1
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Focosi D, Franchini M, Senefeld JW, Joyner MJ, Sullivan DJ, Pekosz A, Maggi F, Casadevall A. Passive immunotherapies for the next influenza pandemic. Rev Med Virol 2024; 34:e2533. [PMID: 38635404 DOI: 10.1002/rmv.2533] [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: 10/17/2023] [Revised: 03/13/2024] [Accepted: 03/20/2024] [Indexed: 04/20/2024]
Abstract
Influenzavirus is among the most relevant candidates for a next pandemic. We review here the phylogeny of former influenza pandemics, and discuss candidate lineages. After briefly reviewing the other existing antiviral options, we discuss in detail the evidences supporting the efficacy of passive immunotherapies against influenzavirus, with a focus on convalescent plasma.
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Affiliation(s)
- Daniele Focosi
- North-Western Tuscany Blood Bank, Pisa University Hospital, Pisa, Italy
| | - Massimo Franchini
- Division of Hematology and Transfusion Medicine, Mantua Hospital, Mantua, Italy
| | - Jonathon W Senefeld
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
| | - Michael J Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - David J Sullivan
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrew Pekosz
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Fabrizio Maggi
- National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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2
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Davies S, Boller E, Chase J, Beaubrun A, Miller C, Jensen I. A cost-consequence analysis of the Xpert Xpress CoV-2/Flu/RSV plus test strategy for the diagnosis of influenza-like illnesses. J Med Econ 2024; 27:430-441. [PMID: 38328858 DOI: 10.1080/13696998.2024.2313391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/30/2024] [Indexed: 02/09/2024]
Abstract
AIMS Influenza-like illnesses (ILI) affect millions each year in the United States (US). Determining definitively the cause of symptoms is important for patient management. Xpert Xpress CoV-2/Flu/RSV plus (Xpert Xpress) is a rapid, point-of-care (POC), multiplex real-time polymerase chain reaction (RT-PCR) test intended for the simultaneous qualitative detection and differentiation of SARS-CoV-2, influenza A/B, and respiratory syncytial virus (RSV). The objective of our analysis was to develop a cost-consequence model (CCM) demonstrating the clinico-economic impacts of implementing PCR testing with Xpert Xpress compared to current testing strategies. METHODS A decision tree model, with a 1-year time horizon, was used to compare testing with Xpert Xpress alone to antigen POC testing and send-out PCR strategies in the US outpatient setting from a payer perspective. A hypothetical cohort of 1,000,000 members was modeled, a portion of whom develop symptomatic ILIs and present to an outpatient care facility. Our main outcome measure is cost per correct treatment course. RESULTS The total cost per correct treatment course was $1,131 for the Xpert Xpress strategy compared with a range of $3,560 to $5,449 in comparators. POC antigen testing strategies cost more, on average, than PCR strategies. LIMITATIONS Simplifying model assumptions were used to allow for modeling ease. In clinical practice, treatment options, costs, and diagnostic test sensitivity and specificity may differ from what is included in the model. Additionally, the most recent incidence and prevalence data was used within the model, which is not reflective of historical averages due to the SARS-CoV-2 pandemic. CONCLUSION The Xpert Xpress CoV-2/Flu/RSV plus test allows for rapid and accurate diagnostic results, leading to reductions in testing costs and downstream healthcare resource utilization compared to other testing strategies. Compared to POC antigen testing strategies, PCR strategies were more efficient due to improved diagnostic accuracy and reduced use of confirmatory testing.
