diagnostics (Basel) 2023; 13:diagnostics13111869. [PMID: 37296721 DOI: 10.3390/diagnostics13111869] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
Community-acquired pneumonia (CAP) is among the most common causes of death and one of the leading healthcare concerns worldwide. It can evolve into sepsis and septic shock, which have a high mortality rate, especially in critical patients and comorbidities. The definitions of sepsis were revised in the last decade as "life-threatening organ dysfunction caused by a dysregulated host response to infection". Procalcitonin (PCT), C-reactive protein (CRP), and complete blood count, including white blood cells, are among the most commonly analyzed sepsis-specific biomarkers also used in pneumonia in a broad range of studies. It appears to be a reliable diagnostic tool to expedite care of these patients with severe infections in the acute setting. PCT was found to be superior to most other acute phase reactants and indicators, including CRP as a predictor of pneumonia, bacteremia, sepsis, and poor outcome, although conflicting results exist. In addition, PCT use is beneficial to judge timing for the cessation of antibiotic treatment in most severe infectious states. The clinicians should be aware of strengths and weaknesses of known and potential biomarkers in expedient recognition and management of severe infections. This manuscript is intended to present an overview of the definitions, complications, and outcomes of CAP and sepsis in adults, with special regard to PCT and other important markers.
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Affiliation(s)
- Sedat Ozbay
- Department of Emergency Medicine, Sivas Numune Education and Research Hospital, Sivas 58040, Turkey
| | - Mustafa Ayan
- Department of Emergency Medicine, Sivas Numune Education and Research Hospital, Sivas 58040, Turkey
| | - Orhan Ozsoy
- Department of Emergency Medicine, Sivas Numune Education and Research Hospital, Sivas 58040, Turkey
| | - Canan Akman
- Department of Emergency Medicine, Canakkale Onsekiz Mart University, Canakkale 17100, Turkey
| | - Ozgur Karcioglu
- Department of Emergency Medicine, University of Health Sciences, Taksim Education and Research Hospital, Beyoglu, Istanbul 34098, Turkey
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13
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Shirata M, Ito I, Jo T, Iwao T, Oi I, Hamao N, Nishioka K, Yamana H, Nagase T, Yasunaga H, Hirai T. Factors Associated With the Development of Bacterial Pneumonia Related to Seasonal Influenza Virus Infection: A Study Using a Large-scale Health Insurance Claim Database. Open Forum Infect Dis 2023; 10:ofad222. [PMID: 37234515 PMCID: PMC10205552 DOI: 10.1093/ofid/ofad222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
Background Influenza-related bacterial pneumonia is a leading complication of influenza infection. However, the differences in the incidence rates and risk factors associated with concomitant viral/bacterial pneumonia (CP) and secondary bacterial pneumonia following influenza (SP) remain unclear. This study aimed to clarify the incidence rates of CP and SP following seasonal influenza and identify factors associated with their development. Methods This retrospective cohort study was conducted using the JMDC Claims Database, a health insurance claims database in Japan. All patients aged <75 years who developed influenza during 2 consecutive epidemic seasons, 2017/2018 and 2018/2019, were analyzed. CP was defined as bacterial pneumonia diagnosed between 3 days before and 6 days after the date of influenza diagnosis, and SP was defined as pneumonia diagnosed 7-30 days after the date of diagnosis. Multivariable logistic regression analyses were performed to identify factors associated with the development of CP and SP. Results Among the 10 473 014 individuals registered in the database, 1 341 355 patients with influenza were analyzed. The average age at diagnosis (SD) was 26.6 (18.6) years. There were 2901 (0.22%) and 1262 (0.09%) patients who developed CP and SP, respectively. Age 65-74 years, asthma, chronic bronchitis/emphysema, cardiovascular disease, renal disease, malignant tumor, and immunosuppression were significant risk factors for both CP and SP, whereas cerebrovascular disease, neurological disease, liver disease, and diabetes were risk factors specific to CP development. Conclusions The results determined the incidence rates of CP and SP and identified their risk factors, such as older age and comorbidities.
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Affiliation(s)
- Masahiro Shirata
- Correspondence: Isao Ito, MD, PhD, Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo, Kyoto 606-8507, Japan (); or Masahiro Shirata, MD, Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo, Kyoto 606-8507, Japan ()
| | - Isao Ito
- Correspondence: Isao Ito, MD, PhD, Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo, Kyoto 606-8507, Japan (); or Masahiro Shirata, MD, Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo, Kyoto 606-8507, Japan ()
| | - Taisuke Jo
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomohide Iwao
- Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan
| | - Issei Oi
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Nobuyoshi Hamao
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kensuke Nishioka
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hayato Yamana
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takahide Nagase
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Yi G, de Kraker MEA, Buetti N, Zhong X, Li J, Yuan Z, Zhu W, Zhou J, Zhou H. Risk factors for in-hospital mortality and secondary bacterial pneumonia among hospitalized adult patients with community-acquired influenza: a large retrospective cohort study. Antimicrob Resist Infect Control 2023; 12:25. [PMID: 37004057 PMCID: PMC10064953 DOI: 10.1186/s13756-023-01234-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 03/22/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Secondary bacterial pneumonia is an important complication of seasonal influenza, but little data is available about impact on death and risk factors. This study identified risk factors for all-cause in-hospital mortality and secondary bacterial pneumonia among hospitalized adult patients with community-acquired influenza. METHODS A retrospective cohort study was performed at a tertiary teaching hospital in southwest China. The study cohort included all adult hospitalized patients with a laboratory-confirmed, community-acquired influenza virus infection during three consecutive influenza seasons from 2017 to 2020. Cause-specific Cox regression was used to analyze risk factors for mortality and secondary bacterial pneumonia, respectively, accounting for competing events (discharge alive and discharge alive or death without secondary bacterial pneumonia, respectively). RESULTS Among 174 patients enrolled in this study, 14.4% developed secondary bacterial pneumonia and 11.5% died during hospitalization. For all-cause in-hospital mortality, time-varying secondary bacterial pneumonia was a direct risk factor of death (cause-specific hazard ratio [csHR] 3.38, 95% confidence interval [CI] 1.25-9.17); underlying disease indirectly increased death risk through decreasing the hazard of being discharged alive (csHR 0.55, 95% CI 0.39-0.77). For secondary bacterial pneumonia, the final model only confirmed direct risk factors: age ≥ 65 years (csHR 2.90, 95% CI 1.27-6.62), male gender (csHR 3.78, 95% CI 1.12-12.84) and mechanical ventilation on admission (csHR 2.96, 95% CI 1.32-6.64). CONCLUSIONS Secondary bacterial pneumonia was a major risk factor for in-hospital mortality among adult hospitalized patients with community-acquired influenza. Prevention strategies for secondary bacterial pneumonia should target elderly male patients and critically ill patients under mechanical ventilation.
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Affiliation(s)
- Guangzhao Yi
- Department of Hospital Infection Control, The First Affiliated Hospital of Chongqing Medical University, You Yi Road 1, Chongqing, 400016, China
- Department of Disease Prevention and Health Protection, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Marlieke E A de Kraker
- Infection Control Program, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Niccolò Buetti
- Infection Control Program, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Xiaoni Zhong
- Research Center for Medicine and Social Development, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Jinyan Li
- Information Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhe Yuan
- Department of Hospital Infection Control, The First Affiliated Hospital of Chongqing Medical University, You Yi Road 1, Chongqing, 400016, China
- Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weimin Zhu
- Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Disease Prevention and Health Protection, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jia Zhou
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hongyu Zhou
- Department of Hospital Infection Control, The First Affiliated Hospital of Chongqing Medical University, You Yi Road 1, Chongqing, 400016, China.
- Research Center for Medicine and Social Development, School of Public Health, Chongqing Medical University, Chongqing, China.
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15
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Liu YN, Zhang YF, Xu Q, Qiu Y, Lu QB, Wang T, Zhang XA, Lin SH, Lv CL, Jiang BG, Li H, Li ZJ, Gao GF, Yang WZ, Hay SI, Wang LP, Fang LQ, Liu W. Infection and co-infection patterns of community-acquired pneumonia in patients of different ages in China from 2009 to 2020: a national surveillance study. THE LANCET MICROBE 2023; 4:e330-e339. [PMID: 37001538 DOI: 10.1016/s2666-5247(23)00031-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Severe community-acquired pneumonia (SCAP) is associated with a substantial number of hospitalisations and deaths worldwide. Infection or co-infection patterns, along with their age dependence and clinical effects are poorly understood. We aimed to explore the causal and epidemiological characteristics by age, to better describe patterns of community-acquired pneumonia (CAP) and their association with severe disease. METHODS National surveillance of CAP was conducted through a network of hospitals in 30 provinces in China from 2009-20 inclusive. Patients with CAP were included if they had evidence of acute respiratory tract, had evidence of pneumonia by chest radiography, diagnosis of pneumonia within 24 h of hospital admission, and resided in the study catchment area. For the enrolled patients with CAP, nasopharyngeal and oral swabs were taken and tested for eight viral pathogens; and blood, urine, or expectorated sputum was tested for six bacterial pathogens. Clinical outcomes, including SCAP, were investigated with respect to age and patterns of infections or co-infections by performing binary logistic regression and multivariate analysis. FINDINGS Between January, 2009, and December, 2020, 18 807 patients with CAP (3771 [20·05%] with SCAP) were enrolled. For both children (aged ≤5 years) and older adults (aged >60 years), a higher overall rate of viral and bacterial infections, as well as viral-bacterial co-infections were seen in patients with SCAP than in patients with non-SCAP. For adults (aged 18-60 years), however, only a higher rate of bacterial-bacterial co-infection was observed. The most frequent pathogens associated with SCAP were respiratory syncytial virus (RSV; 21·30%) and Streptococcus pneumoniae (12·61%) among children, and influenza virus (10·94%) and Pseudomonas aeruginosa (15·37%) among older adults. Positive rates of detection of most of the tested pathogens decreased during 2020 compared with the 2009-19 period, except for RSV, P aeruginosa, and Klebsiella pneumoniae. Multivariate analyses showed SCAP was significantly associated with infection with human adenovirus, human rhinovirus, K pneumoniae, or co-infection of RSV and Haemophilus influenzae or RSV and Staphylococcus aureus in children and adolescents (aged <18 years), and significantly associated with infection with P aeruginosa, K pneumoniae, or S pneumoniae, or co-infection with P aeruginosa and K pneumoniae in adults (aged ≥18 years). INTERPRETATION Both prevalence and infection pattern of respiratory pathogens differed between patients with SCAP and patients with non-SCAP in an age-dependent manner. These findings suggest potential advantages to age-related strategies for vaccine schedules, as well as clinical diagnosis, treatment, and therapy. FUNDING China Mega-Project on Infectious Disease Prevention and The National Natural Science Funds of China. TRANSLATION For the Chinese translation of the abstract see Supplementary Materials section.
