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. 2022 Jul;16(4):780-788.
doi: 10.1111/irv.12967. Epub 2022 Mar 18.

Viral co-infections are associated with increased rates of hospitalization in those with influenza

Kerry L Shannon  1 , Valerie O Osula  1 , Kathryn Shaw-Saliba  1 , Justin Hardick  1 , Breana McBryde  1 , Andrea Dugas  1 , Yu-Hsiang Hsieh  1 , Bhakti Hansoti  1   2 , Richard E Rothman  1 ; Emergency Department National Influenza Network Investigators
Collaborators, Affiliations

Viral co-infections are associated with increased rates of hospitalization in those with influenza

Kerry L Shannon et al. Influenza Other Respir Viruses. 2022 Jul.

Abstract

Background: Influenza causes significant morbidity and mortality in the United States. Among patients infected with influenza, the presence of bacterial co-infection is associated with worse clinical outcomes; less is known regarding the clinical importance of viral co-infections. The objective of this study was to determine rates of viral co-infections in emergency department (ED) patients with confirmed influenza and association of co-infection with disease severity.

Methods: Secondary analysis of a biorepository and clinical database from a parent study where rapid influenza testing was implemented in four U.S. academic EDs, during the 2014-2015 influenza season. Patients were systematically tested for influenza virus using a validated clinical decision guideline. Demographic and clinical data were extracted from medical records; nasopharyngeal specimens from influenza-positive patients were tested for viral co-infections (ePlex, Genmark Diagnostics). Patterns of viral co-infections were evaluated using chi-square analysis. The association of viral co-infection with hospital admission was assessed using univariate and multivariate regression.

Results: The overall influenza A/B positivity rate was 18.1% (1071/5919). Of the 999 samples with ePlex results, the prevalence of viral co-infections was 7.9% (79/999). The most common viral co-infection was rhinovirus/enterovirus (RhV/EV), at 3.9% (39/999). The odds of hospital admission (OR 2.33, 95% CI: 1.01-5.34) increased significantly for those with viral co-infections (other than RhV/EV) versus those with influenza A infection only.

Conclusion: Presence of viral co-infection (other than RhV/EV) in ED influenza A/B positive patients was independently associated with increased risk of hospital admission. Further research is needed to determine clinical utility of ED multiplex testing.

Keywords: co-infection; emergency department; hospitalization; influenza; multiplex.

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FIGURE 1
Schema of samples included for molecular detection
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