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Affiliation(s)
- Shawn Davies
- PRECISIONheor, Precision Value & Health, Boston, MA, USA
| | - Emily Boller
- PRECISIONheor, Precision Value & Health, Boston, MA, USA
| | | | | | - Cynthia Miller
- PRECISIONheor, Precision Value & Health, Boston, MA, USA
| | - Ivar Jensen
- PRECISIONheor, Precision Value & Health, Boston, MA, USA
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3
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Tenforde MW, Cummings CN, O’Halloran AC, Rothrock G, Kirley PD, Alden NB, Meek J, Yousey-Hindes K, Openo KP, Anderson EJ, Monroe ML, Kim S, Nunez VT, McMahon M, McMullen C, Khanlian SA, Spina NL, Muse A, Gaitán MA, Felsen CB, Lung K, Shiltz E, Sutton M, Thomas A, Talbot HK, Schaffner W, Price A, Chatelain R, Reed C, Garg S. Influenza Antiviral Use in Patients Hospitalized With Laboratory-Confirmed Influenza in the United States, FluSurv-NET, 2015-2019. Open Forum Infect Dis 2023; 10:ofac681. [PMID: 36686630 PMCID: PMC9846184 DOI: 10.1093/ofid/ofac681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
From surveillance data of patients hospitalized with laboratory-confirmed influenza in the United States during the 2015-2016 through 2018-2019 seasons, initiation of antiviral treatment increased from 86% to 94%, with increases seen across all age groups. However, 62% started therapy ≥3 days after illness onset, driven by late presentation to care.
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Affiliation(s)
- Mark W Tenforde
- Correspondence: Mark W. Tenforde, MD, PhD, MPH, DTM&H, 1600 Clifton Road NE, Mailstop H24-7, Atlanta, GA 30329-4027 ()
| | - Charisse N Cummings
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alissa C O’Halloran
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Pam Daily Kirley
- California Emerging Infections Program, Oakland, California, USA
| | - Nisha B Alden
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - James Meek
- Connecticut Emerging Infections Program, New Haven, Connecticut, USA
- Yale School of Public Health, New Haven, Connecticut, USA
| | - Kimberly Yousey-Hindes
- Connecticut Emerging Infections Program, New Haven, Connecticut, USA
- Yale School of Public Health, New Haven, Connecticut, USA
| | - Kyle P Openo
- Georgia Emerging Infections Program, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Evan J Anderson
- Georgia Emerging Infections Program, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Maya L Monroe
- Maryland Department of Health, Baltimore, Maryland, USA
| | - Sue Kim
- Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | - Val Tellez Nunez
- Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | | | | | - Sarah A Khanlian
- University of New Mexico Health Science Center, Santa Fe, New Mexico, USA
| | - Nancy L Spina
- New York State Department of Health, Albany, New York, USA
| | - Alison Muse
- New York State Department of Health, Albany, New York, USA
| | - Maria A Gaitán
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Christina B Felsen
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Krista Lung
- Ohio Department of Health, Columbus, Ohio, USA
| | - Eli Shiltz
- Ohio Department of Health, Columbus, Ohio, USA
| | | | - Ann Thomas
- Oregon Health Authority, Portland, Oregon, USA
| | - H Keipp Talbot
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Andrea Price
- Salt Lake County Health Department, Salt Lake City, Utah, USA
| | - Ryan Chatelain
- Salt Lake County Health Department, Salt Lake City, Utah, USA
| | - Carrie Reed
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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4
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Morehouse ZP, Chance N, Ryan GL, Proctor CM, Nash RJ. A narrative review of nine commercial point of care influenza tests: an overview of methods, benefits, and drawbacks to rapid influenza diagnostic testing. J Osteopath Med 2023; 123:39-47. [PMID: 35977624 DOI: 10.1515/jom-2022-0065] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/15/2022] [Indexed: 12/27/2022]
Abstract
CONTEXT Rapid influenza diagnostic tests (RIDTs) are becoming increasingly accurate, available, and reliable as the first line of testing when suspecting influenza infections, although the global burden of influenza infections remains high. Rapid diagnosis of influenza infections has been shown to reduce improper or delayed treatment and to increase access to diagnostic measures in public health, primary care, and hospital-based settings. OBJECTIVES As the use of RIDTs continues to expand in all healthcare settings, there is a multitude of molecular techniques being employed by these various testing platforms. With this in mind, we compare the sensitivity, specificity, and time to diagnosis for nine highly utilized commercial RIDTs. METHODS Nine commercially available RIDTs were identified from the US Centers for Disease Control and Prevention (CDC) website, which were also referenced on PubMed by name within the title or abstract of peer-reviewed publications examining the sensitivity and specificity of each test against a minimum of three influenza A virus (IAV) strains as well as seasonal influenza B virus (IBV). Data from the peer-reviewed publications and manufacturers' websites were combined to discuss the sensitivity, specify, and time to diagnosis associated with each RIDT. RESULTS The sensitivity and specificity across the examined RIDTs were greater than 85.0% for both IAV and IBV across all platforms, with the reverse transcriptase-polymerase chain reaction (RT-PCR) assays maintaining sensitivity and specificity greater than 95.0% for all viruses tested. However, the RT-PCR platforms were the longest in time to diagnosis when compared to the other molecular methods utilized in the examined RIDTs. CONCLUSIONS Herein, we discussed the benefits and limitations of nine commercially available RIDTs and the molecular techniques upon which they are based, showing the relative accuracy and speed of each test for IAV and IBV detection as reported by the peer-reviewed literature and commercial manufacturers.
