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Volume 17, Number 8—August 2011

Dispatch

Predictors of Pneumococcal Co-infection for Patients with Pandemic (H1N1) 2009

Mar Masiá, Sergio Padilla, Pedro Antequera, José Manuel Ramos, Montserrat Ruiz, and Félix GutiérrezComments to Author 
Author affiliations: Author affiliations: Hospital Universitario de Elche, Elche, Spain (M. Masiá, S. Padilla, J.M. Ramos, M. Ruiz, F. Gutiérrez); University Miguel Hernández, Elche (F. Gutiérrez); Hospital Universitario de San Juan, Alicante, Spain (P. Antequera)

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Table

Demographic and clinical data of patients with pandemic (H1N1) 2009 virus, by pneumococcal co-infection status, Spain, July 2009–March 2010*

Variable
Influenza plus pneumococcal disease, n = 14
Influenza without pneumococcal disease, n = 86
p value†
Influenza plus pneumococcal pneumonia, n = 9
Influenza plus nonpneumococcal pneumonia, n = 15
p value†
Female sex 8 (57.1) 41 (47.7) 0.511 6 (66.7) 7 (46.7) 0.341
Age, y
42.1 (35.7–57.0)
39.2 (27.3–52.1)
0.371
39.7 (31.1–63.1)
43.6 (31.7–51.3)
0.788
Concurrent conditions‡ 10 (71.4) 71 (82.6) 0.325 7 (77.8) 11 (73.3) 0.808
Pregnancy 1 (7.1) 1 (1.1) 0.188 1 (11.1) 0 0.261
Decompensated concurrent condition 3 (21.4) 15 (17.4) 0.628 2 (22.2) 5 (33.3) 0.604
HIV infection 0 (0) 8 (9.3) 0.303 0 2 (13.3) 0.280
Smoker 3 (21.4) 21 (24.4) 0.908 2 (22.2) 3 (20.0) 0.782
Alcoholism
2 (14.2)
6 (6.9)
0.293
1 (11.1)
1 (6.66)
0.674
Hospital admission 12 (85.7) 21 (24.4) 0.000 9 (100) 11 (73.3) 0.090
ICU admission
2 (14.3)
2 (2.3)
0.034
2 (22.2)
1 (6.7)
0.265
Pneumonia 9 (64.3) 15 (17.4) 0.000 9 (100) 15 (100) NA
Pneumococcal bacteremia
2 (14.2)
NA
NA
1 (11.1)
0
0.303
Oliguria/anuria 0 (0) 1 (1.1) 0.694 0 0 NA
O2 saturation <94% 3 (21.4) 12 (13.9) 0.403 2 (22.2) 7 (46.7) 0.311
Axillary temperature, °C 38.1 (37.5–38.9) 36.8 (36.4–37.8) 0.009 37.7 (37.5–38.8) 36.5 (35.9–37.8) 0.679
O2 saturation, %
95 (85.2–95.5)
96.3 (94–98)
0.006
93 (72–95)
93 (78–110)
0.308
CURB-65 score 0 (0–2) 0 (0–1) 0.201 2 (0–2.5) 0 (0–1) 0.156
Confusion 4 (28.6) 1 (1.2) 0.000 4 (44.4) 0 0.005
BUN level >20 mg/dL 2 (14.3) 4 (4.7) 0.628 2 (22.2) 4 (26.7) 0.808
Respiratory rate >30 breaths/min 3 (21.4) 3 (3.5) 0.009 3 (33.3) 1 (6.7) 0.090
BP <90/60 mm Hg 2 (14.3) 2 (2.3) 0.034 2 (22.2) 2 (13.3) 0.572
Age >65 y 2 (14.3) 4 (4.7) 0.159 2 (22.2) 1 (6.7) 0.265
CURB-65 score >1 9 (64.3) 62 (72.1) 0.550 5 (55.5) 7 (46.7) 0.673
CURB-65 score >2
5 (35.7)
3 (3.5)
0.000
5 (55.5)
1 (6.7)
0.007
C-reactive protein, mg/L 190.7 (74.0–190.7) 26.6 (11.80–79.35) 0.000 255 (134–320) 89 (60–162) 0.008
Procalcitonin, ng/mL§
1.25 (0.12–26.00),
n = 6
0.5 (0.1–0.5),
n = 19
0.198
13.5 (0.59–27.70),
n = 4
0.5 (0.08–6.03),
n = 3
0.289
Death 0 0 NA 0 0 NA

*All values are number (%) for categorical variables and median (interquartile range) for continuous variables. NA, not applicable; ICU, intensive care unit; CURB-65, confusion of new onset, urea greater than 7 mmol/L (blood urea nitrogen [BUN] >19), respiratory rate >30 breaths/min, systolic blood pressure (BP) <90 mm Hg or diastolic blood pressure <60 mm Hg, age >65 (10).
†The χ2 or Fisher exact test was used for categorical variables and the Mann-Whitney test for continuous variables.
‡Asthma, chronic lung disease, heart disease, neurologic and neurodevelopmental conditions, blood disorders, endocrine disorders (such as diabetes mellitus), kidney disorders, liver disorders, metabolic disorders, weakened immune system, people <19 y of age who are receiving long-term aspirin therapy, people who are morbidly obese (body mass index >40).
§Measured in patients with signs of sepsis; n values as shown.

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