Association Between Antimicrobial-Resistant Pathogens and Seasonal Influenza Infection Rates

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Researchers sought to determine whether there is a correlation between antimicrobial-resistant pathogens and influenza infection rates that occur during influenza season in ambulatory and inpatient settings.

The following article is a part of conference coverage from the IDWeek 2021, being held virtually from September 29 to October 3, 2021. The team at Infectious Disease Advisor will be reporting on the latest news and research conducted by leading experts in the field. Check back for more from the IDWeek 2021.

A surprising association was found between antimicrobial-resistant Gram-negative (GN) pathogens and seasonal influenza epidemic patterns, as well as evidence for a correlation between Gram-positive (GP) pathogens and respiratory-related influenza infections. These findings were presented at IDWeek, held virtually from September 29 to October 3, 2021.

Data were sourced from the BD Insights Research Database which collected information from 257 healthcare institutions in the United States between 2011 and 2019. Patients aged17 years and older were assessed for susceptibility to GN and GP bacteria. The tested GN pathogens included Enterobacterales, Pseudomonas aeruginosa, Acinetobacter baumannii, and Stenotrophomonas maltophilia. The GP pathogens comprised Staphylococcus aureus, and Streptococcus pneumoniae. The rate of antimicrobial resistance and seasonal influenza infections among the included patients were assessed for correlations.

A total of 16,576,274 pathogenic infections were identified. Of the infections, 1,502,796 were GN quinolone resistant; 498,012 were methicillin-resistant S aureus (MRSA); 154,841 were GN carbapenem resistant; and 44,131 were macrolide, penicillin, and extended-spectrum cephalosporin resistant S pneumoniae.

The researchers noted a correlation between overall influenza infection rates and antimicrobial-resistant pathogens including S pneumoniae-resistant macrolides (b, 0.464; P <.001), A baumannii-resistant carbapenems (b, 0.205; P <.001), Enterobacterales-resistant quinolones (b, 0.041; P <.001), S pneumonia-resistant penicillins (b, 0.062; P =.011), P aeruginosaresistant quinolones (b, 0.039; P =.015), and S pneumoniae-resistant extended-spectrum cephalosporins (b, 0.033; P =.036).

Although MRSA was the only GP pathogen which did not correlate with overall influenza infection rates (b, 0.060; P =.615), it was found to be associated with significantly increased rates of respiratory-related influenza infection (b, 0.66; P =.028).

After stratification by respiratory and nonrespiratory infectious sources, the researchers observed a correlation between influenza infection rates and all antimicrobial-resistant pathogens, including MRSA. In addition, stratification by inpatient and outpatient settings showed a correlation between all GN resistant pathogens and influenza infection rates among patients who were hospitalized.

The researchers noted that patterns of antimicrobial resistance among GN and GP pathogens may be associated with influenza epidemics. Additional studies are needed to confirm these findings and to unravel the relationship between pathogenic susceptibility and viral infections. “These insights may help inform targeted antimicrobial stewardship initiatives during influenza season,” the researchers concluded.

Disclosure: One author declared affiliations with industry. Please see the original reference for a full list of disclosures.


Amiche A, Kabler H, Weeks J, Yu K, Gupta V. Antibiotic resistance patterns, seasonality, and correlation with the influenza season in the United States a multicenter evaluation reveals surprising association between influenza season and gram negative pathogens Presented at: IDWeek; September 29 to October 3, 2021.Poster 176.

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