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Wongsurakiat P, Sunhapanit S, Muangman N. Bacterial Coinfection and Superinfection in Respiratory Syncytial Virus-Associated Acute Respiratory Illness: Prevalence, Pathogens, Initial Antibiotic-Prescribing Patterns and Outcomes. Trop Med Infect Dis 2023; 8:tropicalmed8030148. [PMID: 36977149 PMCID: PMC10057067 DOI: 10.3390/tropicalmed8030148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023] Open
Abstract
We aimed to determine the prevalence of bacterial coinfection (CoBact) and bacterial superinfection (SuperBact), the causative pathogens, the initial antibiotic-prescribing practice, and the associated clinical outcomes of hospitalized patients with respiratory syncytial virus-associated acute respiratory illness (RSV-ARI). This retrospective study included 175 adults with RSV-ARI, virologically confirmed via RT-PCR, during the period 2014–2019. Thirty (17.1%) patients had CoBact, and 18 (10.3%) had SuperBact. The independent factors associated with CoBact were invasive mechanical ventilation (OR: 12.1, 95% CI: 4.7–31.4; p < 0.001) and neutrophilia (OR: 3.3, 95% CI: 1.3–8.5; p = 0.01). The independent factors associated with SuperBact were invasive mechanical ventilation (aHR: 7.2, 95% CI: 2.4–21.1; p < 0.001) and systemic corticosteroids (aHR: 3.1, 95% CI: 1.2–8.1; p = 0.02). CoBact was associated with higher mortality compared to patients without CoBact (16.7% vs. 5.5%, p = 0.05). Similarly, SuperBact was associated with higher mortality compared to patients without SuperBact (38.9% vs. 3.8%, p < 0.001). The most common CoBact pathogen identified was Pseudomonas aeruginosa (30%), followed by Staphylococcus aureus (23.3%). The most common SuperBact pathogen identified was Acinetobacter spp. (44.4%), followed by ESBL-positive Enterobacteriaceae (33.3%). Twenty-two (100%) pathogens were potentially drug-resistant bacteria. In patients without CoBact, there was no difference in mortality between patients who received an initial antibiotic treatment of <5 days or ≥5 days.
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Affiliation(s)
- Phunsup Wongsurakiat
- Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand
- Correspondence:
| | - Siwadol Sunhapanit
- Division of Pulmonary Medicine and Pulmonary Critical Care, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand
| | - Nisa Muangman
- Diagnostic Division, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand
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Abstract
OBJECTIVE We assessed the neurologic manifestation of influenza among hospitalized children with influenza (neuro-flu), comparing their demographic and clinical characteristics to hospitalized children without neurologic manifestation (classic-flu). METHODS A retrospective, cohort study. All children with laboratory confirmed influenza (PCR), admitted to the Soroka University Medical Center (SUMC) between 2016 and 2019 were included. RESULTS Overall, 951 patients were identified: 201 with neuro-flu, and 750 with classic-flu. Seizures (n = 125) were the most common neurological manifestation of neuro-flu (seizure-flu): 73 simple febrile seizures, 45 atypical febrile seizures, and 7 afebrile seizures. Neurological comorbidities rates were significantly higher in neuro-flu versus classic-flu (13.0% vs. 6.0%), while respiratory and cardiac comorbidities were less common in neuro-flu (4.5% and 0.5% vs. 8.0% and 4.5%, respectively). Neuro-flu (compared with classic-flu) was associated with leukocytosis (21.0% vs. 13.0%, P < 0.001) and lower C-reactive protein (CRP) levels (2.4 ± 4.1 vs. 3.3 ± 5.4, P = 0.03). Notably, patients with classic flu had a more prominent respiratory disease, as they had more chest radiographs (CXR) performed (60.5% vs. 45.0%, P < 0.001), higher rates of pneumonia (27.0% vs. 12.0%, P < 0.001), and antibiotic (antibacterial) treatment (60.0% vs. 42.0%, P < 0.001). CONCLUSIONS Influenza can appear as a neurologic disease, manifested mainly with febrile seizures. Children with neuro-flu have more neurologic comorbidities, suggesting that neuro-flu is mainly driven by host-factors, rather than by pathogen-factors. The relatively lower rates of pneumonia in neuro-flu suggests that these patients are admitted in the early stage of the influenza infection, which triggers the neurologic response.
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Abavisani M, Khayami R, Hoseinzadeh M, Kodori M, Kesharwani P, Sahebkar A. CRISPR-Cas system as a promising player against bacterial infection and antibiotic resistance. Drug Resist Updat 2023; 68:100948. [PMID: 36780840 DOI: 10.1016/j.drup.2023.100948] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/25/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023]
Abstract
The phenomenon of antibiotic resistance (AR) and its increasing global trends and destructive waves concerns patients and the healthcare system. In order to combat AR, it is necessary to explore new strategies when the current antibiotics fail to be effective. Thus, knowing the resistance mechanisms and appropriate diagnosis of bacterial infections may help enhance the sensitivity and specificity of novel strategies. On the other hand, resistance to antimicrobial compounds can spread from resistant populations to susceptible ones. Antimicrobial resistance genes (ARGs) significantly disseminate AR via horizontal and vertical gene transfer. The clustered regularly interspaced short palindromic repeats (CRISPR)-Cas system is a member of the bacterial immune system with the ability to remove the ARGs; therefore, it can be introduced as an effective and innovative strategy in the battle against AR. Here, we reviewed CRISPR-based bacterial diagnosis technologies. Moreover, the strategies to battle AR based on targeting bacterial chromosomes and resistance plasmids using the CRISPR-Cas system have been explained. Besides, we have presented the limitations of CRISPR delivery and potential solutions to help improve the future development of CRISPR-based platforms.
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Affiliation(s)
- Mohammad Abavisani
- Student research committee, Mashhad University of Medical Sciences, Mashhad, the Islamic Republic of Iran; Department of Microbiology and Virology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, the Islamic Republic of Iran
| | - Reza Khayami
- Department of Medical Genetics and Molecular Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, the Islamic Republic of Iran
| | - Melika Hoseinzadeh
- Student research committee, Mashhad University of Medical Sciences, Mashhad, the Islamic Republic of Iran
| | - Mansoor Kodori
- Non communicable Diseases Research Center, Bam University of Medical sciences, Bam, the Islamic Republic of Iran
| | - Prashant Kesharwani
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India; Center for Transdisciplinary Research, Department of Pharmacology, Saveetha Dental College, Saveetha Institute of Medical and Technical Science, Chennai, India
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, the Islamic Republic of Iran; Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, the Islamic Republic of Iran; Department of Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, the Islamic Republic of Iran.
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Editorial on the Research Topic of the Special Issue "Current Status of Acinetobacter Infections". Pathogens 2023; 12:pathogens12020219. [PMID: 36839491 PMCID: PMC9960586 DOI: 10.3390/pathogens12020219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023] Open
Abstract
Emerging bacterial infections will continue to be an important issue for public health, mostly because of the constant changes on our earth [...].
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20
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Falces-Romero I, Bloise I, García-Rodríguez J, Cendejas-Bueno E. Staphylococcus aureus bacteremia in patients with SARS-CoV-2 infection. Med Clin (Barc) 2023:S0025-7753(23)00029-5. [PMID: 36841646 PMCID: PMC9884619 DOI: 10.1016/j.medcli.2023.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The aim was to compare the incidence of Staphylococcus aureus bacteremia in COVID-19 and non-COVID-19 adult patients during the pandemic period versus the previous two years. Also, we described the characteristics of both cohorts of patients in pandemic period to find differences. MATERIAL AND METHODS Retrospective study in our tertiary-care centre reviewing S. aureus bacteremia episodes in COVID-19 and non-COVID-19 patients through clinical records and the Microbiology Department database. RESULTS In 2018 and 2019, the incidence of S. aureus bacteremia episodes was 1.95 and 1.63 per 1000 admissions respectively. In the pandemic period, global incidence was 1.96 episodes per 1000 non-COVID-19 admissions and 10.59 episodes per 1000 COVID-19 admissions. A total of 241 bacteremia was registered during this pandemic period in 74 COVID-19 patients and in 167 non-COVID-19 patients. Methicillin resistance was detected in 32.4% and 13.8% of isolates from COVID-19 and non-COVID-19 patients respectively. In COVID-19 patients, mortality rates were significantly higher. CONCLUSIONS We showed a significantly high rates of S. aureus bacteremia incidence in COVID-19 patients and higher methicillin resistance and 15-day mortality rates than in non-COVID-19 patients.
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Affiliation(s)
- Iker Falces-Romero
- Clinical Microbiology and Parasitology Department, Hospital Universitario La Paz, IdiPaz, Madrid, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
| | - Iván Bloise
- Clinical Microbiology and Parasitology Department, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - Julio García-Rodríguez
- Clinical Microbiology and Parasitology Department, Hospital Universitario La Paz, IdiPaz, Madrid, Spain,CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Emilio Cendejas-Bueno
- Clinical Microbiology and Parasitology Department, Hospital Universitario La Paz, IdiPaz, Madrid, Spain,CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
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Liao D, Su X, Wang J, Yu J, Luo H, Tian W, Ye Z, He J. Pushing the envelope: Immune mechanism and application landscape of macrophage-activating lipopeptide-2. Front Immunol 2023; 14:1113715. [PMID: 36761746 PMCID: PMC9902699 DOI: 10.3389/fimmu.2023.1113715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/10/2023] [Indexed: 01/25/2023] Open
Abstract
Mycoplasma fermentans can cause respiratory diseases, arthritis, genitourinary tract infections, and chronic fatigue syndrome and have been linked to the development of the human immunodeficiency virus. Because mycoplasma lacks a cell wall, its outer membrane lipoproteins are one of the main factors that induce inflammation in the organism and contribute to disease development. Macrophage-activating lipopeptide-2 (MALP-2) modulates the inflammatory response of monocytes/macrophages in a bidirectional fashion, indirectly enhances the cytotoxicity of NK cells, promotes oxidative bursts in neutrophils, upregulates surface markers on lymphocytes, enhances antigen presentation on dendritic cells and induces immune inflammatory responses in sebocytes and mesenchymal cells. MALP-2 is a promising vaccine adjuvant for this application. It also promotes vascular healing and regeneration, accelerates wound and bone healing, suppresses tumors and metastasis, and reduces lung infections and inflammation. MALP-2 has a simple structure, is easy to synthesize, and has promising prospects for clinical application. Therefore, this paper reviews the mechanisms of MALP-2 activation in immune cells, focusing on the application of MALP-2 in animals/humans to provide a basis for the study of pathogenesis in Mycoplasma fermentans and the translation of MALP-2 into clinical applications.
