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Video:Influenza and MRSA coinfection

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Description

Influenza and MRSA coinfection is a infection combination where the influenza virus first weakens the hosts immune system and damages the respiratory tract, making it easier for the bacteria to invade the lungs. This co-infection leads to severe, rapidly progressing necrotizing pneumonia with high mortality rates because the bacteria are resistant to common antibiotics. The synergy between the virus and the bacterium creates a condition more severe than either infection alone, necessitating prompt treatment with both antiviral and specific anti-MRSA medications.[1][2]A systematic review indicates that bacterial coinfection in influenza affected individuals ranged from 2 to 6 percent. MRSA is one of the most common coinfecting pathogens, accounting for 28 percent of bacterial coinfections in influenza cases.[3]

Presentation

As to the presentation of Influenza and MRSA coinfection we find the following:[4][5] high fever, severe cough, shortness of breath, chest pain and fatigue.

Risk factor

As to the risk factors that can facilitate Influenza and MRSA coinfection we find:immunocompromise, advanced age and chronic illness.[4][6]

Mechanism

In terms of the mechanism of influenza and MRSA coinfection we find influenza infection first weakens the hosts immune system by impairing the function of immune cells. Additionally it disrupts the respiratory tracts physical defenses, such as the mucociliary escalator, making it easier for bacteria to descend into human lungs. The viral infection helps MRSA by exposing adhesion sites on damaged lung tissue,this allows the bacteria to multiply more easily. Some MRSA strains produce toxins Panton-Valentine leukocidin , which directly kill the very immune cells that are trying to clear the bacteria. The synergistic relationship of the coinfection leads to severe, rapid-onset pneumonia.[7][8][1][2][9]

Diagnosis

As to evaluating influenza and MRSA coinfection, it begins with confirming the influenza infection. Simultaneously, clinicians look for signs of secondary bacterial infection, this involves obtaining cultures to identify MRSA. Sometimes, a nasal swab for MRSA PCR can be used to screen for colonization. Imaging is important for assessing the extent of lung damage.[5][10]

Management

In terms of management of this coinfection we find that antiviral therapy with oseltamivir(or zanamivir) should begin immediately. For anti-MRSA antibiotics, vancomycin is the first choice, though linezolid is a good alternative. Adding a second anti-MRSA agent within the 24 hours can greatly improve survival rates.[11][12][5]

Prognosis

In terms of the prognosis we find high mortality rates,that is, coinfection is associated with much higher mortality than either infection alone. In some studies, more than half of individuals with this coinfection do not survive.[13]

Epidemiology

In a 2021 U.S. study of 38 thousand individuals hospitalized with community-acquired pneumonia , 11 (point) 2 percent tested positive for influenza. Among those, S. aureus was the most frequent bacterial coinfection, and 42 (point) 8 percent of isolates were MRSA.[10]

History

As to history we find that in the early 2000s the link between influenza and MRSA became a focus of public health surveillance. The Centers for Disease Control and Prevention and other researchers began reporting a increase in influenza-related pediatric deaths due to bacterial co-infections, particularly with MRSA, during the 2003 to 2004 and 2006 to 2007 influenza seasons, these were the first verified case(s).[14]Then during the 2009 H1N1 pandemic further indicated the synergy between influenza and MRSA; many studies showed that MRSA co-infection was a risk factor for severe disease and death.[11]

Research

A 2025 study by Gomi et al, demonstrated that omadacycline, an aminomethylcycline antibiotic, not only matched linezolid in survival efficacy but also reduced inflammation and neutrophil infiltration in a murine model of post-influenza MRSA pneumonia.[15]

