Risk factors for in-hospital mortality and secondary bacterial pneumonia among hospitalized adult patients with community-acquired influenza: a large retrospective cohort study
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...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-03-01
|
| Series: | Antimicrobial Resistance and Infection Control |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13756-023-01234-y |
| _version_ | 1827974281487712256 |
|---|---|
| author | Guangzhao Yi Marlieke E. A. de Kraker Niccolò Buetti Xiaoni Zhong Jinyan Li Zhe Yuan Weimin Zhu Jia Zhou Hongyu Zhou |
| author_facet | Guangzhao Yi Marlieke E. A. de Kraker Niccolò Buetti Xiaoni Zhong Jinyan Li Zhe Yuan Weimin Zhu Jia Zhou Hongyu Zhou |
| author_sort | Guangzhao Yi |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-09T19:51:49Z |
| format | Article |
| id | doaj.art-553fd50b1cae4bbc8d4704da50117500 |
| institution | Directory Open Access Journal |
| issn | 2047-2994 |
| language | English |
| last_indexed | 2024-04-09T19:51:49Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Antimicrobial Resistance and Infection Control |
| spelling | doaj.art-553fd50b1cae4bbc8d4704da501175002023-04-03T05:41:08ZengBMCAntimicrobial Resistance and Infection Control2047-29942023-03-0112111210.1186/s13756-023-01234-yRisk factors for in-hospital mortality and secondary bacterial pneumonia among hospitalized adult patients with community-acquired influenza: a large retrospective cohort studyGuangzhao Yi0Marlieke E. A. de Kraker1Niccolò Buetti2Xiaoni Zhong3Jinyan Li4Zhe Yuan5Weimin Zhu6Jia Zhou7Hongyu Zhou8Department of Hospital Infection Control, The First Affiliated Hospital of Chongqing Medical UniversityInfection Control Program, Faculty of Medicine, Geneva University HospitalsInfection Control Program, Faculty of Medicine, Geneva University HospitalsResearch Center for Medicine and Social Development, School of Public Health, Chongqing Medical UniversityInformation Center, The First Affiliated Hospital of Chongqing Medical UniversityDepartment of Hospital Infection Control, The First Affiliated Hospital of Chongqing Medical UniversityDepartment of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical UniversityDepartment of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical UniversityDepartment of Hospital Infection Control, The First Affiliated Hospital of Chongqing Medical UniversityAbstract 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.https://doi.org/10.1186/s13756-023-01234-yRisk factorsSeasonal influenzaSecondary bacterial pneumoniaAll-cause in-hospital mortality |
| spellingShingle | Guangzhao Yi Marlieke E. A. de Kraker Niccolò Buetti Xiaoni Zhong Jinyan Li Zhe Yuan Weimin Zhu Jia Zhou Hongyu Zhou Risk factors for in-hospital mortality and secondary bacterial pneumonia among hospitalized adult patients with community-acquired influenza: a large retrospective cohort study Antimicrobial Resistance and Infection Control Risk factors Seasonal influenza Secondary bacterial pneumonia All-cause in-hospital mortality |
| title | Risk factors for in-hospital mortality and secondary bacterial pneumonia among hospitalized adult patients with community-acquired influenza: a large retrospective cohort study |
| title_full | Risk factors for in-hospital mortality and secondary bacterial pneumonia among hospitalized adult patients with community-acquired influenza: a large retrospective cohort study |
| title_fullStr | Risk factors for in-hospital mortality and secondary bacterial pneumonia among hospitalized adult patients with community-acquired influenza: a large retrospective cohort study |
| title_full_unstemmed | Risk factors for in-hospital mortality and secondary bacterial pneumonia among hospitalized adult patients with community-acquired influenza: a large retrospective cohort study |
| title_short | Risk factors for in-hospital mortality and secondary bacterial pneumonia among hospitalized adult patients with community-acquired influenza: a large retrospective cohort study |
| title_sort | risk factors for in hospital mortality and secondary bacterial pneumonia among hospitalized adult patients with community acquired influenza a large retrospective cohort study |
| topic | Risk factors Seasonal influenza Secondary bacterial pneumonia All-cause in-hospital mortality |
| url | https://doi.org/10.1186/s13756-023-01234-y |
| work_keys_str_mv | AT guangzhaoyi riskfactorsforinhospitalmortalityandsecondarybacterialpneumoniaamonghospitalizedadultpatientswithcommunityacquiredinfluenzaalargeretrospectivecohortstudy AT marliekeeadekraker riskfactorsforinhospitalmortalityandsecondarybacterialpneumoniaamonghospitalizedadultpatientswithcommunityacquiredinfluenzaalargeretrospectivecohortstudy AT niccolobuetti riskfactorsforinhospitalmortalityandsecondarybacterialpneumoniaamonghospitalizedadultpatientswithcommunityacquiredinfluenzaalargeretrospectivecohortstudy AT xiaonizhong riskfactorsforinhospitalmortalityandsecondarybacterialpneumoniaamonghospitalizedadultpatientswithcommunityacquiredinfluenzaalargeretrospectivecohortstudy AT jinyanli riskfactorsforinhospitalmortalityandsecondarybacterialpneumoniaamonghospitalizedadultpatientswithcommunityacquiredinfluenzaalargeretrospectivecohortstudy AT zheyuan riskfactorsforinhospitalmortalityandsecondarybacterialpneumoniaamonghospitalizedadultpatientswithcommunityacquiredinfluenzaalargeretrospectivecohortstudy AT weiminzhu riskfactorsforinhospitalmortalityandsecondarybacterialpneumoniaamonghospitalizedadultpatientswithcommunityacquiredinfluenzaalargeretrospectivecohortstudy AT jiazhou riskfactorsforinhospitalmortalityandsecondarybacterialpneumoniaamonghospitalizedadultpatientswithcommunityacquiredinfluenzaalargeretrospectivecohortstudy AT hongyuzhou riskfactorsforinhospitalmortalityandsecondarybacterialpneumoniaamonghospitalizedadultpatientswithcommunityacquiredinfluenzaalargeretrospectivecohortstudy |