Viral co‐infections are associated with increased rates of hospitalization in those with influenza. Issue 4 (18th March 2022)

• Record Type: Journal Article
• Authors: Shannon, Kerry L.; Osula, Valerie O.; Shaw‐Saliba, Kathryn; Hardick, Justin; McBryde, Breana; Dugas, Andrea; Hsieh, Yu‐Hsiang; Hansoti, Bhakti; Rothman, Richard E.
• Other Names: Steele Mark investigator.; Stubbs Amy investigator.; Kemble Laurie investigator.; Beckham Danielle investigator.; Neal Niccole investigator.; Lovecchio Frank investigator.; Mulrow Mary investigator.; Talan David investigator.; Moran Greg investigator.; Krishnadasan Anusha investigator.; Pathmarajah Kavitha investigator.; Torrez Raquel investigator.; Gonzalez Eva investigator.; Martin Gabina investigator.; Quinteros Urzagaste Noemi investigator.; Furoy Jacklyn investigator.; Hernandez Mayra investigator.; Collison Claire investigator.; Dugas Andrea investigator.; Duval Anna investigator.; Beard Raphaelle investigator.; Avornu Ama investigator.; Medina Rebecca investigator.
• Is Part Of: Influenza and other respiratory viruses. Volume 16:Issue 4(2022)
• Page Start: 780
• Page End: 788
• Publication Date: 2022-03-18
• Subjects: co‐infection -- emergency department -- hospitalization -- influenza -- multiplex; Influenza -- Periodicals; Respiratory infections -- Periodicals; Virus diseases -- Periodicals; Influenza, Human -- Periodicals; Respiratory Tract Diseases -- Periodicals; Virus Diseases -- Periodicals; Grippe -- Périodiques; Appareil respiratoire -- Infections -- Périodiques; Maladies à virus -- Périodiques; 616.203
• DOI: 10.1111/irv.12967
• Languages: English
• ISSNs: 1750-2640

Abstract

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.