Abstract：
BACKGROUND: The clinical burden of influenza is increasing worldwide. Aging, immunosuppression, and underlying respiratory illness are determinants of poor clinical outcomes, including greater mortality. Bacterial infections seem to be the main reason. Updated information on the role of bacterial infection as the cause of complications would be of value in improving the prognosis of patients with influenza.
METHODS: A systematic review and meta-analysis were performed by using the PubMed repository using keywords like: Influenza, H1N1, Streptococcus pneumoniae, bacterial coinfection, secondary coinfection, bacterial complications in pneumonia, and seasonal influenza. Only articles written in English were included in publications from 2010 to 2020. The analyses were conducted following the preferred reporting items for systematic review and meta-analyses guidelines. The results were independently validated using a TrinetX database cohort of roughly 4 million patients.
RESULTS: We included 135 studies that contained data from 48,259 patients hospitalized with influenza of any age. Bacterial infections were diagnosed in 5391 (11.2%). Streptococcus pneumoniae (30.7%) and Staphylococcus aureus (30.4%) were the most frequent microorganisms, followed by Haemophilus influenzae (7.1%) and Pseudomonas aeruginosa (5.9%). The random-effects model of the meta-analysis indicated that bacterial infections posed a 3.4-fold increased risk of death compared with influenza infection alone. Unexpectedly, asthma was protective (odds ratio 0.8).
CONCLUSIONS: Bacterial infections diagnosed in 11.2% of patients with influenza increase 3.4-fold the mortality risk. S. pneumoniae, S. aureus, H. influenzae, and P. aeruginosa account for nearly 75% of the cases. Earlier diagnosis and use of antibiotics should improve outcomes in this population.
METHODS: A systematic review and meta-analysis were performed by using the PubMed repository using keywords like: Influenza, H1N1, Streptococcus pneumoniae, bacterial coinfection, secondary coinfection, bacterial complications in pneumonia, and seasonal influenza. Only articles written in English were included in publications from 2010 to 2020. The analyses were conducted following the preferred reporting items for systematic review and meta-analyses guidelines. The results were independently validated using a TrinetX database cohort of roughly 4 million patients.
RESULTS: We included 135 studies that contained data from 48,259 patients hospitalized with influenza of any age. Bacterial infections were diagnosed in 5391 (11.2%). Streptococcus pneumoniae (30.7%) and Staphylococcus aureus (30.4%) were the most frequent microorganisms, followed by Haemophilus influenzae (7.1%) and Pseudomonas aeruginosa (5.9%). The random-effects model of the meta-analysis indicated that bacterial infections posed a 3.4-fold increased risk of death compared with influenza infection alone. Unexpectedly, asthma was protective (odds ratio 0.8).
CONCLUSIONS: Bacterial infections diagnosed in 11.2% of patients with influenza increase 3.4-fold the mortality risk. S. pneumoniae, S. aureus, H. influenzae, and P. aeruginosa account for nearly 75% of the cases. Earlier diagnosis and use of antibiotics should improve outcomes in this population.
摘要：
背景：全球流感的临床负担正在增加。衰老,免疫抑制,和潜在的呼吸系统疾病是不良临床结果的决定因素，包括更高的死亡率。细菌感染似乎是主要原因。有关细菌感染作为并发症原因的最新信息将对改善流感患者的预后具有价值。
方法：通过使用Pubmed存储库使用关键字进行系统综述和荟萃分析：流感，H1N1,肺炎链球菌,细菌共感染，继发性合并感染,肺炎的细菌性并发症，季节性流感。从2010年到2020年，只有英文文章才被收录在出版物上。根据PRISMA指南进行分析。使用TrinetX数据库队列对大约400万患者进行了独立验证。
结果：我们纳入了136项研究，这些研究包含了48,259名任何年龄的流感住院患者的数据。在5,391（11.2％）中诊断出细菌感染。肺炎链球菌(30.7%)和金黄色葡萄球菌(30.4%)是最常见的微生物,其次是流感嗜血杆菌(7.1%)和铜绿假单胞菌(5.9%)。荟萃分析的随机效应模型表明，与单独的流感感染相比，细菌感染导致死亡风险增加3.4倍。出乎意料的是,哮喘是保护性的(比值比0.8).
结论：在11.2%的流感患者中诊断出细菌感染使死亡风险增加3.4倍。肺炎链球菌，金黄色葡萄球菌，流感嗜血杆菌和铜绿假单胞菌占病例的近75%。早期诊断和使用抗生素应改善该人群的预后。
方法：通过使用Pubmed存储库使用关键字进行系统综述和荟萃分析：流感，H1N1,肺炎链球菌,细菌共感染，继发性合并感染,肺炎的细菌性并发症，季节性流感。从2010年到2020年，只有英文文章才被收录在出版物上。根据PRISMA指南进行分析。使用TrinetX数据库队列对大约400万患者进行了独立验证。
结果：我们纳入了136项研究，这些研究包含了48,259名任何年龄的流感住院患者的数据。在5,391（11.2％）中诊断出细菌感染。肺炎链球菌(30.7%)和金黄色葡萄球菌(30.4%)是最常见的微生物,其次是流感嗜血杆菌(7.1%)和铜绿假单胞菌(5.9%)。荟萃分析的随机效应模型表明，与单独的流感感染相比，细菌感染导致死亡风险增加3.4倍。出乎意料的是,哮喘是保护性的(比值比0.8).
结论：在11.2%的流感患者中诊断出细菌感染使死亡风险增加3.4倍。肺炎链球菌，金黄色葡萄球菌，流感嗜血杆菌和铜绿假单胞菌占病例的近75%。早期诊断和使用抗生素应改善该人群的预后。