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Affiliation(s)
- Zachary P Morehouse
- Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA.,Omni International, Inc, A PerkinElmer Company, Kennesaw, GA, USA.,Jeevan Biosciences, Inc, Tucker, GA, USA
| | - Nathan Chance
- Kirksville College of Osteopathic Medicine, A.T. Still University, Kirksville, MO, USA
| | | | | | - Rodney J Nash
- Omni International, Inc, A PerkinElmer Company, Kennesaw, GA, USA.,Jeevan Biosciences, Inc, Tucker, GA, USA.,Department of Biology, Georgia State University, Atlanta, GA, USA
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5
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Ayuso García B, Marchan A, Arrieta Ortubay E, Castillo Maza C, Romay Lema E, Lalueza A, Lumbreras C. In-hospital incidence of and risk factors for influenza-associated respiratory failure. Eur J Clin Invest 2022; 52:e13858. [PMID: 35997028 DOI: 10.1111/eci.13858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Respiratory failure (RF) is the most important complication of influenza virus infection. Its definition and incidence are heterogeneous in the literature. METHODS This systematic review and meta-analysis aim to determine the incidence of and risk factors for RF in patients hospitalized with influenza. Electronic databases were searched for articles on RF in patients hospitalized for influenza infection up to December 2021 regardless of their geographical location. Observational and experimental studies were considered for inclusion, excluding case series. The Newcastle-Ottawa and Johanna Briggs scales were used for quality assessment. A random-effects meta-analysis was performed, followed by subgroup analyses according to, among others, presence/absence of pneumonia, RF definition, serotype and time period. PRISMA guidelines were followed for this review. RESULTS Thirty-six studies were finally included in the meta-analysis. Overall, RF incidence was 24% (range 5%-85%, 95% confidence interval [95CI] 19%-31%). Significantly higher incidences of RF were found in patients with pneumonia (42%, 95CI 28%-57%, p = .006), when RF was defined as hypoxemia (58%, 95CI 31%-81%, p < .001), and during the 2009 pandemic (25%, 95CI 16%-36%) and postpandemic period (23%, 95CI 15%-34%, p = .01). No differences were found between human influenza serotypes. Assessment of risk factors associated with the development of RF was not possible due to their inconsistent and heterogeneous reporting. CONCLUSION Respiratory failure is frequent in hospitalized influenza patients, especially in patients with pneumonia and since the 2009 pandemic, although its definition and reporting widely vary in the literature. This complicates its characterization and comparison between cohorts and with other respiratory viruses.