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Affiliation(s)
- Daoyong Liao
- The Affiliated Nanhua Hospital, Department of Clinical Laboratory, Hengyang Medical School, University of South China, Hengyang, China
| | - Xiaoling Su
- The Affiliated Nanhua Hospital, Department of Clinical Laboratory, Hengyang Medical School, University of South China, Hengyang, China
| | - Jingyun Wang
- The Affiliated Nanhua Hospital, Department of Clinical Laboratory, Hengyang Medical School, University of South China, Hengyang, China
| | - Jianwei Yu
- Department of Public Health Laboratory Sciences, School of Public Health, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Haodang Luo
- The Affiliated Nanhua Hospital, Department of Clinical Laboratory, Hengyang Medical School, University of South China, Hengyang, China,Institute of Pathogenic Biology, Hengyang Medical School, Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, China
| | - Wei Tian
- The Affiliated Nanhua Hospital, Department of Clinical Laboratory, Hengyang Medical School, University of South China, Hengyang, China
| | - Zufeng Ye
- The Affiliated Nanhua Hospital, Department of Clinical Laboratory, Hengyang Medical School, University of South China, Hengyang, China
| | - Jun He
- The Affiliated Nanhua Hospital, Department of Clinical Laboratory, Hengyang Medical School, University of South China, Hengyang, China,*Correspondence: Jun He,
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22
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Shi B, Han H, Li H, Tan L, Li X, Wang K, Li B, He W, Tian C, Yan F, Shi Y, Zheng Y, Zhao Z. NLRP6 Induces Lung Injury and Inflammation Early in Brucella and Influenza Coinfection. J Pers Med 2022; 12:jpm12122063. [PMID: 36556283 PMCID: PMC9785007 DOI: 10.3390/jpm12122063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022] Open
Abstract
(1) Background: With the resurgence of brucellosis epidemics in China in recent years, the chances of a brucella coinfection with other common respiratory pathogens, such as the influenza virus, have increased dramatically. However, little is known about the pathogenicity or the mechanisms of brucella and influenza coinfections. (2) Methods: To clarify the interventions in the early stages of lung damage due to brucella and influenza coinfections, we evaluated the effect of the coinfection on disease progression and mortality using a coinfection model in WT mice and NLRP6-/- mice, and we verified the function of NLRP6 in infection and proinflammation. (3) Results: The coinfection induced significant respiratory symptoms, weight loss, and a high mortality rate in WT mice. Influenza in the coinfection group significantly increased brucella proliferation in a synergistic manner. Meanwhile, a histological examination showed severe lung tissue destruction and excessive inflammatory responses in coinfected WT animals, and the expression of NLRP6 and IL-18 was dramatically increased in the lung tissues. Furthermore, NLRP6 deletion attenuated lung injuries and inflammation, a reduced bacterial load, and decreased IL-18 protein expression. (4) Conclusions: Our findings indicated that NLRP6 plays a critical role and might be a promising potential therapeutic target for brucella-influenza coinfections.
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Affiliation(s)
- Bochang Shi
- Inner Mongolia Key Laboratory of Molecular Biology, Inner Mongolia Medical University, Hohhot 010000, China
| | - Hui Han
- Inner Mongolia Key Laboratory of Molecular Biology, Inner Mongolia Medical University, Hohhot 010000, China
- Qingdao Binhai University, Qingdao 266000, China
| | - Huabin Li
- College of Veterinary Medicine, Shanxi Agricultural University, Jinzhong 030600, China
| | - Lingyun Tan
- School of Basic Medicine Sciences, Anhui Medical University, Hefei 230000, China
| | - Xinyu Li
- School of Basic Medicine Sciences, Anhui Medical University, Hefei 230000, China
| | - Keyu Wang
- Department of Clinical Laboratory, The Second Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing 100000, China
| | - Bo Li
- The Fifth Medical Center of PLA General Hospital, Beijing 100000, China
| | - Wei He
- School of Basic Medicine Sciences, Anhui Medical University, Hefei 230000, China
| | - Chongyu Tian
- College of Veterinary Medicine, Shanxi Agricultural University, Jinzhong 030600, China
| | - Fang Yan
- College of Veterinary Medicine, Shanxi Agricultural University, Jinzhong 030600, China
| | - Yanchun Shi
- Inner Mongolia Key Laboratory of Molecular Biology, Inner Mongolia Medical University, Hohhot 010000, China
| | - Yuanqiang Zheng
- Inner Mongolia Key Laboratory of Molecular Biology, Inner Mongolia Medical University, Hohhot 010000, China
- Beijing University of Chinese Medicine, Beijing 100000, China
- Correspondence: (Y.Z.); (Z.Z.); Tel.: +86-139-4810-1570 (Y.Z.); +86-186-1285-0349 (Z.Z.)
| | - Zhongpeng Zhao
- School of Basic Medicine Sciences, Anhui Medical University, Hefei 230000, China
- Correspondence: (Y.Z.); (Z.Z.); Tel.: +86-139-4810-1570 (Y.Z.); +86-186-1285-0349 (Z.Z.)
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23
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Oral mitis group streptococci reduce infectivity of influenza A virus via acidification and H2O2 production. PLoS One 2022; 17:e0276293. [DOI: 10.1371/journal.pone.0276293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 10/04/2022] [Indexed: 11/11/2022] Open
Abstract
Members of the mitis group streptococci are the most abundant inhabitants of the oral cavity and dental plaque. Influenza A virus (IAV), the causative agent of influenza, infects the upper respiratory tract, and co-infection with Streptococcus pneumoniae is a major cause of morbidity during influenza epidemics. S. pneumoniae is a member of mitis group streptococci and shares many features with oral mitis group streptococci. In this study, we investigated the effect of viable Streptococcus oralis, a representative member of oral mitis group, on the infectivity of H1N1 IAV. The infectivity of IAV was measured by a plaque assay using Madin-Darby canine kidney cells. When IAV was incubated in growing culture of S. oralis, the IAV titer decreased in a time- and dose-dependent manner and became less than 100-fold, whereas heat-inactivated S. oralis had no effect. Other oral streptococci such as Streptococcus mutans and Streptococcus salivarius also reduced the viral infectivity to a lesser extent compared to S. oralis and Streptococcus gordonii, another member of the oral mitis group. S. oralis produces hydrogen peroxide (H2O2) at a concentration of 1–2 mM, and its mutant deficient in H2O2 production showed a weaker effect on the inactivation of IAV, suggesting that H2O2 contributes to viral inactivation. The contribution of H2O2 was confirmed by an inhibition assay using catalase, an H2O2-decomposing enzyme. These oral streptococci produce short chain fatty acids (SCFA) such as acetic acid as a by-product of sugar metabolism, and we also found that the inactivation of IAV was dependent on the mildly acidic pH (around pH 5.0) of these streptococcal cultures. Although inactivation of IAV in buffers of pH 5.0 was limited, incubation in the same buffer containing 2 mM H2O2 resulted in marked inactivation of IAV, which was similar to the effect of growing S. oralis culture. Taken together, these results reveal that viable S. oralis can inactivate IAV via the production of SCFAs and H2O2. This finding also suggests that the combination of mildly acidic pH and H2O2 at low concentrations could be an effective method to inactivate IAV.
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24
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Influenza mortality in French regions after the Hong Kong flu pandemic. DEMOGRAPHIC RESEARCH 2022. [DOI: 10.4054/demres.2022.47.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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25
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Jones RP, Ponomarenko A. Roles for Pathogen Interference in Influenza Vaccination, with Implications to Vaccine Effectiveness (VE) and Attribution of Influenza Deaths. Infect Dis Rep 2022; 14:710-758. [PMID: 36286197 PMCID: PMC9602062 DOI: 10.3390/idr14050076] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/15/2022] [Accepted: 09/15/2022] [Indexed: 08/29/2023] Open
Abstract
Pathogen interference is the ability of one pathogen to alter the course and clinical outcomes of infection by another. With up to 3000 species of human pathogens the potential combinations are vast. These combinations operate within further immune complexity induced by infection with multiple persistent pathogens, and by the role which the human microbiome plays in maintaining health, immune function, and resistance to infection. All the above are further complicated by malnutrition in children and the elderly. Influenza vaccination offers a measure of protection for elderly individuals subsequently infected with influenza. However, all vaccines induce both specific and non-specific effects. The specific effects involve stimulation of humoral and cellular immunity, while the nonspecific effects are far more nuanced including changes in gene expression patterns and production of small RNAs which contribute to pathogen interference. Little is known about the outcomes of vaccinated elderly not subsequently infected with influenza but infected with multiple other non-influenza winter pathogens. In this review we propose that in certain years the specific antigen mix in the seasonal influenza vaccine inadvertently increases the risk of infection from other non-influenza pathogens. The possibility that vaccination could upset the pathogen balance, and that the timing of vaccination relative to the pathogen balance was critical to success, was proposed in 2010 but was seemingly ignored. Persons vaccinated early in the winter are more likely to experience higher pathogen interference. Implications to the estimation of vaccine effectiveness and influenza deaths are discussed.
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Affiliation(s)
- Rodney P Jones
- Healthcare Analysis and Forecasting, Wantage OX12 0NE, UK
| | - Andrey Ponomarenko
- Department of Biophysics, Informatics and Medical Instrumentation, Odessa National Medical University, Valikhovsky Lane 2, 65082 Odessa, Ukraine
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26
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Verma AK, McKelvey M, Uddin MB, Palani S, Niu M, Bauer C, Shao S, Sun K. IFN-γ transforms the transcriptomic landscape and triggers myeloid cell hyperresponsiveness to cause lethal lung injury. Front Immunol 2022; 13:1011132. [PMID: 36203588 PMCID: PMC9530332 DOI: 10.3389/fimmu.2022.1011132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
Acute Respiratory Distress Syndrome (ARDS) is an inflammatory disease that is associated with high mortality but no specific treatment. Our understanding of initial events that trigger ARDS pathogenesis is limited. We have developed a mouse model of inflammatory lung injury by influenza and methicillin-resistant Staphylococcus aureus (MRSA) coinfection plus daily antibiotic therapy. Using this pneumonic ARDS model, here we show that IFN-γ receptor signaling drives inflammatory cytokine storm and lung tissue damage. By single-cell RNA sequencing (scRNA-seq) analysis, we demonstrate that IFN-γ signaling induces a transcriptional shift in airway immune cells, particularly by upregulating macrophage and monocyte expression of genes associated with inflammatory diseases. Further evidence from conditional knockout mouse models reveals that IFN-γ receptor signaling in myeloid cells, particularly CD11c+ mononuclear phagocytes, directly promotes TNF-α hyperproduction and inflammatory lung damage. Collectively, the findings from this study, ranging from cell-intrinsic gene expression to overall disease outcome, demonstrate that influenza-induced IFN-γ triggers myeloid cell hyperresponsiveness to MRSA, thereby leading to excessive inflammatory response and lethal lung damage during coinfection.
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Affiliation(s)
- Atul K. Verma
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, United States
| | - Michael McKelvey
- Department of Experimental Pathology, University of Texas Medical Branch, Galveston, TX, United States
| | - Md Bashir Uddin
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, United States
| | - Sunil Palani
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, United States
| | - Meng Niu
- Department of Genetics, Cell Biology & Anatomy, University of Nebraska Medical Center, Omaha, NE, United States
| | - Christopher Bauer
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Shengjun Shao
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, United States
| | - Keer Sun
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, United States
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, United States
- *Correspondence: Keer Sun,
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27
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Orsini EM, Sacha GL, Han X, Wang X, Duggal A, Rajendram P. Risk factors associated with development of coinfection in critically Ill patients with COVID-19. Acute Crit Care 2022; 37:312-321. [PMID: 36102003 PMCID: PMC9475158 DOI: 10.4266/acc.2022.00136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/03/2022] [Indexed: 12/15/2022] Open
Abstract
Background At outset of the coronavirus disease 2019 (COVID-19) pandemic, the significance of bacterial and fungal coinfections in individuals with COVID-19 was unknown. Initial reports indicated that the prevalence of coinfection in the general population was low, but there was uncertainty regarding the risk of coinfection in critically ill patients. Methods Nine hundred critically ill adult patients with COVID-19 infection were enrolled in this observational case-control study. Patients with a coinfection (case) and patients without a coinfection (control) were compared using univariate and multivariable analyses. A subgroup analysis was performed on patients with coinfection, dividing them into early (infection within 7 days) and late (infection after 7 days) infection groups. Results Two hundred and thirty-three patients (25.9%) had a bacterial or fungal coinfection. Vasopressor use (P<0.001) and severity of illness (higher Acute Physiology and Chronic Health Evaluation III score, P=0.009) were risk factors for the development of a coinfection. Patients with coinfection had higher mortality and length of stay. Vasopressor and corticosteroid use and central line and foley catheter placement were risk factors for late infection (>7 days). There were high rates of drug-resistant infections. Conclusions Critically ill patients with COVID-19 are at risk for both community-acquired and hospital-acquired infections throughout their hospitalization for COVID-19. It is important to consider the development of a coinfection in clinically worsening critically ill patients with COVID-19 and consider the likelihood of drug-resistance when choosing an empiric regimen.
