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. 2013 Sep;67(3):185-93.
doi: 10.1016/j.jinf.2013.05.006. Epub 2013 Jun 6.

Community-acquired pneumonia during the first post-pandemic influenza season: a prospective, multicentre cohort study

Diego Viasus  1 , Carmen Marinescu, Aroa Villoslada, Elisa Cordero, Juan Gálvez-Acebal, María C Fariñas, Irene Gracia-Ahufinger, Anabel Fernández-Navarro, Jordi Niubó, Lucia Ortega, Elena Muñez-Rubio, María P Romero-Gómez, Jordi Carratalà; Influenza A (H1N1) Study Group of the Spanish Network for Research in Infectious Diseases (REIPI)
Collaborators, Affiliations

Community-acquired pneumonia during the first post-pandemic influenza season: a prospective, multicentre cohort study

Diego Viasus et al. J Infect. 2013 Sep.

Abstract

Objectives: To determine the aetiology, clinical features and prognosis of CAP during the first post-pandemic influenza season. We also assessed the factors associated with severe disease and tested the ability of a scoring system for identifying influenza A (H1N1)pdm09-related pneumonia.

Methods: Prospective cohort study carried out at 10 tertiary hospitals of Spain. All adults hospitalised with CAP from December 01, 2010 to March 31, 2011 were analysed.

Results: A total of 747 adults with CAP required hospitalisation. The aetiology was determined in 315 (42.2%) patients, in whom 154 (21.9%) were due to bacteria, 125 (16.7%) were due to viruses and 36 (4.8%) were mixed (due to viruses and bacteria). The most frequently isolated bacteria were Streptococccus pneumoniae. Among patients with viral pneumonia, the most common organism identified were influenza A (H1N1)pdm09. Independent factors associated with severe disease were impaired consciousness, septic shock, tachypnea, hyponatremia, hypoxemia, influenza B, and influenza A (H1N1)pdm09. The scoring system evaluated did not differentiate reliably between patients with influenza A (H1N1)pdm09-related pneumonia and those with other aetiologies.

Conclusions: The frequency of bacterial and viral pneumonia during the first post-pandemic influenza season was similar. The main identified virus was influenza A (H1N1)pdm09, which was associated with severe disease. Although certain presenting clinical features may allow recognition of influenza A (H1N1)pdm09-related pneumonia, it is difficult to express them in a reliable scoring system.

Keywords: Clinical features; Community-acquired pneumonia; Influenza A (H1N1)pdm09; Mortality; Post-pandemic period.

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Figures

Figure 1
Figure 1
Distribution of cases and causative agentsa by week during the study period (2010–2011). aMost cases of community-acquired pneumonia caused by influenza A (H1N1)pdm09 (76.7%) and influenza B (62.5%) occurred during epidemiological weeks 1–6 and 6–9, respectively. According to data provided by the Spanish Influenza Surveillance System (http://vgripe.isciii.es/gripe/inicio.do), the highest incidence of influenza cases during the first post-pandemic influenza season period were in weeks 2–3 (236 cases/100 000 inhabitants).
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