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Volume 22, Number 7—July 2016

Dispatch

Increased Mortality Rates Associated with Staphylococcus aureus and Influenza Co-infection, Maryland and Iowa, USA1

Jennifer S. McDanelComments to Author , Eli N. Perencevich, Jeremy Storm2, Daniel J. Diekema, Loreen Herwaldt, J. Kristie Johnson, Patricia L. Winokur, and Marin L. Schweizer
Author affiliations: University of Iowa, Iowa City, Iowa, USA (J.S. McDanel, E.N. Perencevich, J. Storm, D.J. Diekema, L. Herwaldt, P.L. Winokur, M.L. Schweizer); Iowa City Veterans Affairs Health Care System, Iowa City (J.S. McDanel E.N. Perencevich, P.L. Winokur, M.L. Schweizer); University of Iowa Hospitals and Clinics, Iowa City (D.J. Diekema, L. Herwaldt); University of Maryland School of Medicine, Baltimore, Maryland, USA (J.K. Johnson)

Main Article

Table 1

Characteristics of patients in cohorts demonstrating increased mortality rates associated with Staphylococcus aureus and influenza co-infection, Maryland and Iowa, USA*

Characteristic Positive influenza test, n = 32 Negative influenza test, n = 163 Odds ratio 95% CI p value
Female sex 12 (38) 67 (41) 0.86 (0.39–1.88) 0.704
Age ≥18 y 24 (75) 112 (69) 1.37 (0.58–3.25) 0.479
Hospital admission within previous 12 mo 12 (38) 75 (46) 0.70 (0.32–1.53) 0.376
Previous MRSA infection or colonization
 4 (13)
 33 (20)
 0.56 (0.18–1.72)
 0.307
Co-occurring conditions
Cancer 3 (9) 24 (15) 0.60 (0.17–2.12) 0.579
Cerebrovascular disease 0 (0) 6 (4) UTD 0.592
Chronic pulmonary disease 11 (34) 41 (25) 1.56 (0.69–3.51) 0.282
Heart disease 4 (13) 20 (12) 1.02 (0.32–3.22) 1.000
Diabetes 6 (19) 15 (9) 2.28 (0.81–6.41) 0.123
Liver disease 0 (0) 6 (4) UTD 0.592
Renal disease 5 (16) 8 (5) 3.59 (1.09–11.79) 0.042
Charlson Comorbidity Index score, median (IQR)
 1 (0–2)
 1 (0–3)
 0.89 (0.75–1.07)
 0.641
Methicillin resistance
MRSA 16 (50) 93 (57) 0.75 (0.35–1.61) 0.462
MSSA 15 (47) 66 (40) 1.30 (0.61–2.78) 0.503
Unknown
 1 (3)
 4 (2)
 1.28 (0.14–11.86)
 1.000
First positive S. aureus culture collected ≤2 d after hospital admission
 24 (75)
 78 (48)
 3.27 (1.39–7.70)
 0.005
Year of first positive S. aureus culture 0.038
2003 1 (3) 3 (2) Reference
2004 1 (3) 10 (6) 0.30 (0.01–6.38)
2005 7 (22) 25 (15) 0.84 (0.08–9.38)
2006 0 (0) 25 (15) UTD
2007 2 (6) 14 (9) 0.43 (0.03–6.41)
2008 12 (38) 26 (16) 1.39 (0.13–14.73)
2009
 9 (28)
 60 (37)
 0.45 (0.04–4.81)
Antimicrobial drugs received
Vancomycin 25 (78) 128 (79) 0.98 (0.39–2.44) 0.960
Linezolid 7 (22) 26 (16) 1.48 (0.58–3.77) 0.414
Quinolone 19 (59) 50 (31) 3.30 (1.51–7.21) 0.002
Macrolide 13 (41) 58 (36) 1.24 (0.57–2.69) 0.588
Aminoglycoside 2 (6) 41 (25) 0.20 (0.05–0.87) 0.018
Cephalosporin
 20 (63)
 105 (64)
 0.92 (0.42–2.02)
 0.836
30-d in-hospital deaths
 9 (28)
 18 (11)
 3.15 (1.27–7.86)
 0.021
*Values are no. (%) patients except as indicated. MRSA, methicillin-resistant Staphylococcus aureus; UTD; unable to determine because calculation includes zero; IQR; interquartile range; MSSA, methicillin-susceptible S. aureus.

Main Article

1Presented in part at ID Week, October 17-21, 2012, San Diego, CA, USA. Abstract 36846.

2Current affiliation: Infectious Disease Specialists, P.C., Sioux Falls, South Dakota, USA.

Page created: June 14, 2016
Page updated: June 14, 2016
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