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28
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Britto C, Mohorianu I, Yeung T, Cheung E, Novak T, Hall MW, Mourani PM, Weiss SL, Thomas NJ, Markovitz B, Randolph AG, Moffitt KL. Host respiratory transcriptome signature associated with poor outcome in children with influenza-Staphylococcus aureus pneumonia. J Infect Dis 2022; 226:1286-1294. [PMID: 35899844 DOI: 10.1093/infdis/jiac325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/25/2022] [Indexed: 11/14/2022] Open
Abstract
Respiratory coinfection of influenza with Staphylococcus aureus often causes severe disease; methicillin resistant S. aureus (MRSA) coinfection is frequently fatal. Understanding disease pathogenesis may inform therapies. We aimed to identify host and pathogen transcriptomic (mRNA) signatures from the respiratory compartment of patients with influenza-S. aureus coinfection (ISAC) critical illness that predict worse outcomes. mRNA extracted from endotracheal aspirates was evaluated for S. aureus and host transcriptomic biosignatures. Influenza-MRSA outcomes were worse, but of 190 S. aureus virulence-associated genes, 6 were differentially expressed between MRSA- versus methicillin-susceptible S. aureus coinfected patients and none discriminated outcome. Host gene expression in ISAC patients was compared to influenza infection alone. Patients with poor clinical outcomes (death or prolonged multi-organ dysfunction) had relatively reduced expression of interferons and down-regulation of interferon gamma-induced immune cell chemoattractants CXCL10 and CXCL11. In influenza-S. aureus respiratory coinfection, airway host but not pathogen gene expression profiles predicted worse clinical outcomes.
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Affiliation(s)
- Carl Britto
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA.,Oxford Vaccine Group, Department of Paediatrics, University of Oxford, UK.,Division of Infectious Disease, St. John's Research Institute, Bengaluru, India
| | - Irina Mohorianu
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, UK.,Wellcome-MRC Cambridge, Stem Cell Institute, University of Cambridge, UK
| | - Tracy Yeung
- Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA
| | - Elaine Cheung
- Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA
| | - Tanya Novak
- Department of Anesthesia, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Anesthesia, Harvard Medical School, Boston, MA, USA
| | - Mark W Hall
- Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Peter M Mourani
- Department of Pediatrics, Section of Critical Care Medicine, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, AR, USA
| | - Scott L Weiss
- Division of Critical Care, Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Neal J Thomas
- Department of Pediatrics, Penn State Hershey Children's Hospital, Penn State University College of Medicine, Hershey, PA, USA
| | - Barry Markovitz
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Adrienne G Randolph
- Department of Anesthesia, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Anesthesia, Harvard Medical School, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Kristin L Moffitt
- Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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29
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Gómez-Zorrilla S, Sendra E, Horcajada JP. A profile of delafloxacin in the treatment of adults with community-acquired bacterial pneumonia. Expert Rev Clin Pharmacol 2022; 15:671-688. [PMID: 35838033 DOI: 10.1080/17512433.2022.2100346] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Community-acquired bacterial pneumonia (CABP) is the most common infectious cause of hospital admission in adults, and poses a significant clinical and economic burden. At the same time, antimicrobial resistance is increasing worldwide with only a few new antibiotics developed in recent years. Delafloxacin is an anionic fluoroquinolone available in intravenous and oral formulations and with a broad spectrum of activity targeting Gram-positives, including methicillin-resistant Staphylococcus aureus (MRSA), gram-negative organisms, and atypical and anaerobic organisms. It also has a better adverse event profile compared to other fluoroquinolones. AREAS COVERED This article reviews the current epidemiology of CABP, etiologic agents and current resistance rates, current treatment guidelines, characteristics of delafloxacin (chemistry, microbiology, PK/PD), clinical efficacy and safety in pneumonia and other indications, and regulatory affairs. EXPERT OPINION : Delafloxacin's susceptibility profile against respiratory pathogens, bioequivalent intravenous and oral formulations and favorable safety profile, support its use for the treatment of CABP. It could be useful as empirical treatment in countries with high rates of penicillin-resistant S. pneumoniae and in patients with suspected or documented pneumonia due to MRSA. In post-influenza staphylococcal bacterial pneumonia, MRSA could be also considered an important pathogen.
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Affiliation(s)
- Silvia Gómez-Zorrilla
- Department of Infectious Diseases, Hospital del Mar, Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain
| | - Elena Sendra
- Department of Infectious Diseases, Hospital del Mar, Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Juan P Horcajada
- Department of Infectious Diseases, Hospital del Mar, Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain
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30
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Azijli K, Minderhoud TC, de Gans CJ, Lieveld AW, Nanayakkara PW. Optimal use of procalcitonin to rule out bacteremia in patients with possible viral infections. J Am Coll Emerg Physicians Open 2022; 3:e12621. [PMID: 35601651 PMCID: PMC9120727 DOI: 10.1002/emp2.12621] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 11/23/2022] Open
Abstract
Objective During the winter, many patients present with suspected infection that could be a viral or a bacterial (co)infection. The aim of this study is to investigate whether the optimal use of procalcitonin (PCT) is different in patients with and without proven viral infections for the purpose of excluding bacteremia. We hypothesize that when a viral infection is confirmed, this lowers the probability of bacteremia and, therefore, influences the appropriate cutoff of procalcitonin. Methods This study was conducted in the emergency department of an academic medical center in The Netherlands in the winter seasons of 2019 and 2020. Adults (>18 years) with suspected infection, in whom a blood culture and a rapid polymerase chain reaction test for influenza was performed were included. Results A total of 546 patients were included of whom 47 (8.6%) had a positive blood culture. PCT had an area under the curve of 0.85, 95% confidence interval (95% CI) 0.80-0.91, for prediction of bacteremia. In patients with a proven viral infection (N = 212) PCT < 0.5 μg/L had a sensitivity of 100% (95% CI 63.1-100) and specificity of 81.2% (95% CI 75.1-86.3) to exclude bacteremia. In patients without a viral infection, the procalcitonin cutoff point of < 0.25 μg/L showed a sensitivity of 87.2% (95% CI 72.6-95.7) and specificity of 64.1 % (95% CI 58.3-69.6). Conclusion In patients with a viral infection, our findings suggest that a PCT concentration of <0.50 μg/L makes bacteremia unlikely. However, this finding needs to be confirmed in a larger population of patients with viral infections, especially because the rate of coinfection in our cohort was low.
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Affiliation(s)
- Kaoutar Azijli
- Department of Emergency MedicineAmsterdam Public Health Research InstituteAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Tanca C. Minderhoud
- Department of General and Acute Internal MedicineAmsterdam Public Health Research InstituteAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Carlijn J. de Gans
- Department of Emergency MedicineAmsterdam Public Health Research InstituteAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Department of General and Acute Internal MedicineGelre Hospital ApeldoornAmsterdamThe Netherlands
| | - Arthur W.E. Lieveld
- Department of General and Acute Internal MedicineAmsterdam Public Health Research InstituteAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Prabath W.B. Nanayakkara
- Department of General and Acute Internal MedicineAmsterdam Public Health Research InstituteAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
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31
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The Contribution of Viral Proteins to the Synergy of Influenza and Bacterial Co-Infection. Viruses 2022; 14:v14051064. [PMID: 35632805 PMCID: PMC9143653 DOI: 10.3390/v14051064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/12/2022] [Accepted: 05/12/2022] [Indexed: 02/04/2023] Open
Abstract
A severe course of acute respiratory disease caused by influenza A virus (IAV) infection is often linked with subsequent bacterial superinfection, which is difficult to cure. Thus, synergistic influenza-bacterial co-infection represents a serious medical problem. The pathogenic changes in the infected host are accelerated as a consequence of IAV infection, reflecting its impact on the host immune response. IAV infection triggers a complex process linked with the blocking of innate and adaptive immune mechanisms required for effective antiviral defense. Such disbalance of the immune system allows for easier initiation of bacterial superinfection. Therefore, many new studies have emerged that aim to explain why viral-bacterial co-infection can lead to severe respiratory disease with possible fatal outcomes. In this review, we discuss the key role of several IAV proteins-namely, PB1-F2, hemagglutinin (HA), neuraminidase (NA), and NS1-known to play a role in modulating the immune defense of the host, which consequently escalates the development of secondary bacterial infection, most often caused by Streptococcus pneumoniae. Understanding the mechanisms leading to pathological disorders caused by bacterial superinfection after the previous viral infection is important for the development of more effective means of prevention; for example, by vaccination or through therapy using antiviral drugs targeted at critical viral proteins.
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32
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Bacterial coinfection in influenza pneumonia: Rates, pathogens, and outcomes. Infect Control Hosp Epidemiol 2022; 43:212-217. [PMID: 33890558 PMCID: PMC9116507 DOI: 10.1017/ice.2021.96] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Evidence from pandemics suggests that influenza is often associated with bacterial coinfection. Among patients hospitalized for influenza pneumonia, we report the rate of coinfection and distribution of pathogens, and we compare outcomes of patients with and without bacterial coinfection. METHODS We included adults admitted with community-acquired pneumonia (CAP) and tested for influenza from 2010 to 2015 at 179 US hospitals participating in the Premier database. Pneumonia was identified using an International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) algorithm. We used multiple logistic and gamma-generalized linear mixed models to assess the relationships between coinfection and inpatient mortality, intensive care unit (ICU) admission, length of stay, and cost. RESULTS Among 38,665 patients hospitalized with CAP and tested for influenza, 4,313 (11.2%) were positive. In the first 3 hospital days, patients with influenza were less likely than those without to have a positive culture (10.3% vs 16.2%; P < .001), and cultures were more likely to contain Staphylococcus aureus (34.2% vs 28.2%; P = .007) and less likely to contain Streptococcus pneumoniae (24.9% vs 31.0%; P = .008). Of S. aureus isolates, 42.8% were methicillin resistant among influenza patients versus 53.2% among those without influenza (P = .01). After hospital day 3, pathogens for both groups were similar. Bacterial coinfection was associated with increased odds of in-hospital mortality (aOR, 3.00; 95% CI, 2.17-4.16), late ICU transfer (aOR, 2.83; 95% CI, 1.98-4.04), and higher cost (risk-adjusted mean multiplier, 1.77; 95% CI, 1.59-1.96). CONCLUSIONS In a large US inpatient sample hospitalized with influenza and CAP, S. aureus was the most frequent cause of bacterial coinfection. Coinfection was associated with worse outcomes and higher costs.