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Affiliation(s)
- Blanca Ayuso García
- Department of Internal Medicine, University Hospital 12 de Octubre, Madrid, Spain
| | - Alvaro Marchan
- Department of Internal Medicine, University Hospital 12 de Octubre, Madrid, Spain
| | | | | | - Eva Romay Lema
- Infectious Diseases Unit, University Hospital Lucus Augusti, Lugo, Spain
| | - Antonio Lalueza
- Department of Internal Medicine, University Hospital 12 de Octubre, Madrid, Spain.,Department of Medicine, School of Medicine, Complutense University, Madrid, Spain.,Research Institute of Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Carlos Lumbreras
- Department of Internal Medicine, University Hospital 12 de Octubre, Madrid, Spain.,Department of Medicine, School of Medicine, Complutense University, Madrid, Spain.,Research Institute of Hospital 12 de Octubre (i+12), Madrid, Spain.,Infectious Diseases Unit, University Hospital 12 de Octubre, Madrid, Spain
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6
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Ou H, Chen L, Wu H. Enhanced Programmed Cell Death Protein 1/Programmed Cell Death Ligand 1 Expression Induced by Severe Influenza A Virus Infection Impairs Host's Antiviral Response. Viral Immunol 2022; 35:566-576. [PMID: 36094816 DOI: 10.1089/vim.2022.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Emerging research shows that the Programmed Cell Death Protein 1/Programmed Cell Death Ligand 1(PD-1/PD-L1) pathway modulates the antiviral response following influenza A virus (IAV) infection, and there is a need to understand further the role of the PD-1/PD-L1 signaling pathway in IAV infection. BALB/c mice were infected with different types of IAV to establish models of varying degrees of infection (mild and severe). The mice were pretreated with or without a PD-1 antagonist to evaluate the role of the PD-1/PD-L1 pathway in IAV infection. The general activity, degree of weight change, viral titer, pathological damage, protein expression, transcriptome level, and cytokine expression were evaluated in the mice. IAV infection, especially severe infection, induced expression of PD-1 and PD-L1 in the lungs and spleen of the mice at 6 days postinfection. Moreover, the expression level was positively correlated with the degree of pathological damage in the lung. PD-1 antagonists can alleviate weight loss in severely infected mice, reduce the viral load and pathological damage, enhance immune response-related gene expression, and induce the most robust responses of interferon-gamma without inducing an obvious Th1/Th17 response. The PD-1/PD-L1 signaling pathway induced by severe IAV infection seriously impairs the host's antiviral response; thus, blocking this signaling pathway may promote IAV recovery.
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Affiliation(s)
- Huilin Ou
- Ningbo Medical Centre, Li Huili Hospital affiliated of Ningbo University, Ningbo, China
| | - Linfang Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongcheng Wu
- Ningbo Medical Centre, Li Huili Hospital affiliated of Ningbo University, Ningbo, China
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7
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Derqui N, Nealon J, Mira-Iglesias A, Díez-Domingo J, Mahé C, Chaves SS. Predictors of influenza severity among hospitalized adults with laboratory confirmed influenza: Analysis of nine influenza seasons from the Valencia region, Spain. Influenza Other Respir Viruses 2022; 16:862-872. [PMID: 35411561 PMCID: PMC9343335 DOI: 10.1111/irv.12985] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/03/2022] [Accepted: 03/15/2022] [Indexed: 01/10/2023] Open
Abstract
Purpose Influenza hospitalizations contribute substantially to healthcare disruption. We explored the impact of ageing, comorbidities and other risk factors to better understand associations with severe clinical outcomes in adults hospitalized with influenza. Methods We analysed multi‐season data from adults ≥18 years, hospitalized with laboratory‐confirmed influenza in Valencia, Spain. Severity was defined as intensive care unit (ICU) admission, assisted ventilation and/or death. Generalized estimating equations were used to estimate associations between risk factors and severity. Rate of hospital discharge was analysed with a cumulative incidence function. Results Only 26% of influenza patients had their primary discharge diagnosis coded as influenza. Comorbidities were associated with severity among adults aged 50–79 years, with the highest odds ratio (OR) in patients with ≥3 comorbidities aged 50–64 years (OR = 6.7; 95% CI: 1.0–44.6). Morbid obesity and functional dependencies were also identified risk factors (ORs varying from 3 to 5 depending on age). The presence of increasing numbers of comorbidities was associated with prolonged hospital stay. Conclusions Influenza clinical outcomes are aggravated by the presence of comorbidities and ageing. Increased awareness of influenza among hospitalized patients could prompt clinical and public health interventions to reduce associated burden.
