Clinical characteristics and outcomes of mixed virus or bacterial infection in children with laboratory-confirmed influenza infection

Abstract

Background/Purpose: This study investigated the demographic characteristics and influenza complications of paediatric patients and explored the association of different influenza virus types and viral and bacterial coinfections with disease severity. Methods: This retrospective cohort study used data collected in 2010–2016 from the Chang Gung Research Database (CGRD), the largest collection of multi-institutional electronic medical records in Taiwan. Data were retrieved for children aged 0–18 years with laboratory-confirmed influenza. We extracted and analysed the demographic characteristics and the data on clinical features, complications, microbiological information, and advanced therapies of each case. Results: We identified 6193 children with laboratory-confirmed influenza, of whom 1964 (31.7%) were hospitalised. The age of patients with influenza A infection was lower than that of patients with influenza B (4.48 vs. 6.68, p < 0.001). Patients with influenza B infection had a higher incidence of myositis or rhabdomyolysis (4.4%, p < 0.001) and a higher need for advanced therapies (OR, 1.96; 95% CI, 1.32–2.9, p < 0.001). In addition to bacterial (OR, 9.07; 95% CI, 5.29–15.54, p < 0.001) and viral coinfection (OR, 7.73; 95% CI, 5.4–11.07, p < 0.001), dual influenza A and B infection was also a risk factor for influenza complications (OR, 2.13; 95% CI, 1.47–3.09, p < 0.001). Conclusion: Dual influenza A and B infection and bacterial coinfection can contribute to influenza complications. Early recognition of any influenza complication is critical for the timely initiation of organ-specific advanced therapies to improve influenza-associated outcomes.

Keywords

• Influenza
• Coinfection
• Pediatrics
• Complications
• Therapy