1
|
Brock RC, Goudie RJB, Peters C, Thaxter R, Gouliouris T, Illingworth CJR, Conway Morris A, Beggs CB, Butler M, Keevil VL. Efficacy of air cleaning units for preventing SARS-CoV-2 and other hospital-acquired infections on medicine for older people wards: a quasi-experimental controlled before-and-after study. J Hosp Infect 2024; 155:1-8. [PMID: 39374708 DOI: 10.1016/j.jhin.2024.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 09/23/2024] [Accepted: 09/25/2024] [Indexed: 10/09/2024]
Abstract
BACKGROUND Nosocomial infections are costly, and airborne transmission is increasingly recognized as important for spread. Air cleaning units (ACUs) may reduce transmission, but little research has focused on their effectiveness on open wards. AIM To assess whether ACUs reduce nosocomial severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), or other, infections on older adult inpatient wards. METHODS This was a quasi-experimental before-and-after study on two intervention-control ward pairs in a UK teaching hospital. Infections were identified using routinely collected electronic health record data during 1 year of ACU implementation and the preceding year ('core study period'). Extended analyses included 6 months of additional data from one ward pair following ACU removal. Hazard ratios (HRs) were estimated through Cox regression controlling for age, sex, ward and background infection risk. The time that the ACUs were switched on was also recorded for Intervention Ward 2. FINDINGS ACUs were initially feasible, but compliance reduced towards the end of the study (average operation in first vs second half of ACU time on Intervention Ward 2: 77% vs 53%). In total, 8171 admissions for >48 h (6112 patients, median age 85 years) were included. Overall, the incidence of ward-acquired SARS-CoV-2 was 3.8%. ACU implementation was associated with a non-significant trend of lower hazard for SARS-CoV-2 infection [HR core study period 0.90, 95% confidence interval (CI) 0.53-1.52; HR extended study period 0.78, 95% CI 0.53-1.14]. Only 1.5% of admissions resulted in other notable ward-acquired infections. CONCLUSION ACUs may reduce SARS-CoV-2 infection to a clinically meaningfully degree. Larger studies could reduce uncertainty, perhaps using a crossover design, and factors influencing acceptability to staff and patients should be explored further.
Collapse
Affiliation(s)
- R C Brock
- MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - R J B Goudie
- MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - C Peters
- Department of Microbiology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - R Thaxter
- Infection Control, Cambridge University Hospitals, Cambridge, UK
| | - T Gouliouris
- Department of Infectious Diseases, Cambridge University Hospitals, Cambridge, UK; Department of Medicine, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - A Conway Morris
- Department of Medicine, School of Clinical Medicine, University of Cambridge, Cambridge, UK; The John Farman ICU, Cambridge University Hospitals, Cambridge, UK
| | - C B Beggs
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK; Department of Medicine for the Elderly, Cambridge University Hospitals, Cambridge, UK
| | - M Butler
- Department of Medicine for the Elderly, Cambridge University Hospitals, Cambridge, UK
| | - V L Keevil
- Department of Medicine, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Department of Medicine for the Elderly, Cambridge University Hospitals, Cambridge, UK.
| |
Collapse
|
2
|
Shrestha M, Sherer PP, Paek SC, Prasert K, Chawalchitiporn S, Praphasiri P. Influenza vaccine hesitancy among healthcare workers in a Northeastern province in Thailand: Findings of a cross-sectional survey. PLoS One 2024; 19:e0310761. [PMID: 39298526 DOI: 10.1371/journal.pone.0310761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 09/05/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Healthcare workers (HCWs) are an important target group for influenza vaccination due to their increased risk of infection. However, their uptake remains a challenge. This study aimed to identify and measure influenza vaccine hesitancy among HCWs in Nakhon Phanom province, Thailand. METHODS A representative cross-sectional survey was conducted during August-September 2020, among 350 HCWs at six hospitals in the province selected by a two-stage cluster sampling using a self-administered questionnaire. HCWs who either delayed getting influenza vaccines, accepted the vaccines but were unsure, or refused the vaccine with doubts were categorized as hesitant. HCWs who accepted the influenza vaccine without any doubts were classified as non-hesitant. Determinants of vaccine hesitancy were identified by a multivariable logistic regression analysis. RESULTS A total of 338 participants (97%) filled the questionnaires. The mean age of the participants was 37.2 years. Most participants were female (280; 83%), nurses (136; 40%), working at district hospitals (238; 71%), with bachelor's degree (223; 66%), and without any pre-existing chronic medical conditions (264; 78%). Influenza vaccine hesitancy was evident among nearly 60% of the participants (197/338), who had varying patterns of hesitancy. Significant factors of influenza vaccine hesitancy were found to be age above 50 years (adjusted odds ratio [aOR] 3.2, 95% CI 1.3-8.5), fair knowledge of influenza and vaccination (aOR 0.4, 95% CI 0.2-0.8), and negative influence of other HCW (High level-aOR 2.3, 95% CI 1.1-4.8; Moderate level- aOR 2.1, 95% CI 1.1-4.4). CONCLUSION Influenza vaccine hesitancy was highly prevalent among the Thai HCWs in Nakhon Phanom province. Imparting updated information to the HCW, in combination with positive guidance from influential HCWs in the hospital, may help reduce hesitancy. These data may be useful to the National Immunization Program to design appropriate approaches to target hesitant HCWs in Thailand to improve influenza vaccine coverage.
Collapse
Affiliation(s)
- Manash Shrestha
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand
| | - Penchan Pradubmook Sherer
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand
| | - Seung Chun Paek
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand
| | - Kriengkrai Prasert
- Nakhon Phanom Hospital, Nakhon Phanom, Thailand
- Faculty of Public Health, Kasetsart University, Sakon Nakhon, Thailand
| | | | - Prabda Praphasiri
- Faculty of Public Health, Kasetsart University, Sakon Nakhon, Thailand
| |
Collapse
|
3
|
Valek AL, Srinivasa VR, Ayres AM, Cheung S, Harrison LH, Snyder GM. Incidence and transmission associated with respiratory viruses in an acute care facility: An observational study. Infect Control Hosp Epidemiol 2024; 45:774-776. [PMID: 38351601 PMCID: PMC11102818 DOI: 10.1017/ice.2024.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/30/2023] [Accepted: 01/01/2024] [Indexed: 05/18/2024]
Abstract
We estimated the extent of respiratory virus transmission over three pre-COVID-19 seasons. Of 16,273 assays, 22.9% (3,726) detected ≥1 respiratory virus. The frequency of putatively hospital-acquired infection ranged from 6.9% (influenza A/B) to 24.7% (adenovirus). The 176 clusters were most commonly associated with rhinovirus/enterovirus (70) and influenza A/B (62).
