Co-infection with influenza A(H1N1) and A(H3N2) correlates with increased hypoxemia, fungal co-infections, and negative short-term outcomes in adults suffering from influenza-related community-acquired pneumonia

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Influenza-associated community-acquired pneumonia is an important cause of acute hypoxemic respiratory failure, intensive care admission, and in-hospital death among adults.
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Simultaneous detection of influenza A(H1N1) and A(H3N2) is biologically plausible but uncommon and may represent coinfection, sequential infection with overlapping shedding, or a high-viral-burden state.
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Previous surveillance cohorts found that hospitalized adults with A(H1N1)pdm09 had higher odds of intensive care admission, mechanical ventilation, and hypoxemia than those with A(H3N2).
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Targeted next-generation sequencing of bronchoalveolar lavage fluid provides broad pathogen co-detection, but a detected organism does not necessarily establish clinically significant infection.
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The study compared 51 adults with H1N1 mono-positivity and 46 with H1N1/H3N2 dual positivity during hospitalization for influenza-associated community-acquired pneumonia.

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