References

  1. ↑ Langouët-Astrié, Christophe; Oshima, Kaori; McMurtry, Sarah A.; Yang, Yimu; Kwiecinski, Jakub M.; LaRivière, Wells B.; Kavanaugh, Jeffrey S.; Zakharevich, Igor; Hansen, Kirk C.; Shi, Deling; Zhang, Fuming; Boguslawski, Kristina M.; Perelman, Sofya S.; Su, Gouwei; Torres, Victor J.; Liu, Jian; Horswill, Alexander R.; Schmidt, Eric P. (29 November 2022). "The influenza-injured lung microenvironment promotes MRSA virulence, contributing to severe secondary bacterial pneumonia". Cell Reports. 41 (9): 111721. doi:10.1016/j.celrep.2022.111721. ISSN 2211-1247. PMC 10082619. PMID 36450248.
  2. ↑ 2.0 2.1 Mulcahy, Michelle E.; McLoughlin, Rachel M. (13 December 2016). "Staphylococcus aureus and Influenza A Virus: Partners in Coinfection". mBio. 7 (6): e02068–16. doi:10.1128/mBio.02068-16. ISSN 2150-7511.
  3. ↑ Klein, Eili Y.; Monteforte, Bradley; Gupta, Alisha; Jiang, Wendi; May, Larissa; Hsieh, Yu-Hsiang; Dugas, Andrea (September 2016). "The frequency of influenza and bacterial coinfection: a systematic review and meta-analysis". Influenza and Other Respiratory Viruses. 10 (5): 394–403. doi:10.1111/irv.12398. PMC 4947938. PMID 27232677.
  4. ↑ 4.0 4.1 "Seasonal Flu and Staph Infection". Influenza (Flu). 9 September 2024. Retrieved 22 September 2025.
  5. ↑ 5.0 5.1 5.2 "Severe Coinfection with Seasonal Influenza A (H3N2) Virus and Staphylococcus aureus — Maryland, February–March 2012". www.cdc.gov. Retrieved 22 September 2025.
  6. ↑ Papanicolaou, Genovefa A. (15 November 2013). "Severe influenza and S. aureus pneumonia: for whom the bell tolls?". Virulence. 4 (8): 666–668. doi:10.4161/viru.26957. ISSN 2150-5608. PMC 3925697. PMID 24165206.
  7. ↑ Jia, Leili; Xie, Jing; Zhao, Jiangyun; Cao, Dekang; Liang, Yuan; Hou, Xuexin; Wang, Ligui; Li, Zhenjun (3 August 2017). "Mechanisms of Severe Mortality-Associated Bacterial Co-infections Following Influenza Virus Infection". Frontiers in Cellular and Infection Microbiology. 7 338. doi:10.3389/fcimb.2017.00338. ISSN 2235-2988. PMC 5540941. PMID 28824877.
  8. ↑ Sun, Keer; Metzger, Dennis W. (1 April 2014). "Influenza infection suppresses NADPH oxidase-dependent phagocytic bacterial clearance and enhances susceptibility to secondary methicillin-resistant Staphylococcus aureus infection". Journal of Immunology (Baltimore, Md.: 1950). 192 (7): 3301–3307. doi:10.4049/jimmunol.1303049. ISSN 1550-6606. PMC 3965630. PMID 24563256.
  9. ↑ Smith, Amber M.; McCullers, Jonathan A. (2014). "Secondary Bacterial Infections in Influenza Virus Infection Pathogenesis". Influenza Pathogenesis and Control - Volume I. Springer International Publishing. pp. 327–356. doi:10.1007/82_2014_394. ISBN 978-3-319-11155-1. PMID 25027822. Archived from the original on 2025-01-21. Retrieved 2025-08-25.
  10. ↑ 10.0 10.1 Bartley, Patricia S.; Deshpande, Abhishek; Yu, Pei-Chun; Klompas, Michael; Haessler, Sarah D.; Imrey, Peter B.; Zilberberg, Marya D.; Rothberg, Michael B. (February 2022). "Bacterial coinfection in influenza pneumonia: Rates, pathogens, and outcomes". Infection Control and Hospital Epidemiology. 43 (2): 212–217. doi:10.1017/ice.2021.96. ISSN 1559-6834. PMC 9116507. PMID 33890558.
  11. ↑ 11.0 11.1 Randolph, Adrienne G; Xu, Ruifei; Novak, Tanya; Newhams, Margaret M; Bubeck Wardenburg, Juliane; Weiss, Scott L; Sanders, Ronald C; Thomas, Neal J; Hall, Mark W; Tarquinio, Keiko M; Cvijanovich, Natalie; Gedeit, Rainer G; Truemper, Edward J; Markovitz, Barry; Hartman, Mary E (18 January 2019). "Vancomycin Monotherapy May Be Insufficient to Treat Methicillin-resistant Staphylococcus aureus Coinfection in Children With Influenza-related Critical Illness". Clinical Infectious Diseases. 68 (3): 365–372. doi:10.1093/cid/ciy495.
  12. ↑ Choo, Eun Ju; Chambers, Henry F. (December 2016). "Treatment of Methicillin-Resistant Staphylococcus aureus Bacteremia". Infection & Chemotherapy. 48 (4): 267–273. doi:10.3947/ic.2016.48.4.267. ISSN 2093-2340. PMC 5204005. PMID 28032484.
  13. ↑ McDanel, Jennifer S.; Perencevich, Eli N.; Storm, Jeremy; Diekema, Daniel J.; Herwaldt, Loreen; Johnson, J. Kristie; Winokur, Patricia L.; Schweizer, Marin L. "Increased Mortality Rates Associated with Staphylococcus aureus and Influenza Co-infection, Maryland and Iowa, USA - Volume 22, Number 7—July 2016 - Emerging Infectious Diseases journal - CDC". doi:10.3201/eid2207.151319.
  14. ↑ "Bacterial Coinfection Often Present in Pediatric Flu Deaths | MDedge". ma1.mdedge.com. Retrieved 13 August 2025.
  15. ↑ Gomi, Sumiko; Price, Emily; Burgoyne, Hailey; Faozia, Sabrina; Katahira, Eva; McIndoo, Eric; Nmaju, Anyauba A.; Sharma, Kavita; Aghazadeh-Habashi, Ali; Bryant, Amy E.; Stevens, Dennis L.; Pierce, Jessica V.; Serio, Alisa W.; Hobdey, Sarah E. (4 August 2025). "Omadacycline exhibits anti-inflammatory properties and improves survival in a murine model of post-influenza MRSA pneumonia". Antimicrobial Agents and Chemotherapy. 69 (9): e00469–25. doi:10.1128/aac.00469-25. Retrieved 2 October 2025.
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