Collapse
Affiliation(s)
- Abby L. Valek
- Department of Infection Prevention and Control, UPMC Presbyterian, Pittsburgh, PA, USA
| | - Vatsala Rangachar Srinivasa
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Microbial Genomic Epidemiology Laboratory, Center for Genomic Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ashley M. Ayres
- Department of Infection Prevention and Control, UPMC Presbyterian, Pittsburgh, PA, USA
| | - Steven Cheung
- School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lee H. Harrison
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Microbial Genomic Epidemiology Laboratory, Center for Genomic Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Graham M. Snyder
- Department of Infection Prevention and Control, UPMC Presbyterian, Pittsburgh, PA, USA
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| |
Collapse
|
4
|
Cho Y, Lee HK, Kim J, Yoo KB, Choi J, Lee Y, Choi M. Prediction of hospital-acquired influenza using machine learning algorithms: a comparative study. BMC Infect Dis 2024; 24:466. [PMID: 38698304 PMCID: PMC11067145 DOI: 10.1186/s12879-024-09358-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 04/26/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Hospital-acquired influenza (HAI) is under-recognized despite its high morbidity and poor health outcomes. The early detection of HAI is crucial for curbing its transmission in hospital settings. AIM This study aimed to investigate factors related to HAI, develop predictive models, and subsequently compare them to identify the best performing machine learning algorithm for predicting the occurrence of HAI. METHODS This retrospective observational study was conducted in 2022 and included 111 HAI and 73,748 non-HAI patients from the 2011-2012 and 2019-2020 influenza seasons. General characteristics, comorbidities, vital signs, laboratory and chest X-ray results, and room information within the electronic medical record were analysed. Logistic Regression (LR), Random Forest (RF), Extreme Gradient Boosting (XGB), and Artificial Neural Network (ANN) techniques were used to construct the predictive models. Employing randomized allocation, 80% of the dataset constituted the training set, and the remaining 20% comprised the test set. The performance of the developed models was assessed using metrics such as the area under the receiver operating characteristic curve (AUC), the count of false negatives (FN), and the determination of feature importance. RESULTS Patients with HAI demonstrated notable differences in general characteristics, comorbidities, vital signs, laboratory findings, chest X-ray result, and room status compared to non-HAI patients. Among the developed models, the RF model demonstrated the best performance taking into account both the AUC (83.3%) and the occurrence of FN (four). The most influential factors for prediction were staying in double rooms, followed by vital signs and laboratory results. CONCLUSION This study revealed the characteristics of patients with HAI and emphasized the role of ventilation in reducing influenza incidence. These findings can aid hospitals in devising infection prevention strategies, and the application of machine learning-based predictive models especially RF can enable early intervention to mitigate the spread of influenza in healthcare settings.
Collapse
Affiliation(s)
- Younghee Cho
- College of Nursing, Yonsei University, Seoul, Republic of Korea
- Department of Digital Health, Samsung SDS, Seoul, Republic of Korea
| | - Hyang Kyu Lee
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Joungyoun Kim
- College of Engineering, University of Seoul, Seoul, Republic of Korea
| | - Ki-Bong Yoo
- Division of Health Administration, Yonsei University, Wonju, Republic of Korea
| | - Jongrim Choi
- College of Nursing, Keimyung University, Daegu, Republic of Korea
| | - Yongseok Lee
- Department of Digital Health, Samsung SDS, Seoul, Republic of Korea
| | - Mona Choi
- College of Nursing, Yonsei University, Seoul, Republic of Korea.
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
| |
Collapse
|
5
|
Suh W, Han SB. Nosocomial influenza in a pediatric general ward: Effects of isolation and cohort placement of children with influenza. Infect Control Hosp Epidemiol 2023; 44:1637-1642. [PMID: 36924052 DOI: 10.1017/ice.2023.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Many studies have described nosocomial outbreaks of influenza in specialized wards. We evaluated nosocomial transmission of influenza in a pediatric general ward. DESIGN Retrospective observational study. SETTING Single secondary hospital. PATIENTS The study included 814 hospitalized children with influenza between September 2015 and August 2020. METHODS The medical records of the included children were retrospectively reviewed, and clinical characteristics of children with community-acquired (CA) influenza and hospital-acquired (HA) influenza were determined. The room of each included child during hospitalization was traced to identify the children exposed to them. RESULTS CA influenza and HA influenza were diagnosed in 789 (96.9%) and 25 (3.1%) children, respectively. Among children with CA influenza, 691 (87.6%) were isolated or place in a cohort on admission. In total, 98 children (12.4%) admitted to multibed rooms exposed 307 children with noninfluenza diseases to influenza during 772 patient days; 3 exposed children (1.0%) were diagnosed with HA influenza. Including these 3 children, 25 children (19 without definite in-hospital exposure to influenza and 3 exposed to other children with HA influenza) were diagnosed with HA influenza, and 11 (44.0%) exposed 31 children with noninfluenza diseases to influenza for 85 patient days. Also, 3 exposed children (9.7%) were diagnosed with HA influenza, a significantly higher rate than that for CA influenza (P = .005). The clinical characteristics were comparable between children with HA influenza and those with CA influenza. CONCLUSIONS Cohort placement of children with influenza in a pediatric general ward can be effective in controlling nosocomial transmission of influenza. However, control measures for children with HA influenza should be emphasized.
Collapse
Affiliation(s)
- Woosuck Suh
- Department of Pediatrics, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Seung Beom Han
- Department of Pediatrics, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea
| |
Collapse
|
6
|
Rothman E, Olsson O, Christiansen CB, Rööst M, Inghammar M, Karlsson U. Influenza A subtype H3N2 is associated with an increased risk of hospital dissemination - an observational study over six influenza seasons. J Hosp Infect 2023; 139:134-140. [PMID: 37419188 DOI: 10.1016/j.jhin.2023.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/15/2023] [Accepted: 06/22/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Previous studies on hospital-acquired influenza (HAI) have not systematically evaluated the possible impact of different influenza subtypes. HAI has historically been associated with high mortality, but clinical consequences may be less severe in a modern hospital setting. AIMS To identify and quantify HAI for each season, investigate possible associations with varying influenza subtypes, and to determine HAI-associated mortality. METHODS All influenza-PCR-positive adult patients (>18 years old) hospitalized in Skåne County during 2013-2019, were prospectively included in the study. Positive influenza samples were subtyped. Medical records of patients with suspected HAI were examined to confirm a nosocomial origin and to determine 30-day mortality. RESULTS Of 4110 hospitalized patients with a positive influenza PCR, 430 (10.5%) were HAI. Influenza A(H3N2) infections were more often HAI (15.1%) than influenza A(H1N1)pdm09, and influenza B (6.3% and 6.8% respectively, P<0.001). The majority of HAI caused by H3N2 were clustered (73.3 %) and were the cause of all 20 hospital outbreaks consisting of ≥4 affected patients. In contrast, the majority of HAI caused by influenza A(H1N1)pdm09 and influenza B were solitary cases (60% and 63.2%, respectively, P<0.001). Mortality associated with HAI was 9.3% and similar between subtypes. CONCLUSIONS HAI caused by influenza A(H3N2) was associated with an increased risk of hospital dissemination. Our study is relevant for future seasonal influenza infection control preparedness and shows that subtyping of influenza may help to define relevant infection control measures. Mortality in HAI remains substantial in a modern hospital setting.
Collapse
Affiliation(s)
- E Rothman
- Department of Clinical Microbiology and Infection Prevention and Control, Skåne University Hospital, Sweden; Department of Research and Development, Region Kronoberg, Växjö, Sweden
| | - O Olsson
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden; Department of Infectious Diseases, Skåne University Hospital, Lund, Sweden
| | - C B Christiansen
- Department of Clinical Microbiology and Infection Prevention and Control, Skåne University Hospital, Sweden
| | - M Rööst
- Department of Research and Development, Region Kronoberg, Växjö, Sweden; Department of Clinical Sciences in Malmö, Family Medicine, Clinical Research Centre, Lund University, Malmö, Sweden
| | - M Inghammar
- Department of Infectious Diseases, Skåne University Hospital, Lund, Sweden; Section for Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - U Karlsson
- Department of Clinical Microbiology and Infection Prevention and Control, Skåne University Hospital, Sweden; Section for Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden.
| |
Collapse
|
7
|
Bilgin H, Başarı T, Pazar N, Küçüker I, Can-Sarınoğlu R. Comparison of 28-Day Mortality Between Hospital- and Community-Acquired Influenza Patients. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2023; 5:231-238. [PMID: 38633557 PMCID: PMC10985807 DOI: 10.36519/idcm.2023.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/08/2023] [Indexed: 04/19/2024]
Abstract
Objective This study aimed to compare 28-day mortality between patients have hospital-acquired influenza (HAI) and those have community-acquired influenza (CAI) during the 2017-2019 influenza seasons in a tertiary care center in İstanbul, Türkiye. Materials and Methods This retrospective cohort included all hospitalized patients who had confirmed influenza infection and were over 17 years old. HAI was defined as a case of influenza that tested negative in a PCR test or had no signs of influenza on admission but with a positive test result at any point after 72 hours of admission. CAI was defined as a case of influenza diagnosed within 72 hours of admission or before admission. The primary outcome was 28-day mortality after diagnosis. Biological sex, admission to the intensive care unit (ICU), presence of chronic obstructive pulmonary disease, cardiovascular and immunosuppressive comorbidities, influenza subtype, and other variables identified with univariate analyses (p<0.25) were entered into logistic regression analysis. Results During the study period, 92 (46%) of 201 hospitalized patients who tested positive for influenza were identified as HAI, and the rest (109) were identified as CAI. Univariate analysis showed no differences between survivors and non-survivors in patient characteristics, except non-survivors were more likely to have an ICU admission. The multivariable logistic regression analysis results showed that HAI was associated with 5.6-fold increased odds of mortality (95% confidence interval [CI]=1.6-19.3; p=0.006), after adjustment for age, gender, comorbidity, and ICU admission. Conclusion The results of this study revealed that patients who had HAI were more likely to die within 28 days compared to those who had CAI after controlling for key confounders. The high rate of HAI underscores the critical importance of robust infection control measures for hospital-acquired viral infections. Additional research and targeted interventions are necessary to improve the HAI prognosis.