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Affiliation(s)
- Nieves Derqui
- Sanofi Pasteur, Lyon, France.,Univ Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Joshua Nealon
- Sanofi Pasteur, Lyon, France.,School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ainara Mira-Iglesias
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
| | - Javier Díez-Domingo
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Public Health), Valencia, Spain
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8
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Clinical manifestations of hospitalized influenza patients without risk factors: A prospective multicenter cohort study in Japan via internet surveillance. J Infect Chemother 2022; 28:853-858. [DOI: 10.1016/j.jiac.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/26/2022] [Accepted: 02/06/2022] [Indexed: 11/19/2022]
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9
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Świerczyńska M, Mirowska-Guzel DM, Pindelska E. Antiviral Drugs in Influenza. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053018. [PMID: 35270708 PMCID: PMC8910682 DOI: 10.3390/ijerph19053018] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 11/30/2022]
Abstract
Flu is a serious health, medical, and economic problem, but no therapy is yet available that has satisfactory results and reduces the occurrence of these problems. Nearly 20 years after the registration of the previous therapy, baloxavir marboxil, a drug with a new mechanism of action, recently appeared on the market. This is a promising step in the fight against the influenza virus. This article presents the possibilities of using all available antiviral drugs specific for influenza A and B. We compare all currently recommended anti-influenza medications, considering their mechanisms of action, administration, indications, target groups, effectiveness, and safety profiles. We demonstrate that baloxavir marboxil presents a similar safety and efficacy profile to those of drugs already used in the treatment of influenza. Further research on combination therapy is highly recommended and may have promising results.
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Affiliation(s)
- Magdalena Świerczyńska
- Centre for Preclinical Research and Technology CePT, Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Banacha 1B, 02-097 Warsaw, Poland;
| | - Dagmara M. Mirowska-Guzel
- Centre for Preclinical Research and Technology CePT, Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Banacha 1B, 02-097 Warsaw, Poland;
- Correspondence: ; Tel.: +48-22-116-6160; Fax: +48-22-116-6202
| | - Edyta Pindelska
- Department of Analytical Chemistry and Biomaterials, Faculty of Pharmacy, Medical University of Warsaw, Banacha 1B, 02-093 Warsaw, Poland;
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10
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Eum Y, Yoo E. Using GPS-enabled mobile phones to evaluate the associations between human mobility changes and the onset of influenza illness. Spat Spatiotemporal Epidemiol 2022; 40:100458. [PMID: 35120680 PMCID: PMC8818086 DOI: 10.1016/j.sste.2021.100458] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/19/2021] [Accepted: 10/18/2021] [Indexed: 02/03/2023]
Abstract
Due to the challenges in data collection, there are few studies examining how individuals' routine mobility patterns change when they experience influenza-like symptoms (ILS). In the present study, we aimed to assess the association between changes in routine mobility and ILS using mobile phone-based GPS traces and self-reported surveys from 1,155 participants over the 2016-2017 influenza season. We used a set of mobility metrics to capture individuals' routine mobility patterns and matched their weekly ILS survey responses. For a statistical analysis, we used a time-stratified case-crossover analysis and conducted a stratified analysis to examine if such associations are moderated by demographic and socioeconomic factors, such as age, gender, occupational status, neighborhood poverty and education levels, and work type. We found that statistically significant associations existed between reduced routine mobility patterns and the experience of ILS. Results also indicated that the association between reduced mobility and ILS was significant only for female and for participants with high socioeconomic status. Our findings offered an improved understanding of ILS-associated mobility changes at the individual level and suggest the potential of individual mobility data for influenza surveillance.
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Affiliation(s)
- Youngseob Eum
- Department of Geography, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - EunHye Yoo
- Department of Geography, University at Buffalo, State University of New York, Buffalo, NY, USA
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11
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Ayuso B, Lalueza A, Arrieta E, Romay EM, Marchán-López Á, García-País MJ, Folgueira D, Gude MJ, Cueto C, Serrano A, Lumbreras C. Derivation and external validation of a simple prediction rule for the development of respiratory failure in hospitalized patients with influenza. Respir Res 2022; 23:323. [PMID: 36419130 PMCID: PMC9684757 DOI: 10.1186/s12931-022-02245-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 11/09/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Influenza viruses cause seasonal epidemics worldwide with a significant morbimortality burden. Clinical spectrum of Influenza is wide, being respiratory failure (RF) one of its most severe complications. This study aims to elaborate a clinical prediction rule of RF in hospitalized Influenza patients. METHODS A prospective cohort study was conducted during two consecutive Influenza seasons (December 2016-March 2017 and December 2017-April 2018) including hospitalized adults with confirmed A or B Influenza infection. A prediction rule was derived using logistic regression and recursive partitioning, followed by internal cross-validation. External validation was performed on a retrospective cohort in a different hospital between December 2018 and May 2019. RESULTS Overall, 707 patients were included in the derivation cohort and 285 in the validation cohort. RF rate was 6.8% and 11.6%, respectively. Chronic obstructive pulmonary disease, immunosuppression, radiological abnormalities, respiratory rate, lymphopenia, lactate dehydrogenase and C-reactive protein at admission were associated with RF. A four category-grouped seven point-score was derived including radiological abnormalities, lymphopenia, respiratory rate and lactate dehydrogenase. Final model area under the curve was 0.796 (0.714-0.877) in the derivation cohort and 0.773 (0.687-0.859) in the validation cohort (p < 0.001 in both cases). The predicted model showed an adequate fit with the observed results (Fisher's test p > 0.43). CONCLUSION we present a simple, discriminating, well-calibrated rule for an early prediction of the development of RF in hospitalized Influenza patients, with proper performance in an external validation cohort. This tool can be helpful in patient's stratification during seasonal Influenza epidemics.