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Okahashi N, Sumitomo T, Nakata M, Kawabata S. Secondary streptococcal infection following influenza. Microbiol Immunol 2022; 66:253-263. [PMID: 35088451 DOI: 10.1111/1348-0421.12965] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/18/2022] [Accepted: 01/24/2022] [Indexed: 12/01/2022]
Abstract
Secondary bacterial infection following influenza A virus (IAV) infection is a major cause of morbidity and mortality during influenza epidemics. Streptococcus pneumoniae has been identified as a predominant pathogen in secondary pneumonia cases that develop following influenza. Although IAV has been shown to enhance susceptibility to the secondary bacterial infection, the underlying mechanism of the viral-bacterial synergy leading to disease progression is complex and remains elusive. In this review, cooperative interactions of viruses and streptococci during co- or secondary infection with IAV are described. IAV infects the upper respiratory tract, therefore, streptococci that inhabit or infect the respiratory tract are of special interest. Since many excellent reviews on the co-infection of IAV and S. pneumoniae have already been published, this review is intended to describe the unique interactions between other streptococci and IAV. Both streptococcal and IAV infections modulate the host epithelial barrier of the respiratory tract in various ways. IAV infection directly disrupts epithelial barriers, though at the same time the virus modifies the properties of infected cells to enhance streptococcal adherence and invasion. Mitis group streptococci produce neuraminidases, which promote IAV infection in a unique manner. The studies reviewed here have revealed intriguing mechanisms underlying secondary streptococcal infection following influenza. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Nobuo Okahashi
- Center for Frontier Oral Science, Osaka University Graduate School of Dentistry, Suita-Osaka, Japan
| | - Tomoko Sumitomo
- Department of Oral and Molecular Microbiology, Osaka University Graduate School of Dentistry, Suita-Osaka, Japan
| | - Masanobu Nakata
- Department of Oral Microbiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Shigetada Kawabata
- Department of Oral and Molecular Microbiology, Osaka University Graduate School of Dentistry, Suita-Osaka, Japan
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Gupta V, Yu KC, Kabler H, Watts JA, Amiche A. Antibiotic Resistance Patterns and Association with the Influenza Season in the United States: A Multicenter Evaluation Reveals Surprising Associations Between Influenza Season and Resistance in Gram-negative Pathogens. Open Forum Infect Dis 2022; 9:ofac039. [PMID: 35237702 PMCID: PMC8883593 DOI: 10.1093/ofid/ofac039] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/24/2022] [Indexed: 11/27/2022] Open
Abstract
Background Viral infections are often treated with empiric antibiotics due to suspected bacterial coinfections, leading to antibiotic overuse. We aimed to describe antibiotic resistance (ABR) trends and their association with the influenza season in ambulatory and inpatient settings in the United States. Methods We used the BD Insights Research Database to evaluate antibiotic susceptibility profiles in 30-day nonduplicate bacterial isolates collected from patients >17 years old at 257 US healthcare institutions from 2011 to 2019. We investigated ABR in Gram-positive (Staphylococcus aureus and Streptococcus pneumoniae) and Gram-negative (Enterobacterales [ENT], Pseudomonas aeruginosa [PSA], and Acinetobacter baumannii spp [ACB]) bacteria expressed as the proportion of isolates not susceptible ([NS], intermediate or resistant) and resistance per 100 admissions (inpatients only). Antibiotics included carbapenems (Carb), fluoroquinolones (FQ), macrolides, penicillin, extended-spectrum cephalosporins (ESC), and methicillin. Generalized estimating equations models were used to evaluate monthly trends in ABR outcomes and associations with community influenza rates. Results We identified 8 250 860 nonduplicate pathogens, including 154 841 Gram-negative Carb-NS, 1 502 796 Gram-negative FQ-NS, 498 012 methicillin-resistant S aureus (MRSA), and 44 131 NS S pneumoniae. All S pneumoniae rates per 100 admissions (macrolide-, penicillin-, and ESC-NS) were associated with influenza rates. Respiratory, but not nonrespiratory, MRSA was also associated with influenza. For Gram-negative pathogens, influenza rates were associated with the percentage of FQ-NS ENT, FQ-NS PSA, and Carb-NS ACB. Conclusions Our study showed expected increases in rates of ABR Gram-positive and identified small but surprising increases in ABR Gram-negative pathogens associated with influenza activity. These insights may help inform antimicrobial stewardship initiatives.
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Affiliation(s)
- Vikas Gupta
- Becton, Dickinson and Company, Franklin Lakes, NJ, USA
| | - Kalvin C Yu
- Becton, Dickinson and Company, Franklin Lakes, NJ, USA
| | | | - Janet A Watts
- Becton, Dickinson and Company, Franklin Lakes, NJ, USA
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Huang LJ, Chen SJ, Hu YW, Liu CY, Wu PF, Sun SM, Lee SY, Chen YY, Lee CY, Chan YJ, Chou YC, Wang FD. The impact of antimicrobial stewardship program designed to shorten antibiotics use on the incidence of resistant bacterial infections and mortality. Sci Rep 2022; 12:913. [PMID: 35042878 PMCID: PMC8766441 DOI: 10.1038/s41598-022-04819-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 12/23/2021] [Indexed: 11/30/2022] Open
Abstract
Reassessing the continuing need for and choice of antibiotics by using an antibiotic "time out'' program may reduce unnecessary treatment. This study aimed to explore the effect of an antibiotic stewardship program (ASP) on the antibiotics consumption, incidence of resistant bacterial infections and overall hospital mortality in a tertiary medical center during the study period 2012-2014. An ASP composed of multidisciplinary strategies including pre-prescription approval and post-approval feedback and audit, and a major "time out'' intervention (shorten the default antibiotic prescription duration) usage was introduced in year 2013. Consumption of antibiotics was quantified by calculating defined daily doses (DDDs). Interrupted time series (ITS) analysis was used to explore the changes of antibiotics consumption before and after intervention, accounting for temporal trends that may be unrelated to intervention. Our results showed that following the intervention, DDDs showed a decreased trend in overall (in particular the major consumed penicillins and cephalosporins), in both intensive care unit (ICU) and non-ICU, and in non-restrictive versus restrictive antibiotics. Importantly, ITS analysis showed a significantly slope change since intervention (slope change p value 0.007), whereas the incidence of carbapenem-resistant and vancomycin-resistant pathogens did not change significantly. Moreover, annual overall mortality rates were 3.0%, 3.1% and 3.1% from 2012 to 2014, respectively. This study indicates that implementing a multi-disciplinary strategy to shorten the default duration of antibiotic prescription can be an effective manner to reduce antibiotic consumption while not compromising resistant infection incidence or mortality rates.
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Affiliation(s)
- Ling-Ju Huang
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, No. 201, Shi-Pai, Sec 2, Taipei, 11217, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Su-Jung Chen
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, No. 201, Shi-Pai, Sec 2, Taipei, 11217, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yu-Wen Hu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chun-Yu Liu
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ping-Feng Wu
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, No. 201, Shi-Pai, Sec 2, Taipei, 11217, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Shu-Mei Sun
- Department of Infection Control, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shih-Yi Lee
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yin-Yin Chen
- Department of Infection Control, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chung-Yuan Lee
- Department of Information Management, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yu-Jiun Chan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yueh-Ching Chou
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Fu-Der Wang
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, No. 201, Shi-Pai, Sec 2, Taipei, 11217, Taiwan, ROC.
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
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Chen J, Mittendorfer-Rutz E, Berg L, Norredam M, Sijbrandij M, Klimek P. Associations between Multimorbidity Patterns and Subsequent Labor Market Marginalization among Refugees and Swedish-Born Young Adults-A Nationwide Registered-Based Cohort Study. J Pers Med 2021; 11:jpm11121305. [PMID: 34945776 PMCID: PMC8705997 DOI: 10.3390/jpm11121305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Young refugees are at increased risk of labor market marginalization (LMM). We sought to examine whether the association of multimorbidity patterns and LMM differs in refugee youth compared to Swedish-born youth and identify the diagnostic groups driving this association. Methodology: We analyzed 249,245 individuals between 20–25 years, on 31 December 2011, from a combined Swedish registry. Refugees were matched 1:5 to Swedish-born youth. A multimorbidity score was computed from a network of disease co-occurrences in 2009–2011. LMM was defined as disability pension (DP) or >180 days of unemployment during 2012–2016. Relative risks (RR) of LMM were calculated for 114 diagnostic groups (2009–2011). The odds of LMM as a function of multimorbidity score were estimated using logistic regression. Results: 2841 (1.1%) individuals received DP and 16,323 (6.5%) experienced >180 annual days of unemployment during follow-up. Refugee youth had a marginally higher risk of DP (OR (95% CI): 1.59 (1.52, 1.67)) depending on their multimorbidity score compared to Swedish-born youth (OR (95% CI): 1.51 (1.48, 1.54)); no differences were found for unemployment (OR (95% CI): 1.15 (1.12, 1.17), 1.12 (1.10, 1.14), respectively). Diabetes mellitus and influenza/pneumonia elevated RR of DP in refugees (RRs (95% CI) 2.4 (1.02, 5.6) and 1.75 (0.88, 3.45), respectively); most diagnostic groups were associated with a higher risk for unemployment in refugees. Conclusion: Multimorbidity related similarly to LMM in refugees and Swedish-born youth, but different diagnoses drove these associations. Targeted prevention, screening, and early intervention strategies towards specific diagnoses may effectively reduce LMM in young adult refugees.
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Affiliation(s)
- Jiaying Chen
- Section for Science of Complex Systems, CeMSIIS Medical University of Vienna, 1090 Vienna, Austria;
- Complexity Science Hub Vienna, 1090 Vienna, Austria
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden;
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden;
| | - Lisa Berg
- Department of Public Health Sciences, Stockholm University, 10691 Stockholm, Sweden;
- Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, 10691 Stockholm, Sweden
| | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity, and Health (MESU), Section for Health Services Research, Department of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark;
- Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital Hvidovre, 2650 Hvidovre, Denmark
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands;
| | - Peter Klimek
- Section for Science of Complex Systems, CeMSIIS Medical University of Vienna, 1090 Vienna, Austria;
- Complexity Science Hub Vienna, 1090 Vienna, Austria
- Correspondence:
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Maguire PT, Loughran ST, Harvey R, Johnson PA. A TLR5 mono-agonist restores inhibited immune responses to Streptococcus pneumoniae during influenza virus infection in human monocytes. PLoS One 2021; 16:e0258261. [PMID: 34644311 PMCID: PMC8513880 DOI: 10.1371/journal.pone.0258261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/22/2021] [Indexed: 11/20/2022] Open
Abstract
Influenza A virus (IAV) predisposes individuals to often more severe secondary bacterial infections with Streptococcus pneumonia (S. pneumoniae). The outcomes of these infections may be made worse with the increase in antimicrobial resistance and a lack of new treatments to combat this. Th17 responses are crucial in clearing S. pneumoniae from the lung. We previously demonstrated that early IAV infection of human monocytes significantly reduced levels of S. pneumoniae-driven cytokines involved in the Th17 response. Here, we have further identified that IAV targets specific TLRs (TLR2, TLR4, TLR9) involved in sensing S. pneumoniae infection resulting, in a reduction in TLR agonist-induced IL-23 and TGF-β. The effect of IAV is more profound on the TLR2 and TLR9 pathways. We have established that IAV-mediated inhibition of TLR9-induction is related to a downregulation of RORC, a Th17 specific transcription factor. Other studies using mouse models demonstrated that TLR5 agonism improved the efficacy of antibiotics in the treatment of IAV/S. pneumoniae co-infections. Therefore, we investigated if TLR5 agonism could restore inhibited Th17 responses in human monocytes. Levels of pneumococcus-driven cytokines, which had previously been inhibited by IAV were not reduced in the presence of the TLR5 mono-agonist, suggesting that such treatment may overcome IAV inhibition of Th17 responses. The importance of our research is in demonstrating the IAV directly targets S. pneumoniae-associated TLR pathways. Additionally, the IAV-inhibition of Th17 responses can be restored by TLR5 agonism, which indicates that there may be a different Th17 signalling pathway which is not affected by IAV infection.