Collapse
Affiliation(s)
- Hüseyin Bilgin
- Department of Infectious Diseases and Clinical Microbiology,
Marmara University School of Medicine, İstanbul, Türkiye
| | - Tuğçe Başarı
- Department of Infectious Diseases and Clinical Microbiology,
Marmara University School of Medicine, İstanbul, Türkiye
| | - Nazlı Pazar
- Department of Infectious Diseases and Clinical Microbiology,
Marmara University School of Medicine, İstanbul, Türkiye
| | - Işıl Küçüker
- Infection Prevention and Control Unit, Marmara University
Hospital, İstanbul, Türkiye
| | - Rabia Can-Sarınoğlu
- Department of Medical Microbiology, Bahceşehir University School
of Medicine, İstanbul, Türkiye
| |
Collapse
|
8
|
Ambrosch A, Luber D, Klawonn F, Kabesch M. A strict mask policy for hospital staff effectively prevents from nosocomial influenza infections and mortality: monocentric data from five consecutive influenza seasons. J Hosp Infect 2021; 121:82-90. [PMID: 34929232 DOI: 10.1016/j.jhin.2021.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/09/2021] [Accepted: 12/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Influenza infections acquired in hospital show increased mortality, especially in elderly patients with risk factors. Nevertheless, vaccination rates are low among both high-risk patients and healthcare workers (HCW). To more effectively prevent influenza infections in the hospital during the influenza season, we introduced a strict mouth-nose protection (MNP) requirement for all staff throughout the shift on the affected wards as an intervention and studied its effect on nosocomial infection rates. METHODOLOGY The present data were obtained in a retrospective, monocentric analysis over a period of four consecutive influenza seasons from 2015 - 2019. MNP for all staff during the whole shift as an intervention was introduced at 2017 and for the following seasons if at least three flu patients were in the ward at the same time. Data from hospitalised influenza patients before and after intervention were compared with regard to nosocomial incidences and mortality. RESULTS In the years with strict mandatory MNP (2017 - 2019), the nosocomial influenza incidence fell nearly 50 % (OR 0.40, 95%CI 0.28 - 0.56, p < 0.001) accompanied by a significant reduction in nosocomial mortality by 85% (OR 0.15, 95%CI 0.02 - 0.70, p = 0.007). The infectious pressure indicated by influenza incidences and patient days at risk were comparable before and after intervention, as was the low rate of vaccine uptake by nurses. CONCLUSION From our data, we conclude that mandatory MNP for HCW effectively protect patients from nosocomial influenza infections and mortality.
Collapse
Affiliation(s)
- Andreas Ambrosch
- Institute for Laboratory Medicine, Microbiology and Hospital Hygiene, Hospital of the Merciful Brothers Regensburg, Germany.
| | - Doris Luber
- Institute for Laboratory Medicine, Microbiology and Hospital Hygiene, Hospital of the Merciful Brothers Regensburg, Germany
| | - Frank Klawonn
- Biostatistics Research Group, Helmholtz Centre for Infection Research, Braunschweig, Germany; Department of Computer Science, Ostfalia University of Applied Sciences, Wolfenbüttel, Germany
| | - Michael Kabesch
- Clinic and Polyclinic for Children and Youth Medicine of the University of Regensburg (KUNO) at the Clinic St. Hedwig, Merciful Brothers Regensburg, Germany; Science Development Campus Regensburg (WECARE) at the St. Hedwig Clinic of the Merciful Brothers, Regensburg
| |
Collapse
|
9
|
Javaid W, Ehni J, Gonzalez-Reiche AS, Carreño JM, Hirsch E, Tan J, Khan Z, Kriti D, Ly T, Kranitzky B, Barnett B, Cera F, Prespa L, Moss M, Albrecht RA, Mustafa A, Herbison I, Hernandez MM, Pak TR, Alshammary HA, Sebra R, Smith ML, Krammer F, Gitman MR, Sordillo EM, Simon V, van Bakel H. Real-Time Investigation of a Large Nosocomial Influenza A Outbreak Informed by Genomic Epidemiology. Clin Infect Dis 2021; 73:e4375-e4383. [PMID: 33252647 PMCID: PMC8653627 DOI: 10.1093/cid/ciaa1781] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Nosocomial respiratory virus outbreaks represent serious public health challenges. Rapid and precise identification of cases and tracing of transmission chains is critical to end outbreaks and to inform prevention measures. METHODS We combined conventional surveillance with influenza A virus (IAV) genome sequencing to identify and contain a large IAV outbreak in a metropolitan healthcare system. A total of 381 individuals, including 91 inpatients and 290 healthcare workers (HCWs), were included in the investigation. RESULTS During a 12-day period in early 2019, infection preventionists identified 89 HCWs and 18 inpatients as cases of influenza-like illness (ILI), using an amended definition without the requirement for fever. Sequencing of IAV genomes from available nasopharyngeal specimens identified 66 individuals infected with a nearly identical strain of influenza A H1N1pdm09 (43 HCWs, 17 inpatients, and 6 with unspecified affiliation). All HCWs infected with the outbreak strain had received the seasonal influenza virus vaccination. Characterization of 5 representative outbreak viral isolates did not show antigenic drift. In conjunction with IAV genome sequencing, mining of electronic records pinpointed the origin of the outbreak as a single patient and a few interactions in the emergency department that occurred 1 day prior to the index ILI cluster. CONCLUSIONS We used precision surveillance to delineate a large nosocomial IAV outbreak, mapping the source of the outbreak to a single patient rather than HCWs as initially assumed based on conventional epidemiology. These findings have important ramifications for more-effective prevention strategies to curb nosocomial respiratory virus outbreaks.
