title: Infection with community-onset Staphylococcus aureus and influenza virus in hospitalized children.
abstract: 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.
authors.affiliation: Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. CReed1@cdc.gov
authors.forename: Carrie
authors.initials: C
authors.lastname: Reed
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Kallen
authors.forename: Monica
authors.initials: M
authors.lastname: Patton
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Arnold
authors.forename: Monica M
authors.initials: MM
authors.lastname: Farley
authors.forename: Jeff
authors.initials: J
authors.lastname: Hageman
authors.forename: Lyn
authors.initials: L
authors.lastname: Finelli
mesh_terms: D000293:Adolescent; D002648:Child; D002673:Child, Hospitalized; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology / Q000821:virology; D015897:Comorbidity; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007251:Influenza, Human / Q000453:epidemiology*; D008297:Male; D009975:Orthomyxoviridae / Q000302:isolation & purification; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification