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

Abstract

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. 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. 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). 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.