Fall 2015 - Innovation

Influenza Often Overlooked with Bacterial Coinfection

A new study has found that many influenza-positive patients, including those with high-risk conditions, go undiagnosed in favor of a diagnosis of bacterial disease coinfection. In the study, the researchers conducted prospective influenza surveillance of emergency and inpatient settings in three North Carolina hospitals during four consecutive flu seasons from 2009 to 2013. Study enrollment included 4,689 men, women and children within 24 to 48 hours of presentation. More than 70 percent of these patients had cough, nasal congestion and fever, while fatigue/malaise was reported for most adults. Eleven percent were found to have laboratory-confirmed influenza. Of these, 29 percent received a clinical diagnosis of influenza. The number increased to 56 percent for those with laboratory-confirmed influenza and high-risk conditions, which included chronic or pulmonary diseases, diabetes, cancer, HIV and more. Nearly one-third of patients with laboratory-confirmed influenza were diagnosed with bacterial infections and were prescribed antibiotics. Only 18 percent of patients with a bacterial diagnosis who were using antibiotics and with confirmed influenza were diagnosed with influenza.

“We found that the odds of an influenza diagnosis were over threefold lower for all patients with a bacterial diagnosis, including those with high-risk conditions,” wrote Katherine A. Poehling, MD, MPH, of the department of pediatrics, Wake Forest School of Medicine, and colleagues. “Thus, during the influenza season, clinicians should consider if persons with symptoms consistent with a bacterial infection could also have influenza and if coinfection with influenza would alter the treatment recommendations.” Poehling and colleagues added that other factors for not properly diagnosing influenza include the variable timing and duration of influenza seasons and the limited specificity of rapid influenza diagnostic tests.

References

  1. Miller MR, Peters TR, Suerkin CK, Snively BM and Poehling KA. Predictors of Influenza Diagnosis Among Patients with Laboratory-Confirmed Influenza. Journal of Infectious Diseases, 2015; doi:10. 1993/infdis/jib264.
BSTQ Staff
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