1754. Viral and Bacterial Co-detections in Influenza-Positive Patients Hospitalized with Severe Acute Respiratory Illness ­­— Minnesota, 2013-2015
Session: Oral Abstract Session: Prevalence and Outcome of Respiratory Tract Infections
Saturday, October 29, 2016: 9:15 AM
Room: 275-277
Background: Sensitive molecular and multi-pathogen testing has resulted in increased detection of respiratory pathogens, including co-detection of multiple pathogens. The impact of co-detections on patients hospitalized with influenza is unclear. Using a surveillance platform with systematic multi-pathogen testing, we describe co-detections in patients with influenza-positive severe acute respiratory infection (SARI).

Methods: Minnesota conducted SARI surveillance in three hospitals from May 2013–May 2015. We tested respiratory specimens from hospitalized patients with fever, cough, and difficulty breathing for 16 viral and 6 bacterial pathogens using RT-PCR. Medical charts were reviewed to collect clinical information, including bacterial culture results. We compared risk factors and outcomes of adults and children with influenza alone to those with co-detections.

Results: Of the 4,075 SARI patients, 325 (8%) had influenza. Of those with influenza, 71 (22%) had at least one co-detection (16% viral, 6% bacterial). RSV and rhinovirus were most frequent overall and Staphylococcus aureus was the most common bacterial co-detection. Children with viral co-detections were younger than those with influenza alone (median age 2 vs. 4 years, p<0.01). There was no difference in disease severity of children with any co-detections and those with influenza alone. Adults with bacterial co-detections had higher frequency of ICU admissions (50% vs. 10%, p=0.01), increased mortality (25% vs. 1%, p=0.01), and were less likely to have received influenza antivirals (38% vs. 75%, p=0.03) than adults with influenza alone. Adults with influenza and bacterial co-detections had a higher proportion of ICU admissions and death than patients with only bacterial detections, though this was not statistically significant.

Conclusion: Viral co-detections were relatively common among children with influenza-associated SARI. We found no association between viral co-detections and disease severity. Co-detection of both bacteria and influenza may increase disease severity among adults. Clinicians should be aware of the risk of multiple pathogens in SARI and consider influenza co-infection during influenza season as appropriate treatment could improve care.

Kate Russell, MD, MPH1, Ashley Fowlkes, MPH1, Ruth Lynfield, MD, FIDSA2, Hannah Friedlander, MPH2, Kathryn Como-Sabetti, MPH2, Dave Boxrud, MSc2, Anna Strain, PhD3, Sarah Bistodeau, BS3, Andrea Steffens, MPH1 and Carrie Reed, DSc, MPH1, (1)Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, (2)Minnesota Department of Health, St. Paul, MN, (3)Public Health Laboratory, Minnesota Department of Health, St. Paul, MN

Disclosures:

K. Russell, None

A. Fowlkes, None

R. Lynfield, None

H. Friedlander, None

K. Como-Sabetti, None

D. Boxrud, None

A. Strain, None

S. Bistodeau, None

A. Steffens, None

C. Reed, None

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