Immunosuppressed patients with pandemic influenza A 2009 (H1N1) virus infection

E Cordero, T Aydillo, M C Fariñas, J R Paño-Pardo, J Pachón, D Viasus, M Riera, F López-Medrano, A Payeras, A Moreno, J Rodríguez-Baño, J A Oteo, J Martínez-Montauti, J Torre-Cisneros, F Segura, J Carratalá, Novel Influenza A(H1N1) Study Group of the SpanishNetwork for Research in Infectious Diseases (REIPI), Emilio García-Cabrera, José Luis González-Fernández, Manuel Gutiérrez-Cuadra, María Victoria Sanjuan, José Antonio Parra, Alejandro Martín-Quirós, María Romero-Gómez, Guillermo Ruíz-Carrascoso, Juan Carlos Figueira, María Concepción Prados, Jordi Niubo, Antoni Campins, José María Aguado, Juan Vila, Aroa Villoslada, Mercedes García-Gasalla, Laura Linares, Irma Hoyo, María Ángeles Marcos, Tomás Pumarola, Marina de Cueto, Ángel Domínguez, Juan Gálvez, Laura Pérez-Martínez, José R Blanco, Mercedes Sanz, Luis Metola, Valvenera Ibarra, Lucía Ortega, Rosario Lara, Manuel Causse, Juan Gutiérrez-Aroca, Elisa Vidal, Gemma Navarro, Eva María González, E Cordero, T Aydillo, M C Fariñas, J R Paño-Pardo, J Pachón, D Viasus, M Riera, F López-Medrano, A Payeras, A Moreno, J Rodríguez-Baño, J A Oteo, J Martínez-Montauti, J Torre-Cisneros, F Segura, J Carratalá, Novel Influenza A(H1N1) Study Group of the SpanishNetwork for Research in Infectious Diseases (REIPI), Emilio García-Cabrera, José Luis González-Fernández, Manuel Gutiérrez-Cuadra, María Victoria Sanjuan, José Antonio Parra, Alejandro Martín-Quirós, María Romero-Gómez, Guillermo Ruíz-Carrascoso, Juan Carlos Figueira, María Concepción Prados, Jordi Niubo, Antoni Campins, José María Aguado, Juan Vila, Aroa Villoslada, Mercedes García-Gasalla, Laura Linares, Irma Hoyo, María Ángeles Marcos, Tomás Pumarola, Marina de Cueto, Ángel Domínguez, Juan Gálvez, Laura Pérez-Martínez, José R Blanco, Mercedes Sanz, Luis Metola, Valvenera Ibarra, Lucía Ortega, Rosario Lara, Manuel Causse, Juan Gutiérrez-Aroca, Elisa Vidal, Gemma Navarro, Eva María González

Abstract

The purpose of this paper was to prospectively characterize the clinical manifestations and outcomes of confirmed influenza A 2009 (H1N1) virus infection in immunosuppressed patients with hospital admission and compare them with those of a general population. A multicenter prospective cohort study was carried out. All adult patients admitted to 13 hospitals in Spain with confirmed influenza A 2009 (H1N1) virus infection from June 12, 2009 to November 11, 2009 were included. Risk factors for complicated influenza infection were studied in immunosuppressed patients. Overall, 559 patients were included, of which 56 were immunosuppressed, nine with solid or hematological malignancies, 18 with solid-organ transplant recipients, 13 with corticosteroid therapy, and six with other types of immunosuppression. Clinical findings at diagnosis were similar in both groups. Nineteen immunosuppressed patients had pneumonia (33.9%). Immunosuppressed patients with pandemic influenza had bacterial co-infection more frequently (17.9% vs. 6.4%, p = 0.02), specifically, gram-negative bacilli and Staphylococcus aureus infections. Mortality was higher in immunosuppressed patients (7.1% vs. 1.8%, p < 0.05). The only modifiable risk factor of complicated influenza A 2009 (H1N1) was delayed antiviral therapy. In immunosuppressed patients, influenza A 2009 (H1N1) virus infection has higher mortality than in non-immunosuppressed individuals. Bacterial co-infection is common in complicated cases.

Figures

Fig. 1
Fig. 1
Patients with influenza A 2009 (H1N1) infection admitted to the hospital in several Spanish hospitals between April 20, 2009 and November 11, 2009

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