Collapse
Affiliation(s)
- Waleed Javaid
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Infection Prevention, Mount Sinai Beth Israel, New York, New York, USA
| | - Jordan Ehni
- Department of Infection Prevention, Mount Sinai Beth Israel, New York, New York, USA
| | - Ana S Gonzalez-Reiche
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Juan Manuel Carreño
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Elena Hirsch
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jessica Tan
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- The Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zenab Khan
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Divya Kriti
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Thanh Ly
- Clinical Microbiology Laboratory, Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bethany Kranitzky
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Barbara Barnett
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Freddy Cera
- Clinical Laboratory, Mount Sinai Beth Israel, New York, New York, USA
| | - Lenny Prespa
- Clinical Laboratory, Mount Sinai Beth Israel, New York, New York, USA
| | - Marie Moss
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Randy A Albrecht
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- The Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ala Mustafa
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ilka Herbison
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Matthew M Hernandez
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- The Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Theodore R Pak
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hala A Alshammary
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Robert Sebra
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Black Family Stem Cell Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Melissa L Smith
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Florian Krammer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Melissa R Gitman
- Clinical Microbiology Laboratory, Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Emilia Mia Sordillo
- Clinical Microbiology Laboratory, Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Viviana Simon
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- The Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Harm van Bakel
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
10
|
Hospital-acquired influenza in the United States, FluSurv-NET, 2011-2012 through 2018-2019. Infect Control Hosp Epidemiol 2021; 43:1447-1453. [PMID: 34607624 DOI: 10.1017/ice.2021.392] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To estimate population-based rates and to describe clinical characteristics of hospital-acquired (HA) influenza. DESIGN Cross-sectional study. SETTING US Influenza Hospitalization Surveillance Network (FluSurv-NET) during 2011-2012 through 2018-2019 seasons. METHODS Patients were identified through provider-initiated or facility-based testing. HA influenza was defined as a positive influenza test date and respiratory symptom onset >3 days after admission. Patients with positive test date >3 days after admission but missing respiratory symptom onset date were classified as possible HA influenza. RESULTS Among 94,158 influenza-associated hospitalizations, 353 (0.4%) had HA influenza. The overall adjusted rate of HA influenza was 0.4 per 100,000 persons. Among HA influenza cases, 50.7% were 65 years of age or older, and 52.0% of children and 95.7% of adults had underlying conditions; 44.9% overall had received influenza vaccine prior to hospitalization. Overall, 34.5% of HA cases received ICU care during hospitalization, 19.8% required mechanical ventilation, and 6.7% died. After including possible HA cases, prevalence among all influenza-associated hospitalizations increased to 1.3% and the adjusted rate increased to 1.5 per 100,000 persons. CONCLUSIONS Over 8 seasons, rates of HA influenza were low but were likely underestimated because testing was not systematic. A high proportion of patients with HA influenza were unvaccinated and had severe outcomes. Annual influenza vaccination and implementation of robust hospital infection control measures may help to prevent HA influenza and its impacts on patient outcomes and the healthcare system.
Collapse
|
11
|
Nosocomial influenza in patients with cancer before the coronavirus disease 2019 (COVID-19) era and one year after the pandemic: Can we do any better in hospitals? Infect Control Hosp Epidemiol 2021; 43:1723-1725. [PMID: 34287115 PMCID: PMC8387685 DOI: 10.1017/ice.2021.337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
12
|
Li Y, Wang LL, Xie LL, Hou WL, Liu XY, Yin S. The epidemiological and clinical characteristics of the hospital-acquired influenza infections: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25142. [PMID: 33725996 PMCID: PMC7982188 DOI: 10.1097/md.0000000000025142] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/21/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The hospital-acquired influenza (HAI) were usually contributed to severe outcomes among the inpatients. Here, we performed a meta-analysis to summarize and quantify the epidemiological and clinical characteristics of HAI. METHODS We performed a literature search thorough PubMed, Web of Science, Cochrane Library, Embase, Scopus and China National Knowledge Infrastructure (CNKI), and Wanfang databases for observational studies. Random/fix-effects models were used to obtain pooled proportion, odds ratio (OR), and weighted mean difference (WMD). RESULTS A total of 14 studies involving 1483 HAI and 71849 non-hospital-acquired influenza infections (NHAI) cases were included.The proportion of the HAI among the influenza cases was 11.38% (95% confidence interval [CI]: 5.19%-19.55%) and it was increased after 2012 (6.15% vs 12.72%). The HAI cases were significantly older (WMD = 9.51, 95% CI: 0.04-18.98) and the patients with chronic medical diseases were at increased risk of HAI (OR = 1.85, 95% CI: 1.57-2.19). Among them, metabolic disorders (OR = 8.10, 95% CI: 2.46-26.64) ranked the highest danger, followed by malignancy (OR = 3.18, 95% CI: 2.12-4.76), any chronic diseases (OR = 2.81, 95% CI: 1.08-9.31), immunosuppression (OR = 2.13, 95% CI: 1.25-3.64), renal diseases (OR = 1.72, 95% CI:1.40-2.10), heart diseases (OR = 1.52, 95% CI: 1.03-1.44), and diabetes (OR = 1.22, 95% CI: 1.03-1.44). The HAI cases were more likely to experience longer hospital stay (WMD = 10.23, 95% CI: 4.60-15.85) and longer intensive care unit (ICU) stay (WMD = 2.99, 95% CI: 1.50-4.48). In the outcomes within 30 days, those population was still more likely to receive hospitalization (OR = 6.55, 95% CI: 5.19-8.27), death in hospital (OR = 1.99, 95% CI: 1.65-2.40) but less likely to discharged (OR = 0.20, 95% CI: 0.16-0.24). CONCLUSION The proportion of the HAI among the influenza cases was relatively high. Reinforcement of the surveillance systems and vaccination of the high-risk patients and their contacts are necessary for the HAI control.
Collapse
Affiliation(s)
- Yi Li
- Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, PR China
| | | | | | | | | | | |
Collapse
|
13
|
Qalla-Widmer L, Héquet D, Troillet N, Petignat C, Balmelli C, Bassi C, Bellini C, Chave JP, Cometta A, Christin L, Clerc O, Daher O, Fuehrer U, Marchetti O, Merz L, Portillo V, Pralong G, Sandoz L, Senn L, Tâche F, Iten A. Nosocomial influenza in south-western Swiss hospitals during two seasonal epidemics: an observational study. J Hosp Infect 2021; 109:115-122. [PMID: 33422590 DOI: 10.1016/j.jhin.2020.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/24/2020] [Accepted: 12/13/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND In Switzerland each year, influenza leads to between 112,000 and 275,000 medical consultations. Data on nosocomial influenza infection are limited. AIM To describe nosocomial cases of seasonal influenza in south-western Switzerland. METHODS This study was conducted during two seasonal influenza epidemics from 2016 to 2018 in 27 acute care public hospitals in south-western Switzerland. During these two time-periods, every patient hospitalized for >72 h who was positively screened by reverse transcription-polymerase chain reaction or antigen detection for influenza was included in the survey. Characteristics of patients included age, sex, and comorbidities. Included patients were followed up until discharge or death. Complications and administration of antineuraminidases and/or antibiotics were registered. FINDINGS The median influenza vaccine coverage of healthcare workers was 40%. In all, 836 patients were included (98% with type A influenza virus in 2016-2017; 77% with type B virus in 2017-2018). Most patients (81%) had an unknown vaccine status. Overall, the incidence of nosocomial influenza was 0.5 per 100 admissions (0.35 per 1000 patient-days). The most frequent comorbidities were diabetes (20%), chronic respiratory diseases (19%), and malnutrition (17%). Fever (77%) and cough (66%) were the most frequent symptoms. Seventy-one percent of patients received antineuraminidases, 28% received antibiotics. Infectious complications such as pneumonia were reported in 9%. Overall, the all-cause mortality was 6%. CONCLUSION The occurrence of nosocomial influenza underlines the importance of vaccinating patients and healthcare workers, rapidly recognizing community- or hospital-acquired cases, and applying adequate additional measures to prevent dissemination, including the timely administration of antineuraminidases to avoid antibiotic use (and misuse).
Collapse
Affiliation(s)
- L Qalla-Widmer
- Cantonal Unit for Infection Control and Prevention, Public Health Service, Lausanne, Switzerland
| | - D Héquet
- Cantonal Unit for Infection Control and Prevention, Public Health Service, Lausanne, Switzerland.