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Affiliation(s)
- Paula T Maguire
- Viral Immunology Laboratory, School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Sinéad T Loughran
- Department of Applied Science, Dundalk Institute of Technology, County Louth, Ireland
| | - Ruth Harvey
- National Institute for Biological Standards and Controls, Potters Bar, Herts, United Kingdom
| | - Patricia A Johnson
- Viral Immunology Laboratory, School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
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Management of hospitalized influenza A patients during the season 2018/19 : Comparison of three medical departments and the effect on outcome and antibiotic usage. Wien Klin Wochenschr 2021; 133:1310-1317. [PMID: 34613478 DOI: 10.1007/s00508-021-01950-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Diagnosis and treatment of influenza patients are often provided across several medical specialties. We compared patient outcomes at an infectious diseases (ID), a rheumatology (Rheu) and a pulmonology (Pul) department. MATERIAL AND METHODS In this prospective observational multicenter study we included all influenza positive adults who were hospitalized and treated at flu isolation wards in three hospitals in Vienna during the season 2018/2019. RESULTS A total of 490 patients (49% female) with a median age of 73 years (interquartile range [IQR] 61-82) were included. No differences regarding age, sex and most underlying diseases were present at admission. Frequencies of the most common complications differed: acute kidney failure (ID 12.7%, Rheu 21.2%, Pulm 37.1%, p < 0.001), acute heart failure (ID 4.3%, Rheu 17.1%, Pulm 14.4%, p < 0.001) and respiratory insufficiency (ID 45.1%, Rheu 41.5%, Pulm 56.3%, p = 0.030). Oseltamivir prescription was lowest at the pulmonology flu ward (ID 79.6%, Rheu 90.5%, Pulm 61.7%, p < 0.001). In total 176 patients (35.9%) developed pneumonia. Antibiotic selection varied between the departments: amoxicillin/clavulanic acid (ID 28.9%, Rheu 63.8%, Pulm 5.9%, p < 0.001), cefuroxime (ID 28.9%, Rheu 1.3%, Pulm 0%, p < 0.001), 3rd generation cephalosporins (ID 4.4%, Rheu 5%, Pulm 72.5%, p < 0.001), doxycycline (ID 17.8%, Rheu 0%, Pulm 0%, p < 0.001). The median length of stay was significantly different between wards: ID 6 days (IQR 5-8), Rheu 6 days (IQR 5-7) and Pulm 7 days (IQR 5-9.5, p = 0.034). In-hospital mortality was 4.3% and did not differ between specialties. CONCLUSION We detected differences in oseltamivir usage, length of in-hospital stay and antibiotic choices for pneumonia. Influenza-associated mortality was unaffected by specialty.
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Son HJ, Kim T, Lee E, Park SY, Yu S, Hong HL, Kim MC, Hong SI, Bae S, Kim MJ, Kim SH, Yun JH, Jo KM, Lee YM, Lee S, Park JW, Jeon MH, Kim TH, Choo EJ. Risk factors for isolation of multi-drug resistant organisms in coronavirus disease 2019 pneumonia: A multicenter study. Am J Infect Control 2021; 49:1256-1261. [PMID: 34146624 PMCID: PMC8251653 DOI: 10.1016/j.ajic.2021.06.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/01/2021] [Accepted: 06/08/2021] [Indexed: 12/17/2022]
Abstract
Objectives Superimposed multi-drug resistant organisms (MDROs) co-infection can be associated with worse outcomes in patients with severe coronavirus disease 2019 (COVID-19), even if these patients were managed with strict airborne and contact precautions. Identifying risk factors for isolation of MDROs is critical to COVID-19 treatment. Methods All eligible adult patients with confirmed COVID-19 pneumonia from 10 hospitals in the Republic of Korea between February 2020 and May 2020 were retrospectively enrolled. Using this cohort, epidemiology and risk factors for isolation of MDROs were evaluated. Results Of 152 patients, 47 with microbial culture results were included. Twenty isolates of MDROs from 13 (28%) patients were cultured. Stenotrophomonas maltophilia (5 isolates) was the most common MDRO, followed by methicillin-resistant staphylococcus aureus (4 isolates). MDROs were mostly isolated from sputum samples (80%, 16/20). The median time from hospitalization to MDRO isolation was 28 days (interquartile range, 18-38 days). In-hospital mortality was higher in patients with MDRO isolation (62% vs 15%; P = .001). Use of systemic corticosteroids after diagnosis of COVID-19 (adjusted odds ratio [aOR]: 15.07; 95% confidence interval [CI]: 2.34-97.01; P = .004) and long-term care facility (LTCF) stay before diagnosis of COVID-19 (aOR: 6.09; 95% CI: 1.02-36.49; P = .048) were associated with MDRO isolation. Conclusions MDROs were isolated from 28% of COVID-19 pneumonia patients with culture data and 8.6% of the entire cohort. Previous LTCF stay and adjunctive corticosteroid use were risk factors for the isolation of MDROs. Strict infection prevention strategies may be needed in these COVID-19 patients with risk factors.
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Affiliation(s)
- Hyo-Ju Son
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Tark Kim
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Eunjung Lee
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Se Yoon Park
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Shinae Yu
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Hyo-Lim Hong
- Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Republic of Korea
| | - Min-Chul Kim
- Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, South Korea
| | - Sun In Hong
- Department of Infectious Diseases, Gyeongsang National University Changwon Hospital, Korea
| | - Seongman Bae
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Min Jae Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ji Hyun Yun
- Department of Infectious Diseases, Konkuk University Medical Center, Konkuk University School of Medicine
| | - Kyeong Min Jo
- Division of Infectious Disease, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Yu-Mi Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Seungjae Lee
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Jung Wan Park
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Min Hyok Jeon
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Tae Hyong Kim
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Eun Ju Choo
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea.
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Qiu LN, Tan YR, Luo YJ, Chen XJ. Leonurine protects against influenza A virus infection-induced pneumonia in mice. Pathog Dis 2021; 79:6372906. [PMID: 34543397 DOI: 10.1093/femspd/ftab045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/15/2021] [Indexed: 12/24/2022] Open
Abstract
Influenza A virus (H1N1), a swine-origin influenza A virus, causes seasonal epidemics that result in severe illnesses and deaths. Leonurine has been reported to function as an anti-inflammatory agent with protective effects on nervous, urinary and cardiovascular systems. However, the therapeutic effects of leonurine on the pneumonia caused by H1N1 infection remain unclear. Hematoxylin and eosin staining was performed to evaluate the lung injuries of mice infected by H1N1. The amount of immune cells was analyzed by flow cytometry. Enzyme-linked immunosorbent assay was used to evaluate the alteration of multiple cytokines in lung tissues. Real-time quantitative polymerase chain reaction assay was performed to investigate the ribonucleic acid (RNA) levels of certain genes. The protein levels in toll-like receptor 4/nuclear factor kappa-light-chain-enhancer of activated B cells (TLR4/NF-κB) signaling were estimated by western blot assay. Leonurine treatment significantly inhibited the mortality caused by H1N1 infection. Leonurine treatment (60 mg/kg) alleviated the lung injuries caused by virus infection. The inflammatory cell accumulation and cytokine expression were inhibited by the leonurine administration. Leonurine inhibited the mRNA expression of pro-inflammatory cytokines in the lung homogenates at day 5 postinfection. Leonurine regulated the TLR4/NF-κB signaling in the lung homogenates of H1N1-infected mice at day 5 postinfection. Leonurine protects against H1N1 infection-induced pneumonia in mice.
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Affiliation(s)
- Li-Nan Qiu
- Department of Traditional Chinese Medicine, Daqing Oilfield General Hospital, 9 Zhongkang Street, Daqing 163001, China
| | - Ya-Rong Tan
- Day Clinic Centre, Daqing Oilfield General Hospital, 9 Zhongkang Street, Daqing 163001, China
| | - Yu-Ju Luo
- Department of Medical Imaging, Daqing Oilfield General Hospital, 9 Zhongkang Street, Daqing 163001, China
| | - Xiao-Juan Chen
- Department of Pediatrics, Daqing Oilfield General Hospital, 9 Zhongkang Street, Daqing 163001, China
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Adalbert JR, Varshney K, Tobin R, Pajaro R. Clinical outcomes in patients co-infected with COVID-19 and Staphylococcus aureus: a scoping review. BMC Infect Dis 2021; 21:985. [PMID: 34548027 PMCID: PMC8453255 DOI: 10.1186/s12879-021-06616-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/10/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Endemic to the hospital environment, Staphylococcus aureus (S. aureus) is a leading bacterial pathogen that causes deadly infections such as bacteremia and endocarditis. In past viral pandemics, it has been the principal cause of secondary bacterial infections, significantly increasing patient mortality rates. Our world now combats the rapid spread of COVID-19, leading to a pandemic with a death toll greatly surpassing those of many past pandemics. However, the impact of co-infection with S. aureus remains unclear. Therefore, we aimed to perform a high-quality scoping review of the literature to synthesize the existing evidence on the clinical outcomes of COVID-19 and S. aureus co-infection. METHODS A scoping review of the literature was conducted in PubMed, Scopus, Ovid MEDLINE, CINAHL, ScienceDirect, medRxiv, and the WHO COVID-19 database using a combination of terms. Articles that were in English, included patients infected with both COVID-19 and S. aureus, and provided a description of clinical outcomes for patients were eligible. From these articles, the following data were extracted: type of staphylococcal species, onset of co-infection, patient sex, age, symptoms, hospital interventions, and clinical outcomes. Quality assessments of final studies were also conducted using the Joanna Briggs Institute's critical appraisal tools. RESULTS Searches generated a total of 1922 publications, and 28 articles were eligible for the final analysis. Of the 115 co-infected patients, there were a total of 71 deaths (61.7%) and 41 discharges (35.7%), with 62 patients (53.9%) requiring ICU admission. Patients were infected with methicillin-sensitive and methicillin-resistant strains of S. aureus, with the majority (76.5%) acquiring co-infection with S. aureus following hospital admission for COVID-19. Aside from antibiotics, the most commonly reported hospital interventions were intubation with mechanical ventilation (74.8 %), central venous catheter (19.1 %), and corticosteroids (13.0 %). CONCLUSIONS Given the mortality rates reported thus far for patients co-infected with S. aureus and COVID-19, COVID-19 vaccination and outpatient treatment may be key initiatives for reducing hospital admission and S. aureus co-infection risk. Physician vigilance is recommended during COVID-19 interventions that may increase the risk of bacterial co-infection with pathogens, such as S. aureus, as the medical community's understanding of these infection processes continues to evolve.
