{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T22:07:46Z","timestamp":1791929266377,"version":"4.3.4"},"reference-count":65,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2016,6,24]],"date-time":"2016-06-24T00:00:00Z","timestamp":1466726400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000016","name":"U.S. Department of Health and Human Services","doi-asserted-by":"publisher","award":["IDSEP130014\u201001\u201000"],"award-info":[{"award-number":["IDSEP130014\u201001\u201000"]}],"id":[{"id":"10.13039\/100000016","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Influenza Resp Viruses"],"published-print":{"date-parts":[[2016,9]]},"abstract":"<jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>Coinfecting bacterial pathogens are a major cause of morbidity and mortality in influenza. However, there remains a paucity of literature on the magnitude of coinfection in influenza patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>\n                      A systematic search of Me\n                      <jats:styled-content style=\"fixed-case\">SH<\/jats:styled-content>\n                      , Cochrane Library, Web of Science,\n                      <jats:styled-content style=\"fixed-case\">SCOPUS<\/jats:styled-content>\n                      ,\n                      <jats:styled-content style=\"fixed-case\">EMBASE<\/jats:styled-content>\n                      , and PubMed was performed. Studies of humans in which all individuals had laboratory confirmed influenza, and all individuals were tested for an array of common bacterial species, met inclusion criteria.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty\u2010seven studies including 3215 participants met\u00a0all inclusion criteria. Common etiologies were defined from a subset of eight articles. There was high heterogeneity in the results (\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>\n                        <jats:italic>2<\/jats:italic>\n                      <\/jats:sup>\n                      \u00a0=\u00a095%), with reported coinfection rates ranging from 2% to 65%. Although only a subset of papers were responsible for observed heterogeneity, subanalyses and meta\u2010regression analysis found no study characteristic that was significantly associated with coinfection. The most common coinfecting species were\n                      <jats:italic>Streptococcus pneumoniae<\/jats:italic>\n                      and\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      , which accounted for 35% (95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      , 14%\u201356%) and 28% (95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      , 16%\u201340%) of infections, respectively; a wide range of other pathogens caused the remaining infections. An assessment of bias suggested that lack of small\u2010study publications may have biased the results.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The frequency of coinfection in the published studies included in this review suggests that although providers should consider possible bacterial coinfection in all patients hospitalized with influenza, they should not assume all patients are coinfected and be sure to properly treat underlying viral processes. Further, high heterogeneity suggests additional large\u2010scale studies are needed to better understand the etiology of influenza bacterial coinfection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/irv.12398","type":"journal-article","created":{"date-parts":[[2016,5,27]],"date-time":"2016-05-27T10:34:49Z","timestamp":1464345289000},"page":"394-403","source":"Crossref","is-referenced-by-count":494,"title":["The frequency of influenza and bacterial coinfection: a systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"10","author":[{"given":"Eili Y.","family":"Klein","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Johns Hopkins University Baltimore MD USA"},{"name":"Center for Disease Dynamics, Economics &amp; Policy Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley","family":"Monteforte","sequence":"additional","affiliation":[{"name":"Eastern Virginia Medical School Norfolk VA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alisha","family":"Gupta","sequence":"additional","affiliation":[{"name":"Allegheny General Hospital Pittsburgh PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendi","family":"Jiang","sequence":"additional","affiliation":[{"name":"Center for Disease Dynamics, Economics &amp; Policy Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larissa","family":"May","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine The George Washington University Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu\u2010Hsiang","family":"Hsieh","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Johns Hopkins University Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Dugas","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Johns Hopkins University Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,6,24]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.289.2.179"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2012.01.003"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1086\/591708"},{"key":"e_1_2_8_5_1","first-page":"1475","article-title":"Predictors of pneumococcal co\u2010infection for patients with pandemic (H1N1) 2009","volume":"17","author":"Masi\u00e1 M","year":"2011","journal-title":"Emerg Infect Dis"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1750-2659.2012.00360.x"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2012.04.009"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jir861"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.1.3047.634"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI103791"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1084\/jem.89.1.53"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00058-05"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1079\/9781845938567.0000"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.194139"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1155\/2011\/146376"},{"key":"e_1_2_8_16_1","first-page":"325","article-title":"Severe methicillin\u2010resistant Staphylococcus aureus community\u2010acquired pneumonia associated with influenza\u2013Louisiana and Georgia, December 2006\u2010January 2007","volume":"56","author":"Centers for Disease Control Prevention","year":"2007","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"e_1_2_8_17_1","first-page":"289","article-title":"Severe coinfection with seasonal influenza A (H3N2) virus and Staphylococcus aureus\u2013Maryland, February\u2010March 2012","volume":"61","author":"Centers for Disease Control Prevention","year":"2012","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2011-0774"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0b013e31819d8b71"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b2700"},{"key":"e_1_2_8_21_1","first-page":"2008","volume-title":"Hamilton","author":"National Collaborating Centre for Methods and Tools. 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