| | - N Troillet
- Service of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland
| | - C Petignat
- Cantonal Unit for Infection Control and Prevention, Public Health Service, Lausanne, Switzerland
| | - C Balmelli
- Servizio di Prevenzione delle Infezioni e Medicina del Personale, Ente Ospedaliero Cantonale, Ticino, Switzerland
| | - C Bassi
- Prevention and Control of Infection, Hôpital du Jura Bernois, Moutier, Saint-Imier, Switzerland
| | - C Bellini
- Hospitals and Clinics of the Canton of Vaud, Switzerland
| | - J-P Chave
- Hospitals and Clinics of the Canton of Vaud, Switzerland
| | - A Cometta
- Hospitals and Clinics of the Canton of Vaud, Switzerland
| | - L Christin
- Hospitals and Clinics of the Canton of Vaud, Switzerland
| | - O Clerc
- Department of Internal Medicine and Infectious Diseases, Pourtalès Hospital, Neuchâtel, Switzerland
| | - O Daher
- Hospitals and Clinics of the Canton of Vaud, Switzerland
| | - U Fuehrer
- Department of Internal Medicine and Infectious Diseases, Hôpital de Bienne, Switzerland
| | - O Marchetti
- Hospitals and Clinics of the Canton of Vaud, Switzerland
| | - L Merz
- Hospitals and Clinics of the Canton of Vaud, Switzerland
| | - V Portillo
- Prevention and Control of Infection, Hôpital du Jura, Switzerland
| | - G Pralong
- Hospitals and Clinics of the Canton of Vaud, Switzerland
| | - L Sandoz
- Hospitals and Clinics of the Canton of Vaud, Switzerland
| | - L Senn
- Service of Hospital Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - F Tâche
- Hospitals and Clinics of the Canton of Vaud, Switzerland
| | - A Iten
- Infection Control Program, Geneva University Hospitals, Geneva, Switzerland
| |
Collapse
|
14
|
Yang K, Zhang N, Gao C, Qin H, Wang A, Song L. Risk factors for hospital-acquired influenza A and patient characteristics: a matched case-control study. BMC Infect Dis 2020; 20:863. [PMID: 33213361 PMCID: PMC7675395 DOI: 10.1186/s12879-020-05580-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 11/03/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND While hospital-acquired influenza A results in an additional cost burden and considerable mortality in patients, its risk factors are unknown. We aimed to describe the characteristics of patients vulnerable to hospital-acquired influenza A and to identify its risk factors to assist clinicians control hospital-acquired infections and reduce the burden of treatment. METHODS A case-control study was conducted among hospitalized patients aged ≥18 years at a tertiary level teaching hospital during the 2018-2019 influenza A season. Patient data were retrieved from hospital-based electronic medical records. Hospital-acquired influenza A was defined as a case of influenza A diagnosed 7 days or more after admission, in a patient with no evidence of influenza A infection on admission. The controls without influenza A were selected among patients exposed to the same setting and time period. We identified risk factors using conditional logistic regression and described the characteristics of hospital-acquired influenza A by comparing the clinical data of infected patients and the controls. RESULTS Of the 412 hospitalized patients with influenza A from all the departments in the study hospital, 93 (22.6%) cases were classified as hospital-acquired. The most common comorbidities of the 93 cases were hypertension (41.9%), coronary heart disease (21.5%), and cerebrovascular disease (20.4%). Before the onset of hospital-acquired influenza A, patients presented more lymphocytopenia (51.6% vs 35.5%, P = 0.027), hypoalbuminemia (78.5% vs 57.0%, P = 0.002), and pleural effusion (26.9% vs 9.7%, P = 0.002) than the matched controls. Infected patients also had longer hospital stays (18 days vs 14 days, P = 0.002), and higher mortality rates (10.8% vs 2.2%, P = 0.017) than the matched controls. Lymphocytopenia (odds ratio [OR]: 3.11; 95% confidence interval [CI]: 1.24-7.80; P = 0.016), hypoalbuminemia (OR: 2.24; 95% CI: 1.10-4.57; P = 0.027), and pleural effusion (OR: 3.09; 95% CI: 1.26-7.58; P = 0.014) were independently associated with hospital-acquired influenza A. CONCLUSIONS Lymphocytopenia, hypoalbuminemia and pleural effusion are independent risk factors that can help identify patients at high risk of hospital-acquired influenza A, which can extend hospital stay and is associated with a high mortality.
Collapse
Affiliation(s)
- Kui Yang
- Department of Pulmonary and Critical Care Medicine, Xijing Hospital, Fourth Military Medical University, No.127, Changle West Road, Xincheng District, Xi'an, 710032, Shaanxi Province, China
| | - Ni Zhang
- Department of Basic Medicine, Xi'an Medical University, No.1, Xin-Wang Road, Weiyang District, Xi'an, 710021, Shaanxi Province, China
| | - Chunchen Gao
- Department of Medical Genetics and Developmental Biology, Fourth Military Medical University, No.169, Changle West Road, Xincheng District, Xi'an, 710032, Shaanxi Province, China
| | - Hongyan Qin
- Department of Medical Genetics and Developmental Biology, Fourth Military Medical University, No.169, Changle West Road, Xincheng District, Xi'an, 710032, Shaanxi Province, China
| | - Anhui Wang
- Department of Epidemiology, School of Preventive Medicine, Fourth Military Medical University, No.169, Changle West Road, Xincheng District, Xi'an, 710032, Shaanxi Province, China
| | - Liqiang Song
- Department of Pulmonary and Critical Care Medicine, Xijing Hospital, Fourth Military Medical University, No.127, Changle West Road, Xincheng District, Xi'an, 710032, Shaanxi Province, China.
| |
Collapse
|
15
|
Zaraket H, Hurt AC, Clinch B, Barr I, Lee N. Burden of influenza B virus infection and considerations for clinical management. Antiviral Res 2020; 185:104970. [PMID: 33159999 DOI: 10.1016/j.antiviral.2020.104970] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/30/2020] [Accepted: 11/01/2020] [Indexed: 12/27/2022]
Abstract
Influenza B viruses cause significant morbidity and mortality, particularly in children, but the awareness of their impact is often less than influenza A viruses partly due to their lack of pandemic potential. Here, we summarise the biology, epidemiology and disease burden of influenza B, and review existing data on available antivirals for its management. There has long been uncertainty surrounding the clinical efficacy of neuraminidase inhibitors (NAIs) for influenza B treatment. In this article, we bring together the existing data on NAIs and discuss these alongside recent large randomised controlled trial data for the new polymerase inhibitor baloxavir in high-risk influenza B patients. Finally, we offer considerations for the clinical management of influenza B, with a focus on children and high-risk patients where disease burden is highest.
Collapse
Affiliation(s)
- Hassan Zaraket
- Center for Infectious Disease Research, Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Department of Experimental Pathology, Immunology and Microbiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | | | | | - Ian Barr
- WHO Collaborating Centre for Reference and Research on Influenza, Melbourne, Australia; Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute, Melbourne, Australia
| | - Nelson Lee
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Canada.
| |
Collapse
|
16
|
Fullana Barceló MI, Asensio Rodriguez J, Artigues Serra F, Ferre Beltran A, Salva D'agosto P, Almodovar Garcia M, Lopez Bilbao MDC, Sanchis Cortés P, Reina Prieto J, Riera Jaume M. Epidemiological and clinical characteristics of community-acquired and nosocomial influenza cases and risk factors associated with complications: A four season analysis of all adult patients admitted in a tertiary hospital. Influenza Other Respir Viruses 2020; 15:352-360. [PMID: 33125178 PMCID: PMC8051698 DOI: 10.1111/irv.12823] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 01/08/2023] Open
Abstract
Background Information on the characteristics of patients with nosocomial influenza and associated complications is scarce. This study compared epidemiological and clinical characteristics of patients admitted with hospital‐acquired influenza (HAI) to those with community‐acquired influenza (CAI) and analyzed risk factors associated with complications. Methods This retrospective, observational study included all adult patients with confirmed influenza virus infection admitted to Son Espases University Hospital during the influenza season in Spain (October to May) from 2012‐2013 to 2015‐2016. Symptom onset before admission was included as CAI, and 2 days after admission or within 48 hours after previous discharge were considered as HAI. Results Overall, 666 patients with laboratory‐confirmed influenza were included; 590 (88.6%) and 76 (11.4%) had CAI and HAI, respectively. Baseline characteristics and vaccination rates were similar in both groups. Patients with HAI had significantly fewer symptoms, less radiological alterations, and earlier microbiological diagnosis than those with CAI. Eighty‐five (14.4%) and 20 (27.6%) CAI and HAI patients, respectively, experienced at least one complication, including septic shock, admission to the intensive care unit, mechanical ventilation or evolution to death (any one, P = .003). Univariate and multivariate binary logistic regression was performed to assess independent risk factors associated with the occurrence of complications: nosocomial infection, diabetes, oseltamivir treatment, having received no vaccination, microbiological delay, dyspnea, and the state of confusion were the most important significant factors. Conclusions Our study shows the need to implement microbiological diagnostic measures in the first 48 hours to reduce HAI frequency and associated complications.
