Association of bacterial pneumonia and respiratory failure in children with community-acquired influenza infection

Objective: To investigate the association of bacterial pneumonia and respiratory failure in children with community-acquired influenza infection presenting to a pediatric intensive care unit. Design: Retrospective cohort study. Setting: Pediatric intensive care unit at an urban academic tertiary-care children's hospital. Patients: All patients aged <18 yrs admitted to our pediatric intensive care unit with laboratory-confirmed influenza infection between October 2002 and September 2008. Interventions: All patients who met our clinical definitions of respiratory failure and bacterial pneumonia were identified. Patients were stratified by presence or absence of chronic medical conditions associated with an increased risk of influenza-related complications. Measurements and Main Results: There were 59 patients admitted to the pediatric intensive care unit with laboratory-confirmed community-acquired influenza during the period of study. Twenty-four patients (41%) had respiratory failure and 14 patients (24%) met the definition of bacterial pneumonia. The risk of respiratory failure was increased in the presence of bacterial pneumonia (p = .04). Adjusting for age and chronic medical conditions, patients with bacterial pneumonia had a 3.7 times greater odds (p = .04) of respiratory failure. Conclusions: Our findings suggest that bacterial pneumonia was associated with increased odds of respiratory failure in both previously healthy children and those with chronic medical conditions. Early aggressive therapy should be considered for patients with severe influenza.