H1N1, MRSA co-infection increases mortality eight-fold in children

An October study found that children have an eight-fold increase in mortality rate when infected with both H1N1 influenza and methicillin-resistant Staphylococcus aeureus.
The dual infection can lead to a potentially deadly synergy as the bacterial infection destroys lung tissue while the viral assault compromises immunity. Without widespread vaccination, the situation could return as H1N1 is still in circulation and community-acquired MRSA in children is becoming more prevalent, Medscape Medical News reports.
The study was conducted by members of the Pediatric Acute Lung Injury and Sepsis Investigator's Network. The researchers analyzed data from 838 children treated at 35 U.S. pediatric intensive care units for probable H1N1 influenza from April 2009 to April 2010. Most patients were in respiratory failure and despite aggressive treatment and vancomycin use, 75 children, equal to 8.9 percent, died. Overall, 71 of the patients, or 8.5 percent, had presumed diagnosis of early S. aeureus infection of the lung, with 48 percent of those apparently being MRSA.
Of the 838 children, 587 had one or more chronic health conditions, including compromised immune deficiency, a neurological disorder or asthma. Among the 251 previously healthy children, the only shared risk factor for those who died was MRSA.
"There's more risk for MRSA to become invasive in the presence of flu or other viruses," Adrienne Randolph, the study's first author, said in a news release. "These deaths in co-infected children are a warning sign."
The researchers wrote that influenza vaccination is the most effective approach for minimizing mortality and morbidity in co-infected children because an effective vaccine has not yet been developed for MRSA.
Limitations of the study include lack of systematic detection of additional respiratory pathogens, confirmation of H1N1 in only 65 percent of cases and bacterial infections masked by use of broad-spectrum antibiotics.
The study was supported by the Centers for Disease Control and Prevention, the Department of Health and Human Services and the U.S. National Institutes of Health.

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