Collapse
Affiliation(s)
| | | | | | - Adrian Ferre Beltran
- Internal Medicine Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Pilar Salva D'agosto
- Internal Medicine Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | | | - Pilar Sanchis Cortés
- Department of Chemistry, University of Balearic Islands, Palma de Mallorca, Spain
| | - Jorge Reina Prieto
- Virology Unit, Clinical Microbiology Service, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Melchor Riera Jaume
- Infectious Diseases Section, Internal Medicine Department, Infectious Diseases and HIV Group, Hospital Universitario Son Espases, IDISBA, Palma de Mallorca, Spain
| |
Collapse
|
17
|
Dynamics of nosocomial parainfluenza virus type 3 and influenza virus infections at a large German University Hospital between 2012 and 2019. Diagn Microbiol Infect Dis 2020; 99:115244. [PMID: 33253961 PMCID: PMC7568502 DOI: 10.1016/j.diagmicrobio.2020.115244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 10/04/2020] [Accepted: 10/11/2020] [Indexed: 12/16/2022]
Abstract
Nosocomial virus infections cause significant morbidity and mortality. Besides influenza viruses, the disease burden of parainfluenza virus type 3 (PIV-3) is comparatively high among hospitalized patients and severe disease courses can occur. PIV-3 showed the highest rates of nosocomial infections of a panel of respiratory viruses. Therefore, a retrospective observational study was conducted among patients with either PIV-3 or influenza viruses, which served as reference pathogen. The aim was to compare the seasonal dynamics and clinical characteristics of nosocomial infections with these highly transmittable viruses. Nosocomial infection occurred in 15.8% (n = 177) of all influenza cases, mainly in the first half of a season. About 24.3% (n = 104) of the PIV-3 cases were nosocomial and occurred mainly in the second half of a season. Both nosocomial rates of influenza and nosocomial rates of PIV-3 varied between the seasons. Community acquired and nosocomial cases differed in underlying medical conditions and immunosuppression. Knowledge of the baseline rates of nosocomial infections could contribute to the implementation of appropriate infection control measures.
Collapse
|
18
|
Description of an influenza outbreak in a French university hospital and risk factors of nosocomial influenza. Eur J Clin Microbiol Infect Dis 2020; 40:879-884. [PMID: 33057812 DOI: 10.1007/s10096-020-04070-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/09/2020] [Indexed: 10/23/2022]
Abstract
Our objective was to evaluate risk factors of nosocomial influenza (NI) in an university hospital during the 2015/2016 influenza season. All hospitalized patients with influenza-like illness associated with laboratory confirmation by polymerase chain reaction were included in a prospective observational study. We identified 44 cases (19%) of NI among the 233 cases of influenza: 38/178 (21%) in adults and 6/55 (11%) in children. Among adults, hospitalization in a double or multi-occupancy room was independently associated with NI (adjusted Odds Ratio, 3.42; 95% CI, 1.29-9.08; p = 0.013). The results of the study underline the importance of single room to prevent NI.
Collapse
|
19
|
Quantifying influenza exposure within California hospitals and nursing homes using administrative data. Am J Infect Control 2020; 48:831-833. [PMID: 31780203 DOI: 10.1016/j.ajic.2019.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/23/2019] [Accepted: 10/23/2019] [Indexed: 11/20/2022]
Abstract
Influenza acquisition occurs in hospitals and nursing homes (NHs), highlighting the need for infection prevention. We used administrative data to quantify influenza exposure and facility-onset influenza rates for California hospitals and NHs during the 2015-2016 influenza season. Higher facility-onset influenza rates were identified in NHs compared with hospitals, despite fewer influenza exposure-days in NHs. Validation of administrative data are needed.
Collapse
|
20
|
Incidence and characteristics of nosocomial influenza in a country with low vaccine coverage. J Hosp Infect 2020; 105:619-624. [PMID: 32540461 DOI: 10.1016/j.jhin.2020.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/03/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Influenza vaccination coverage is low in France, in at-risk patients and in healthcare workers. AIM We aimed to estimate the incidence of nosocomial influenza, its characteristics and outcome. METHODS During one influenza season, we retrospectively evaluated all cases of documented influenza. Inpatients with symptoms onset ≥48 h after admission were enrolled. Data were collected on a standardized questionnaire. RESULTS From November 2017 to April 2018, 860 patients tested positive for influenza by polymerase chain reaction analysis on a respiratory sample. Among them, 204 (23.7%) were diagnosed ≥48 h after admission, of whom 57 (6.6% of all influenza cases) fulfilled inclusion criteria for nosocomial influenza: 26 women and 31 men, median age 82 years (interquartile range, 72.2-86.9). Twenty patients (38.6%) had recently (<6 months) received the seasonal influenza vaccine. Median time between admission and symptoms onset, and between symptoms onset and diagnosis were, respectively, 11 days (7-19.5) and 29 h (15.5-48). Influenza was mostly acquired in a double-bedded room (N = 39, 68.4%), with documented exposure in 14 cases. Influenza B virus was more common in nosocomial (46/57, 80.7%), than in community-acquired cases (359/803, 44.6%), P<0.001. Mortality rate at three months was 15.8% (N = 9). Incidence of nosocomial influenza was estimated at 0.22 per 1000 hospital-days during the study period. CONCLUSION Nosocomial influenza is not rare in elderly inpatients, and may have severe consequences. Influenza B virus was over-represented, which suggests higher transmissibility and/or transmission clusters.
Collapse
|
21
|
Rombach M, Hin S, Specht M, Johannsen B, Lüddecke J, Paust N, Zengerle R, Roux L, Sutcliffe T, Peham JR, Herz C, Panning M, Donoso Mantke O, Mitsakakis K. RespiDisk: a point-of-care platform for fully automated detection of respiratory tract infection pathogens in clinical samples. Analyst 2020; 145:7040-7047. [DOI: 10.1039/d0an01226b] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
The RespiDisk platform for automated detection of multiple viral and bacterial respiratory tract infection pathogens.
Collapse
Affiliation(s)
| | | | | | | | | | - Nils Paust
- Hahn-Schickard
- 79110 Freiburg
- Germany
- Laboratory for MEMS Applications
- IMTEK – Department of Microsystems Engineering
| | - Roland Zengerle
- Hahn-Schickard
- 79110 Freiburg
- Germany
- Laboratory for MEMS Applications
- IMTEK – Department of Microsystems Engineering
| | - Louis Roux
- LifeAssay Diagnostics (Pty) Ltd
- 7945 Cape Town
- South Africa
| | | | - Johannes R. Peham
- AIT Austrian Institute of Technology
- Molecular Diagnostics
- Center for Health and Bioresources
- 1210 Vienna
- Austria
| | - Christopher Herz
- AIT Austrian Institute of Technology
- Molecular Diagnostics
- Center for Health and Bioresources
- 1210 Vienna
- Austria
| | - Marcus Panning
- Institute of Virology
- Medical Center – University of Freiburg
- Faculty of Medicine
- University of Freiburg
- 79104 Freiburg
| | - Oliver Donoso Mantke
- Quality Control for Molecular Diagnostics (QCMD)
- Unit 5
- Technology Terrace
- Glasgow G20 0XA Scotland
- UK
| | - Konstantinos Mitsakakis
- Hahn-Schickard
- 79110 Freiburg
- Germany
- Laboratory for MEMS Applications
- IMTEK – Department of Microsystems Engineering
| |
Collapse
|
22
|
Naudion P, Lepiller Q, Bouiller K. Risk factors and clinical characteristics of patients with nosocomial influenza A infection. J Med Virol 2019; 92:1047-1052. [PMID: 31825110 DOI: 10.1002/jmv.25652] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 12/05/2019] [Indexed: 12/25/2022]
Abstract
Influenza is a public health burden, responsible for more than half a million deaths worldwide each year and explosive outbreaks in-hospital care units. At present, little is known about clinical characteristics and outcomes with nosocomial influenza infection. To assess clinical characteristics and outcome between nosocomial and community-acquired (CA) influenza in a tertiary care hospital. A retrospective study of hospitalized patients in a French tertiary care hospital from 1st December 2016 to 28th February 2017 for flu-illness confirmed by reverse transcription PCR. Overall, 208 patients with laboratory-confirmed influenza were included; whose 49 nosocomial cases (23.6%). Patients with nosocomial influenza were significantly older (79.1 ± 15.5 vs 64.8 ± 31.1 years old; P = .003), with the more rapidly fatal disease (10.2% vs 1.3%; P = .0032). They had a less respiratory failure (8.2% vs 21.4%; P = .036) but had a longer length of hospitalization (47.3 vs 12.9 days; P < .001) than patients with CA influenza. During this influenza outbreak, 19 patients died (9.1%), none of them were vaccinated. Effective control of outbreaks in hospital facilities is challenging. Hospitalized patients are vulnerable to nosocomial Influenza infections that can increase the length of stay and be responsible for the death. Surveillance and early warning systems should be encouraged. Vaccination policies in conjunction with isolation measures and better hand hygiene could reduce virus spreading in hospitals.
