Vol. 43 No. 5 (2026): October
Review Article

Early bacterial coinfection and secondary bacterial infection in hospitalized adults with influenza. : A systematic review and meta-analysis

PDF (Español (España))
  • Alberto Guevara Tirado,
  • Gerard Guardia Barra,
  • Sebastian Luis Cuadros Arones
Alberto Guevara Tirado
Universidad Científica del Sur, Lima, Peru
Gerard Guardia Barra
Universidad Científica del Sur, Lima, Peru
Sebastian Luis Cuadros Arones
Universidad Científica del Sur, Lima, Peru
DOI: https://doi.org/10.4067/s0716-10182026000500163

Published 2026-10-01

How to Cite

1.
Guevara Tirado A, Guardia Barra G, Cuadros Arones SL. Early bacterial coinfection and secondary bacterial infection in hospitalized adults with influenza. : A systematic review and meta-analysis. Rev. Chilena. Infectol. [Internet]. 2026 Oct. 1 [cited 2026 Oct. 1];43(5). Available from: https://revinf.cl/index.php/revinf/article/view/2736

Copyright (c) 2026 Alberto Guevara Tirado, Gerard Guardia Barra, Sebastian Luis Cuadros Arones

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Background: In hospitalized adults with confirmed influenza, bacterial coinfection is a significant complication, although its frequency and prognostic impact vary.

Aim: To estimate the prevalence of early bacterial coinfection and secondary bacterial infection and their association with clinical outcomes.

Materials and Methods: A systematic review and meta-analysis of observational studies conducted in accordance with PRISMA 2020, using searches in PubMed, Embase, and Scopus. Hospitalized adults with confirmed influenza were included, distinguishing between early coinfection, present at admission or within 48-72 hours, and secondary infection. Prevalence rates were aggregated using random-effects models, logit transformation, and REML; subgroup analyses by care setting and leave-one-out analyses were performed. Quality was assessed using the Newcastle-Ottawa Scale.

Results: Eight studies were included (n=8,986). The early coinfection rate was 19.6% (95% CI: 12.4–29.7; I²=97.4%): 24.0% in the ICU and 17.3% in general hospitalization. The secondary infection rate was 15.3%. Mechanical ventilation was associated with the outcome in the exploratory analysis (OR = 2.29; 95% CI: 1.32-3.95), but not in the strict analysis. Mortality showed no conclusive association.

Conclusions: Early coinfection varies widely across settings. Targeted microbiological testing is recommended, particularly in critically ill patients; however, this does not justify routine antibiotic therapy.

PDF (Español (España))