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Affiliation(s)
- Jenna R Adalbert
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
- Jefferson College of Population Health, 901 Walnut St., Philadelphia, PA, 19107, USA.
| | - Karan Varshney
- Jefferson College of Population Health, 901 Walnut St., Philadelphia, PA, 19107, USA
- Deakin University School of Medicine, Geelong, Victoria, Australia
| | - Rachel Tobin
- Deakin University School of Medicine, Geelong, Victoria, Australia
| | - Rafael Pajaro
- Morristown Medical Center of Atlantic Health System, Morristown, New Jersey, USA
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Viral and Bacterial Co-Infections in the Lungs: Dangerous Liaisons. Viruses 2021; 13:v13091725. [PMID: 34578306 PMCID: PMC8472850 DOI: 10.3390/v13091725] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 12/23/2022] Open
Abstract
Respiratory tract infections constitute a significant public health problem, with a therapeutic arsenal that remains relatively limited and that is threatened by the emergence of antiviral and/or antibiotic resistance. Viral–bacterial co-infections are very often associated with the severity of these respiratory infections and have been explored mainly in the context of bacterial superinfections following primary influenza infection. This review summarizes our current knowledge of the mechanisms underlying these co-infections between respiratory viruses (influenza viruses, RSV, and SARS-CoV-2) and bacteria, at both the physiological and immunological levels. This review also explores the importance of the microbiome and the pathological context in the evolution of these respiratory tract co-infections and presents the different in vitro and in vivo experimental models available. A better understanding of the complex functional interactions between viruses/bacteria and host cells will allow the development of new, specific, and more effective diagnostic and therapeutic approaches.
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Gamon E, Tammena D, Wattenberg M, Augenstein T. [Rare superinfection in a COVID-19 patient-A chronology]. Anaesthesist 2021; 71:38-49. [PMID: 34427689 PMCID: PMC8383027 DOI: 10.1007/s00101-021-01018-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 02/07/2023]
Abstract
Bei einem 55-jährigen Mann, der sich zur elektiven Ablation bei Vorhofflimmern in der Klinik befand, wurde nach einer Reanimationssituation auf der peripheren Station ein SARS-CoV-2-Abstrich positiv getestet. Anamnestisch gab es im Vorwege gesicherten Kontakt zu einem COVID-19-positiven Patienten. Im Verlauf entwickelte sich das Vollbild einer COVID-19-Pneumonie mit umfangreicher intensivmedizinischer Behandlung. Nach rund 2‑wöchiger Therapie musste das Weaning bei erneuter Verschlechterung abgebrochen werden, und es ergaben sich bei dem wiederholt hochseptischen Patienten mikrobiologische Nachweise einer Superinfektion mit Cryptococcus neoformans und später Leclercia adecarboxylata. Der Patient wurde erfolgreich behandelt und überlebte die Erkrankung.
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Affiliation(s)
- E Gamon
- Klinik für Anästhesiologie, Intensivmedizin und Notfallmedizin, Klinikum Links der Weser, Bremen, Deutschland.
| | - D Tammena
- Klinik für Anästhesiologie, Intensivmedizin und Notfallmedizin, Klinikum Links der Weser, Bremen, Deutschland
| | - M Wattenberg
- Klinik für Anästhesiologie, Intensivmedizin und Notfallmedizin, Klinikum Links der Weser, Bremen, Deutschland
| | - T Augenstein
- Klinik für Anästhesiologie, Intensivmedizin und Notfallmedizin, Klinikum Links der Weser, Bremen, Deutschland
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44
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Venkatram S, Alapati A, Dileep A, Diaz-Fuentes G. Change in patterns of hospitalization for influenza during COVID-19 surges. Influenza Other Respir Viruses 2021; 16:72-78. [PMID: 34427056 PMCID: PMC8653106 DOI: 10.1111/irv.12900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 12/15/2022] Open
Abstract
Background Hospitalization due to influenza has been stable in recent years. In March 2020, New York was an epicenter for coronavirus disease 2019 (COVID‐19). Because influenza and COVID‐19 present similarly, there were serious concerns that coinfection of these viruses would burden the healthcare system. We compared incidence and outcomes of patients hospitalized with influenza before and during COVID‐19 (seasons 2017–2021). Methods We conducted a retrospective study evaluating hospitalized patients with influenza. Four influenza seasons were evaluated, 2017–2021, pre‐ and during COVID‐19 pandemic. We compared incidence of influenza and clinical outcomes across the seasons. Results We found 412 patients hospitalized due to influenza in the study period; 394 had influenza, and 18 had both influenza and COVID‐19 infections. Demographics across the four influenza seasons were comparable; the cohort was predominantly female (61%) and had an average age of 60 years old. Comorbid conditions were common. No outcome differences were found for patients with influenza when comparing influenza seasons prior to and during the COVID‐19 pandemic. The mortality for the entire cohort was 6.5%. During the COVID‐19 pandemic, there were 18 (4.4%) influenza patients coinfected with COVID‐19 and 32 (7.8%) patients with bacterial super infection. Predictors of mortality in patients with influenza included presence of shock, heart failure, bacterial pneumonia, and use of mechanical ventilation. Coinfection with COVID‐19 did not increase mortality. Conclusion We observed a significant decrease in the incidence of hospitalization due to influenza during the COVID‐19 pandemic. Clinical presentations and outcomes for patients with influenza remain stable. Being aware of possible increased mortality for patients with both influenza and bacterial pneumonia is important. Although coinfection with COVID‐19 did not increase mortality in influenza patients, identifying the specific virus responsible for infections has major therapeutic implications.
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Affiliation(s)
- Sindhaghatta Venkatram
- Division of Pulmonary and Critical Care Medicine, BronxCare Health System, Affiliated with Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anuhya Alapati
- Division of Pulmonary and Critical Care Medicine, BronxCare Health System, Affiliated with Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Arundhati Dileep
- Division of Pulmonary and Critical Care Medicine, BronxCare Health System, Affiliated with Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gilda Diaz-Fuentes
- Division of Pulmonary and Critical Care Medicine, BronxCare Health System, Affiliated with Icahn School of Medicine at Mount Sinai, New York, NY, USA
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45
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Verma AK, Bauer C, Palani S, Metzger DW, Sun K. IFN-γ Drives TNF-α Hyperproduction and Lethal Lung Inflammation during Antibiotic Treatment of Postinfluenza Staphylococcus aureus Pneumonia. THE JOURNAL OF IMMUNOLOGY 2021; 207:1371-1376. [PMID: 34380647 DOI: 10.4049/jimmunol.2100328] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/29/2021] [Indexed: 01/15/2023]
Abstract
Inflammatory cytokine storm is a known cause for acute respiratory distress syndrome. In this study, we have investigated the role of IFN-γ in lethal lung inflammation using a mouse model of postinfluenza methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. To mimic the clinical scenario, animals were treated with antibiotics for effective bacterial control following MRSA superinfection. However, antibiotic therapy alone is not sufficient to improve survival of wild-type animals in this lethal acute respiratory distress syndrome model. In contrast, antibiotics induce effective protection in mice deficient in IFN-γ response. Mechanistically, we show that rather than inhibiting bacterial clearance, IFN-γ promotes proinflammatory cytokine response to cause lethal lung damage. Neutralization of IFN-γ after influenza prevents hyperproduction of TNF-α, and thereby protects against inflammatory lung damage and animal mortality. Taken together, the current study demonstrates that influenza-induced IFN-γ drives a stepwise propagation of inflammatory cytokine response, which ultimately results in fatal lung damage during secondary MRSA pneumonia, despite of antibiotic therapy.
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Affiliation(s)
- Atul K Verma
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE
| | - Christopher Bauer
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE
| | - Sunil Palani
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE.,Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX; and
| | - Dennis W Metzger
- Department of Immunology and Microbial Disease, Albany Medical College, Albany, NY
| | - Keer Sun
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE; .,Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX; and
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46
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Farrell JM, Zhao CY, Tarquinio KM, Brown SP. Causes and Consequences of COVID-19-Associated Bacterial Infections. Front Microbiol 2021; 12:682571. [PMID: 34354682 PMCID: PMC8329088 DOI: 10.3389/fmicb.2021.682571] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/17/2021] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 literature highlights that bacterial infections are more common in fatal cases than recovered cases. If bacterial infections drive mortality in COVID-19, this has clear implications for patient management. However, it is possible that the enrichment of bacterial infections in COVID-19 fatalities is simply a by-product of late-stage pathology, leading to different advice for patient management. To address this question, we review current knowledge on bacterial infections in COVID-19, assess information from past viral respiratory pandemics, and simulate alternate causal models of interactions between virus, bacteria, and mortality in COVID-19. From these models, we conclude that currently available data are not sufficient to discriminate between these alternate causal pathways, and we highlight what data are required to determine the relative contribution of bacterial infection to COVID-19 morbidity and mortality. We further summarize the potential long-term consequences of SARS-CoV-2 infection.
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Affiliation(s)
- Jennifer M Farrell
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, United States.,Center for Microbial Dynamics and Infection, Georgia Institute of Technology, Atlanta, GA, United States
| | - Conan Y Zhao
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, United States.,Center for Microbial Dynamics and Infection, Georgia Institute of Technology, Atlanta, GA, United States.,Interdisciplinary Graduate Program in Quantitative Biosciences, Georgia Institute of Technology, Atlanta, GA, United States
| | - Keiko M Tarquinio
- Pediatric Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Sam P Brown
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, United States.,Center for Microbial Dynamics and Infection, Georgia Institute of Technology, Atlanta, GA, United States
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47
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Putot A, Bouiller K, Laborde C, Gilis M, Févre A, Hacquin A, Manckoundia P, Hoefler F, Bermejo M, Mendes A, Serratrice C, Prendki V, Sanchez S. Association between Early Antibiotic Therapy and In-Hospital Mortality among Older Patients with SARS-CoV-2 Pneumonia. J Gerontol A Biol Sci Med Sci 2021; 77:e115-e123. [PMID: 34272847 PMCID: PMC8406862 DOI: 10.1093/gerona/glab209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Indexed: 11/17/2022] Open
Abstract
Background It is uncertain whether antibiotic therapy should be started in SARS CoV-2 pneumonia. We aimed to investigate the association between early antibiotic therapy and the risk of in-hospital mortality in older patients. Methods We performed a retrospective international cohort study (ANTIBIOVID) in five COVID-19 geriatric units in France and Switzerland. Among 1,357 consecutive patients aged 75 or more hospitalised and testing positive for SARS-CoV-2, 1072 had a radiologically confirmed pneumonia, of which 914 patients were still alive and hospitalized at 48 hours. To adjust for confounders, a propensity score for treatment was created, and stabilized inverse probability of treatment weighting (SIPTW) was applied. To assess the association between early antibiotic therapy and in-hospital 30-day mortality, SIPTW-adjusted Kaplan-Meier and Cox proportional hazards regression analyses were performed. Results Of the 914 patients with SARS-CoV-2 pneumonia, median age of 86, 428 (46.8%) received antibiotics in the first 48 hours after diagnosis. Among these patients, 147 (34.3%) died in hospital within one month vs 118 patients (24.3%) with no early antibiotic treatment. After SIPTW, early antibiotic treatment was not significantly associated with mortality (adjusted hazard ratio, 1.23; 95% CI, 0.92-1.63; P = .160). Microbiologically confirmed superinfections occurred rarely in both groups (bacterial pneumonia: 2.5% vs 1.5%, P = .220; blood stream infection: 8.2% vs 5.2%, P = .120; Clostridioides difficile colitis: 2.4% vs 1.0%, P = .222). Conclusions In a large multicentre cohort of older inpatients with SARS-CoV-2 pneumonia, early antibiotic treatment did not appear to be associated with an improved prognosis.