Collapse
Affiliation(s)
- Pauline Naudion
- Department of internal medicine, University hospital, Besançon, France
| | | | - Kevin Bouiller
- Department of infectious diseases, University hospital, Besançon, France
| |
Collapse
|
23
|
Parkash N, Beckingham W, Andersson P, Kelly P, Senanayake S, Coatsworth N. Hospital-acquired influenza in an Australian tertiary Centre 2017: a surveillance based study. BMC Pulm Med 2019; 19:79. [PMID: 30991976 PMCID: PMC6469028 DOI: 10.1186/s12890-019-0842-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 04/01/2019] [Indexed: 11/22/2022] Open
Abstract
Background In 2017, Australia experienced its highest levels of influenza virus activity since the 2009 pandemic. This allowed detailed comparison of the characteristics of patients with community and hospital-acquired influenza, and infection control factors that contributed to influenza spread. Methods A surveillance based study was conducted on hospitalised patients with laboratory-confirmed influenza at the Canberra Hospital during April–October 2017. Differences between the hospital-acquired and community-acquired patient characteristics and outcomes were assessed by univariate analysis. Epidemiologic curves were developed and cluster distribution within the hospital was determined. Results Two hundred and ninety-two patients were included in the study. Twenty-eight (9.6%) acquired influenza in hospital, representing a higher proportion than any of the previous 5 years (range 0.9–5.8%). These patients were more likely to have influenza A (p = 0.021), had higher rates of diabetes (p = 0.015), malignancy (p = 0.046) and chronic liver disease (p = 0.043). Patients acquiring influenza in hospital met clinical criteria for influenza like illness in 25% of cases, compared with 64.4% for community-acquired cases (p < 0.001). Hospital-acquired influenza cases occurred in two distinct clusters. Patients were moved an average of 5 times after diagnosis. Mean length of stay following diagnosis was 13 days compared to 5 days for community-acquired cases (p < 0.001). Of the patients with hospital-acquired influenza, 22 were in shared rooms during their incubation period and 9 were not isolated in single rooms following diagnosis. Treatment was initiated within the recommended 48 h period following symptom onset for 62.5% of hospital-acquired cases compared with 39.8% of community-acquired cases (p = 0.033). Conclusions Our results show that clinical presentation differed between patients with hospital-acquired influenza compared with those who acquired influenza in the community. Cases occurred in two clusters suggesting intra-hospital transmission rather than random importation from the community, highlighting the importance of infection control measures to limit influenza spread. Patients with hospital-acquired influenza may present without classical features of an influenza-like illness and this should promote earlier diagnostic testing and isolation to limit spread. Movement of patients after diagnosis is likely to facilitate spread within the hospital.
Collapse
Affiliation(s)
- Nikita Parkash
- Department of Infectious Diseases, Canberra Hospital and Health Services, Canberra, Australian Capital Territory, Australia.
| | - Wendy Beckingham
- Infection Prevention and Control, Canberra Hospital and Health Services, Canberra, Australian Capital Territory, Australia
| | - Patiyan Andersson
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Paul Kelly
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia.,Population Health and Prevention Division, ACT Health, Canberra, Australian Capital Territory, Australia
| | - Sanjaya Senanayake
- Department of Infectious Diseases, Canberra Hospital and Health Services, Canberra, Australian Capital Territory, Australia.,Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Nicholas Coatsworth
- Department of Infectious Diseases, Canberra Hospital and Health Services, Canberra, Australian Capital Territory, Australia.,Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| |
Collapse
|
24
|
Liu WC, Lin CS, Yeh CC, Wu HY, Lee YJ, Chung CL, Cherng YG, Chen TL, Liao CC. Effect of Influenza Vaccination Against Postoperative Pneumonia and Mortality for Geriatric Patients Receiving Major Surgery: A Nationwide Matched Study. J Infect Dis 2019; 217:816-826. [PMID: 29216345 DOI: 10.1093/infdis/jix616] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/29/2017] [Indexed: 01/09/2023] Open
Abstract
Background Limited information is available on the association between influenza vaccination and postoperative outcomes. Methods Using Taiwan's National Health Insurance Research Database reimbursement claims data from 2008-2013, we conducted a matched cohort study of 16903 patients aged >66 years who received influenza vaccinations and later underwent major surgery. Using a propensity score matching procedure adjusted for sociodemographic characteristics, medical condition, surgery type, and anesthesia type, 16903 controls who underwent surgery but were not vaccinated were selected. Logistic regressions were used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for postoperative pneumonia and in-hospital mortality associated with influenza vaccination. Results Patients who received preoperative influenza vaccination had a lower risk of postoperative pneumonia (OR, 0.60; 95% CI, .56-.64) and in-hospital mortality (OR, 0.46; 95% CI, .39-.56), compared with unvaccinated patients, in both sexes and every age group. Vaccinated patients who underwent surgery also had a decreased risk of postoperative intensive care unit admission (OR, 0.56; 95% CI, .53-.60), shorter hospital stays (P < .0001), and lower medical expenditures (P < .0001) than nonvaccinated controls. Conclusions Vaccinated geriatric patients who underwent surgery had lower risks of pneumonia and in-hospital mortality, compared with unvaccinated patients who underwent similar major surgeries. Further studies are needed to explain how preoperative influenza vaccination improves perioperative outcomes.
Collapse
Affiliation(s)
- Wan-Chi Liu
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, Taiwan.,Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taiwan
| | - Chao-Shun Lin
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taiwan.,Department of Anesthesiology, Taipei Medical University Hospital, Taiwan.,Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taiwan
| | - Chun-Chieh Yeh
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Surgery, University of Illinois, Chicago
| | - Hsin-Yun Wu
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, Taiwan.,Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taiwan
| | - Yuarn-Jang Lee
- Divisions of Infectious Diseases, Taipei Medical University Hospital, Taiwan
| | - Chi-Li Chung
- Divisions of Pulmonary Medicine, Taipei Medical University Hospital, Taiwan.,Department of Internal Medicine, Taipei Medical University Hospital, Taiwan
| | - Yih-Giun Cherng
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, Taiwan.,Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taiwan
| | - Ta-Liang Chen
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taiwan.,Department of Anesthesiology, Taipei Medical University Hospital, Taiwan.,Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taiwan
| | - Chien-Chang Liao
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, Taiwan.,Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taiwan.,Department of Anesthesiology, Taipei Medical University Hospital, Taiwan.,Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taiwan.,School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| |
Collapse
|
25
|
[Hospital-acquired pneumonia]. Med Klin Intensivmed Notfmed 2018; 113:685-695. [PMID: 30302527 DOI: 10.1007/s00063-018-0494-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/10/2018] [Accepted: 08/27/2018] [Indexed: 10/28/2022]
Abstract
Hospital-acquired pneumonia (HAP) is a frequent complication of hospitalisation. Due to rising multidrug resistant bacteria an appropriate, empiric and targeted therapy is essential and requires an accurate assessment of risk for multidrug resistant bacteria. A targeted, temporal therapy is indispensable and should begin after a focussed diagnosis. Re-evaluation of therapy is important, as clinical course, microbiological and laboratory results might lead to de-escalation of therapy. In this review article the current German guidelines on the diagnosis and therapy of hospital-acquired pneumonia are summarized. Special focus is put on targeted, risk-adapted therapy.
