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Infection With Community-Onset Staphylococcus aureus and Influenza Virus in Hospitalized Children

Reed, Carrie DSc*†; Kallen, Alexander J. MD†‡; Patton, Monica BS; Arnold, Kathryn E. MD; Farley, Monica M. MD; Hageman, Jeff MHS; Finelli, Lyn DrPH, MS*

The Pediatric Infectious Disease Journal: July 2009 - Volume 28 - Issue 7 - p 572-576
doi: 10.1097/INF.0b013e31819d8b71
Original Studies

Background: Coinfection with influenza virus and Staphylococcus aureus can cause severe illness or death, and may be increasing. During the 2006–2007 influenza season, 30% of influenza-associated pediatric deaths reported to Centers for Disease Control and Prevention had S. aureus coinfection, compared with 2% to 7% in 2004–2006. The overall occurrence, however, remains unclear.

Methods: To assess the burden of coinfection with influenza and community-onset S. aureus in hospitalized children, we conducted a retrospective medical record review of all children admitted to Atlanta pediatric hospitals from October 2006 to April 2007 with laboratory-confirmed influenza or S. aureus cultured from a respiratory or sterile site within 72 hours of admission.

Results: Of 65 children with influenza, 7 (11%) had influenza-S. aureus coinfection; an additional 155 had community-onset S. aureus alone. Of S. aureus isolates, 43% were methicillin-resistant. Coinfected children were more frequently admitted to the intensive care unit (71%, P = 0.05) than other children with influenza (28%) or S. aureus (36%) alone and also had a significantly higher case fatality (29%, P = 0.01; 0% influenza, 5% S. aureus). Recent skin or soft tissue infection was documented in 29% of coinfected children, compared with 2% with influenza alone (P = 0.03).

Conclusions: Children with influenza-S. aureus coinfection had a higher frequency of severe outcomes than children hospitalized with influenza or S. aureus alone. Coinfection should be considered in children with severe respiratory illness during the influenza season.


From the *Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA; †Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA; ‡Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA; §CDC Expenence, Centers for Disease, Control and Prevention, Atlanta, GA; ¶Georgia Department of Human Resources, Division of Public Health, Atlanta, GA; and ∥Veterans Affairs Medical Center, Emory University School of Medicine, Atlanta, GA.

Accepted for publication January 22, 2009.

Address for correspondence: Carrie Reed, DSc, Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS A-32, Atlanta, GA 30333. E-mail:

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© 2009 Lippincott Williams & Wilkins, Inc.