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Affiliation(s)
- Alain Putot
- Department of Geriatric Internal Medicine, Dijon University Hospital, Dijon, France
| | - Kevin Bouiller
- Department of Infectious Diseases, Besançon University Hospital, Besançon, France
| | - Caroline Laborde
- Department of Geriatric Internal Medicine, Nimes University Hospital, Nimes, France
| | - Marine Gilis
- Department of Geriatrics, Besançon University Hospital, Besançon, France
| | - Amélie Févre
- Department of Geriatric Internal Medicine, Nimes University Hospital, Nimes, France
| | - Arthur Hacquin
- Department of Geriatric Internal Medicine, Dijon University Hospital, Dijon, France
| | - Patrick Manckoundia
- Department of Geriatric Internal Medicine, Dijon University Hospital, Dijon, France
| | - Florence Hoefler
- Department of Internal Medicine and Infectious Diseases, Troyes Hospital Centre, Troyes, France
| | - Messaline Bermejo
- Department of Internal Medicine and Infectious Diseases, Troyes Hospital Centre, Troyes, France
| | - Aline Mendes
- Division of Geriatrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Christine Serratrice
- Division of Internal Medicine for the aged, University Hospitals of Geneva, Geneva, Switzerland
| | - Virginie Prendki
- Division of Internal Medicine for the aged, University Hospitals of Geneva, Geneva, Switzerland.,Division of Infectious Diseases, University Hospitals of Geneva, Geneva, Switzerland
| | - Stéphane Sanchez
- Department of Clinical Research, Troyes Hospital Centre, Troyes, France
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Lower Respiratory Tract Pathogens and Their Antimicrobial Susceptibility Pattern: A 5-Year Study. Antibiotics (Basel) 2021; 10:antibiotics10070851. [PMID: 34356772 PMCID: PMC8300710 DOI: 10.3390/antibiotics10070851] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/30/2021] [Accepted: 07/09/2021] [Indexed: 12/11/2022] Open
Abstract
Lower respiratory tract infections (LRTIs) are the most common infections in humans. It is estimated that 2.74 million deaths worldwide occur each year due to LRTIs. The aim of the study was to determine the frequency and antibiotic susceptibility pattern of microorganisms isolated from respiratory samples of patients with LRTIs. Between January 2015 and December 2019, a total of 7038 sputum and bronchoaspirate samples from suspected LRTI patients were collected. Among them, 2753 samples (39.1%) showed significant microbial growth on culture media. The LRTI rate was higher in patients with male gender (67.1%) and with age between 40–59 years (48.6%). The microorganism identification and antibiotic susceptibility testing were performed with Vitek 2. Out of 4278 isolates species, 3102 (72.5%) were Gram-negative bacteria, 1048 (24.5%) were Gram-positive bacteria, and 128 (3.0%) were Candida spp. Major microorganisms isolated were Acinetobacter baumannii (18.6%), Staphylococcus aureus (15.2%), Pseudomonas aeruginosa (14.2%), and Klebsiella pneumoniae (10.9%). In antimicrobial susceptibility testing, Staphylococcus aureus isolates were mostly resistant to Penicillin G (84.1%) and Oxacillin (48.1%), whereas they demonstrated maximum sensitivity to Tigecycline (100%) and Linezolid (99.5%). Among Gram-negative isolates, Acinetobacter baumannii showed maximum sensitivity to Colistin but was resistant to other antibiotics (95–99%). Klebsiella pneumoniae isolates were mostly resistant to Cefotaxime (72.7%) and sensitive to Gentamicin (54.3%), and Pseudomonas aeruginosa was resistant to Ciprofloxacin (40.3%) and sensitive to Amikacin (85.9%). Gram-negative bacteria represented the species most commonly isolated. A high rate of antimicrobial resistance was observed in this study. In conclusion, the correct identification of causative microorganisms and their susceptibility patterns to antibiotics is crucial for choosing targeted and effective antibiotic therapy in LRTIs, and to prevent the emergence of multidrug-resistant bacteria.
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Liu Y, Ling L, Wong SH, Wang MHT, Fitzgerald J, Zou X, Fang S, Liu X, Wang X, Hu W, Chan H, Wang Y, Huang D, Li Q, Wong WT, Choi G, Zou H, Hui DSC, Yu J, Tse G, Gin T, Wu WKK, Chan MTV, Zhang L. Outcomes of respiratory viral-bacterial co-infection in adult hospitalized patients. EClinicalMedicine 2021; 37:100955. [PMID: 34386745 PMCID: PMC8343259 DOI: 10.1016/j.eclinm.2021.100955] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/20/2021] [Accepted: 05/20/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Viral infections of the respiratory tract represent a major global health concern. Co-infection with bacteria may contribute to severe disease and increased mortality in patients. Nevertheless, viral-bacterial co-infection patterns and their clinical outcomes have not been well characterized to date. This study aimed to evaluate the clinical features and outcomes of patients with viral-bacterial respiratory tract co-infections. METHODS We included 19,361 patients with respiratory infection due to respiratory viruses [influenza A and B, respiratory syncytial virus (RSV), parainfluenza] and/or bacteria in four tertiary hospitals in Hong Kong from 2013 to 2017 using a large territory-wide healthcare database. All microbiological tests were conducted within 48 h of hospital admission. Four etiological groups were included: (1) viral infection alone; (2) bacterial infection alone; (3) laboratory-confirmed viral-bacterial co-infection and (4) clinically suspected viral-bacterial co-infection who were tested positive for respiratory virus and negative for bacteria but had received at least four days of antibiotics. Clinical features and outcomes were recorded for laboratory-confirmed viral-bacterial co-infection patients compared to other three groups as control. The primary outcome was 30-day mortality. Secondary outcomes were intensive care unit (ICU) admission and length of hospital stay. Propensity score matching estimated by binary logistic regression was used to adjust for the potential bias that may affect the association between outcomes and covariates. FINDINGS Among 15,906 patients with respiratory viral infection, there were 8451 (53.1%) clinically suspected and 1,087 (6.8%) laboratory-confirmed viral-bacterial co-infection. Among all the bacterial species, Haemophilus influenzae (226/1,087, 20.8%), Pseudomonas aeruginosa (180/1087, 16.6%) and Streptococcus pneumoniae (123/1087, 11.3%) were the three most common bacterial pathogens in the laboratory-confirmed co-infection group. Respiratory viruses co-infected with non-pneumococcal streptococci or methicillin-resistant Staphylococcus aureus was associated with the highest death rate [9/30 (30%) and 13/48 (27.1%), respectively] in this cohort. Compared with other infection groups, patients with laboratory-confirmed co-infection had higher ICU admission rate (p < 0.001) and mortality rate at 30 days (p = 0.028), and these results persisted after adjustment for potential confounders using propensity score matching. Furthermore, patients with laboratory-confirmed co-infection had significantly higher mortality compared to patients with bacterial infection alone. INTERPRETATION In our cohort, bacterial co-infection is common in hospitalized patients with viral respiratory tract infection and is associated with higher ICU admission rate and mortality. Therefore, active surveillance for bacterial co-infection and early antibiotic treatment may be required to improve outcomes in patients with respiratory viral infection.
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Affiliation(s)
- Yingzhi Liu
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Lowell Ling
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Sunny H Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, PR China
- State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, PR China
- CUHK Shenzhen Research Institute, Shenzhen, PR China
| | - Maggie HT Wang
- School of Public Health, The Chinese University of Hong Kong, Hong Kong, PR China
| | | | - Xuan Zou
- Shenzhen Center for Disease Control and Prevention, No.8, Longyuan Road, Nanshan District, Shenzhen, Guangdong Province, PR China
| | - Shisong Fang
- Shenzhen Center for Disease Control and Prevention, No.8, Longyuan Road, Nanshan District, Shenzhen, Guangdong Province, PR China
| | - Xiaodong Liu
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
- CUHK Shenzhen Research Institute, Shenzhen, PR China
| | - Xiansong Wang
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Wei Hu
- Department of Gastroenterology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Hung Chan
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Yan Wang
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Dan Huang
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Qing Li
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Wai T Wong
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Gordon Choi
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, PR China
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - David SC Hui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Jun Yu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, PR China
- State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, PR China
- CUHK Shenzhen Research Institute, Shenzhen, PR China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, PR China
| | - Tony Gin
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - William KK Wu
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
- State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, PR China
- CUHK Shenzhen Research Institute, Shenzhen, PR China
- Corresponding at Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, PR China; State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, PR China; CUHK Shenzhen Research Institute, Shenzhen, PR China.
| | - Matthew TV Chan
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
- Corresponding at Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, PR China; State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, PR China; CUHK Shenzhen Research Institute, Shenzhen, PR China.
| | - Lin Zhang
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, PR China
- CUHK Shenzhen Research Institute, Shenzhen, PR China
- Corresponding at Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, PR China; State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, PR China; CUHK Shenzhen Research Institute, Shenzhen, PR China.
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50
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Pawelka E, Karolyi M, Mader T, Omid S, Kelani H, Baumgartner S, Ely S, Hoepler W, Jilma B, Koenig F, Laferl H, Traugott M, Turner M, Seitz T, Wenisch C, Zoufaly A. COVID-19 is not "just another flu": a real-life comparison of severe COVID-19 and influenza in hospitalized patients in Vienna, Austria. Infection 2021; 49:907-916. [PMID: 33983624 PMCID: PMC8117126 DOI: 10.1007/s15010-021-01610-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/26/2021] [Indexed: 01/08/2023]
Abstract
Background COVID-19 is regularly compared to influenza. Mortality and case-fatality rates vary widely depending on incidence of COVID-19 and the testing policy in affected countries. To date, data comparing hospitalized patients with COVID-19 and influenza is scarce. Methods Data from patients with COVID-19 were compared to patients infected with influenza A (InfA) and B (InfB) virus during the 2017/18 and 2018/19 seasons. All patients were ≥ 18 years old, had PCR-confirmed infection and needed hospital treatment. Demographic data, medical history, length-of-stay (LOS), complications including in-hospital mortality were analyzed. Results In total, 142 patients with COVID-19 were compared to 266 patients with InfA and 300 with InfB. Differences in median age (COVID-19 70.5 years vs InfA 70 years and InfB 77 years, p < 0.001) and laboratory results were observed. COVID-19 patients had fewer comorbidities, but complications (respiratory insufficiency, pneumonia, acute kidney injury, acute heart failure and death) occurred more frequently. Median length-of-stay (LOS) was longer in COVID-19 patients (12 days vs InfA 7 days vs. InfB 7 days, p < 0.001). There was a fourfold higher in-hospital mortality in COVID-19 patients (23.2%) when compared with InfA (5.6%) or InfB (4.7%; p < 0.001). Conclusion In hospitalized patients, COVID-19 is associated with longer LOS, a higher number of complications and higher in-hospital mortality compared to influenza, even in a population with fewer co-morbidities. This data, a high reproduction number and limited treatment options, alongside excess mortality during the SARS-CoV-2 pandemic, support the containment strategies implemented by most authorities.
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Affiliation(s)
- Erich Pawelka
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.
| | - Mario Karolyi
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Theresa Mader
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Sara Omid
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Hasan Kelani
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Sebastian Baumgartner
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Sarah Ely
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Hoepler
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Franz Koenig
- Section for Medical Statistics, Medical University of Vienna, Vienna, Austria
| | - Hermann Laferl
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Marianna Traugott
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Michael Turner
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Tamara Seitz
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Christoph Wenisch
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Alexander Zoufaly
- Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
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