Collapse
|
26
|
Abstract
PURPOSE OF REVIEW The prevalence and incidence of viral nosocomial influenza infections in healthcare settings are underestimated. Nosocomial influenza outbreaks are frequent, and control remains challenging in acute care and long-term healthcare settings. This review examines recent publications on the determinants of nosocomial influenza prevention and control. RECENT FINDINGS Nosocomial influenza outbreaks occur in various healthcare settings, especially among the frail and elderly. The correct diagnosis is commonly missed because a substantial proportion of asymptomatic cases can transmit infections. Rapid diagnosis will facilitate rapid identification of cases and the implementation of control measures but needs confirmation in some circumstances, such as the description of transmission chains. Links between patients and healthcare personnel (HCP) have been well explored by phylogenetic virus characterization and need additional refinement and study. The preventive role of HCP vaccination in influenza incidence among patients should be investigated further in various settings to take into account different strategies for vaccination (i.e. voluntary or mandatory vaccination policies). Indeed, in Europe, influenza vaccination remains modest, whereas in North America hospitals and some states and provinces are now mandating influenza vaccination among HCP. The variability of vaccine effectiveness by seasonal epidemics is also an important consideration for control strategies. SUMMARY When influenza cases occur in the community, the risk of transmission and nosocomial cases increase in healthcare settings requiring vigilance among staff. Surveillance and early warning systems should be encouraged. Outbreak control needs appropriate identification of cases and transmission chains, and rapid implementation of control measures. Vaccination policies in conjunction with appropriate infection control measures could reduce virus spreading in hospitals. HCP vaccination coverage must be improved.
Collapse
|
27
|
Choi HS, Kim MN, Sung H, Lee JY, Park HY, Kwak SH, Lim YJ, Hong MJ, Kim SK, Park SY, Kim HJ, Kim KR, Choi HR, Jeong JS, Choi SH. Laboratory-based surveillance of hospital-acquired respiratory virus infection in a tertiary care hospital. Am J Infect Control 2017; 45:e45-e47. [PMID: 28214160 PMCID: PMC7124227 DOI: 10.1016/j.ajic.2017.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/09/2017] [Accepted: 01/09/2017] [Indexed: 11/15/2022]
Abstract
Of 7,772 laboratory-confirmed cases of respiratory viral infection among hospitalized patients, 22.8% were categorized as having hospital-acquired infection. The overall incidence of hospital-acquired respiratory viral infection was 3.9 (95% confidence interval, 3.7-4.1) cases per 1,000 admitted patients. Rhinovirus was the most common virus (30.3%), followed by influenza virus (17.6%) and parainfluenza virus (15.6%).
Collapse
Affiliation(s)
- Hye-Suk Choi
- Office for Infection Control, Asan Medical Center, Seoul, South Korea
| | - Mi-Na Kim
- Office for Infection Control, Asan Medical Center, Seoul, South Korea; Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Heungsup Sung
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Jeong-Young Lee
- Office for Infection Control, Asan Medical Center, Seoul, South Korea
| | - Hee-Youn Park
- Office for Infection Control, Asan Medical Center, Seoul, South Korea
| | - Sun-Hee Kwak
- Office for Infection Control, Asan Medical Center, Seoul, South Korea
| | - Young-Ju Lim
- Office for Infection Control, Asan Medical Center, Seoul, South Korea
| | - Min-Jee Hong
- Office for Infection Control, Asan Medical Center, Seoul, South Korea
| | - Sun-Kyung Kim
- Office for Infection Control, Asan Medical Center, Seoul, South Korea
| | - So-Yeon Park
- Office for Infection Control, Asan Medical Center, Seoul, South Korea
| | - Hyeon-Jeong Kim
- Office for Infection Control, Asan Medical Center, Seoul, South Korea
| | - Kyu-Ri Kim
- Office for Infection Control, Asan Medical Center, Seoul, South Korea
| | - Hye-Ran Choi
- Department of Clinical Nursing, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Sim Jeong
- Department of Nursing, University of Ulsan, Seoul, South Korea
| | - Sang-Ho Choi
- Office for Infection Control, Asan Medical Center, Seoul, South Korea; Department of Infectious Diseases, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
| |
Collapse
|
28
|
Heyd R, Eis-Hübinger AM, Berger A, Bierbaum S, Pietzonka S, Wenzel JJ, Huzly D, Keppler OT, Panning M. Retrospective analysis of clinical and virological parameters of influenza cases at four university hospitals in Germany, 2015. Infection 2017; 45:349-354. [PMID: 28316058 DOI: 10.1007/s15010-017-1008-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 03/13/2017] [Indexed: 02/05/2023]
Abstract
We conducted a retrospective observational study at four German university hospitals of patients with laboratory-confirmed influenza in 2014/2015. Overall, a fatality rate of 8% was observed. Significantly more A(H1N1)pdm09 patients were admitted to ICU compared to those with A(H3N2). However, fatal outcome was not significantly increased among A(H1N1)pdm09 cases. Nosocomial infections were seen in 17% of cases. Systematic collection of data from hospitals will complement national influenza surveillance.
Collapse
Affiliation(s)
- Robert Heyd
- Institute of Clinical Microbiology and Hygiene, Regensburg University Medical Centre, Regensburg, Germany
| | | | - Annemarie Berger
- Institute for Medical Virology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Sibylle Bierbaum
- Institute for Virology, Medical Center - University of Freiburg, Hermann-Herder-Str. 11, 79014, Freiburg, Germany
| | - Sandra Pietzonka
- Institute of Virology, University of Bonn Medical Centre, Bonn, Germany
| | - Jürgen J Wenzel
- Institute of Clinical Microbiology and Hygiene, Regensburg University Medical Centre, Regensburg, Germany
| | - Daniela Huzly
- Institute for Virology, Medical Center - University of Freiburg, Hermann-Herder-Str. 11, 79014, Freiburg, Germany
| | - Oliver T Keppler
- Institute of Virology, University of Bonn Medical Centre, Bonn, Germany.,Max von Pettenkofer-Institut, Virology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Marcus Panning
- Institute for Virology, Medical Center - University of Freiburg, Hermann-Herder-Str. 11, 79014, Freiburg, Germany.
| |
Collapse
|
29
|
Nye S, Whitley RJ, Kong M. Viral Infection in the Development and Progression of Pediatric Acute Respiratory Distress Syndrome. Front Pediatr 2016; 4:128. [PMID: 27933286 PMCID: PMC5121220 DOI: 10.3389/fped.2016.00128] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 11/11/2016] [Indexed: 12/21/2022] Open
Abstract
Viral infections are an important cause of pediatric acute respiratory distress syndrome (ARDS). Numerous viruses, including respiratory syncytial virus (RSV) and influenza A (H1N1) virus, have been implicated in the progression of pneumonia to ARDS; yet the incidence of progression is unknown. Despite acute and chronic morbidity associated with respiratory viral infections, particularly in "at risk" populations, treatment options are limited. Thus, with few exceptions, care is symptomatic. In addition, mortality rates for viral-related ARDS have yet to be determined. This review outlines what is known about ARDS secondary to viral infections including the epidemiology, the pathophysiology, and diagnosis. In addition, emerging treatment options to prevent infection, and to decrease disease burden will be outlined. We focused on RSV and influenza A (H1N1) viral-induced ARDS, as these are the most common viruses leading to pediatric ARDS, and have specific prophylactic and definitive treatment options.
Collapse
Affiliation(s)
- Steven Nye
- The University of Alabama at Birmingham , Birmingham, AL , USA
| | | | - Michele Kong
- The University of Alabama at Birmingham , Birmingham, AL , USA
| |
Collapse
|