Pediatric Deaths From Influenza/MRSA Coinfection Spark CDC Advisory

Yael Waknine (Medscape Medical News)

January 31, 2008 — Healthcare professionals should be alert to the possibility of bacterial coinfection among children hospitalized with influenza and request bacterial cultures for those who are severely ill or suspected of having community-acquired pneumonia, according to a clinician communication sent today from the Centers for Disease Control and Prevention (CDC).

The warning was based on data collected via the Influenza-Associated Pediatric Mortality Surveillance system, showing that 44% of pediatric influenza-related deaths reported from October 1, 2006, through September 30, 2007, occurred in the setting of bacterial coinfection, and the majority of them (22 [73%] of 30) were caused by Staphylococcus aureus.

Although the number of pediatric influenza-associated deaths only increased moderately from the number reported during the 2 previous surveillance years, the number of deaths in which pneumonia or bacteremia resulting from infection by S aureus increased 5-fold, and many cases (15 of 22) were caused by strains of methicillin-resistant S aureus (MRSA) similar to those associated with US outbreaks of MRSA skin infection.

The median age of children with S aureus infection was higher compared with those having other infections (10 vs 5 years; P < .01), and coinfected children were more likely to have pneumonia and acute respiratory distress syndrome.

Healthcare providers are advised to be aware of the prevalence of MRSA in their communities when choosing empiric therapy for patients with suspected influenza-related pneumonia.

The CDC is requesting that all pediatric influenza-associated deaths be reported as soon as possible to local or state health departments, as well as to the CDC via its Web site, http://sdn.cdc.gov. Information concerning bacterial pathogens should be included on the case-report form, and S aureus isolates should be sent to the CDC for further characterization.

Additional information regarding the CDC advisory may be obtained by contacting the Influenza Division, Epidemiology and Prevention Branch, by telephone at 404-639-3747.