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Affiliation(s)
- Blanca Ayuso
- grid.411171.30000 0004 0425 3881Department of Internal Medicine, University Hospital, 12 de Octubre, Av Córdoba Km 5,400, 28041 Madrid, Spain
| | - Antonio Lalueza
- grid.411171.30000 0004 0425 3881Department of Internal Medicine, University Hospital, 12 de Octubre, Av Córdoba Km 5,400, 28041 Madrid, Spain
| | - Estibaliz Arrieta
- grid.411171.30000 0004 0425 3881Department of Internal Medicine, University Hospital, 12 de Octubre, Av Córdoba Km 5,400, 28041 Madrid, Spain
| | - Eva María Romay
- grid.414792.d0000 0004 0579 2350Infectious Diseases Unit, University Hospital Lucus Augusti, Lugo, Spain
| | - Álvaro Marchán-López
- grid.411171.30000 0004 0425 3881Department of Internal Medicine, University Hospital, 12 de Octubre, Av Córdoba Km 5,400, 28041 Madrid, Spain
| | - María José García-País
- grid.414792.d0000 0004 0579 2350Infectious Diseases Unit, University Hospital Lucus Augusti, Lugo, Spain
| | - Dolores Folgueira
- grid.144756.50000 0001 1945 5329Department of Microbiology, University Hospital 12 de Octubre, Madrid, Spain
| | - María José Gude
- grid.414792.d0000 0004 0579 2350Department of Microbiology, University Hospital Lucus Augusti, Lugo, Spain
| | - Cecilia Cueto
- grid.144756.50000 0001 1945 5329Department of Biochemistry, University Hospital 12 de Octubre, Madrid, Spain
| | - Antonio Serrano
- grid.144756.50000 0001 1945 5329Department of Immunology, University Hospital 12 de Octubre, Madrid, Spain
| | - Carlos Lumbreras
- grid.411171.30000 0004 0425 3881Department of Internal Medicine, University Hospital, 12 de Octubre, Av Córdoba Km 5,400, 28041 Madrid, Spain ,grid.144756.50000 0001 1945 5329Infectious Diseases Unit, University Hospital 12 de Octubre, Madrid, Spain
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12
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Outcomes of early oseltamivir treatment for hospitalized adult patients with community-acquired influenza pneumonia. PLoS One 2021; 16:e0261411. [PMID: 34910777 PMCID: PMC8673668 DOI: 10.1371/journal.pone.0261411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 12/01/2021] [Indexed: 11/19/2022] Open
Abstract
Early initiation of oseltamivir within 48 h to 5 days from illness onset has been associated with improved survival among patients with community-acquired influenza pneumonia. Delay of hospitalization limits early treatment and the survival of patients. To date, the effects of early oseltamivir initiation within 24 hours from admission on patient mortality has remained unknown. This retrospective study reviewed and analyzed the clinical and non-clinical outcomes of 143 patients, with community-acquired influenza pneumonia, who received oseltamivir within 24 h (group A) and after 24 h (group B) from admission. Among the patients, 82 (57.3%) received oseltamivir within 24 h while 61 (42.7%) received oseltamivir after 24 h. The median time from symptom onset to admission for group A and group B was not statistically significant (P < 0.001). The 14-day mortality rate was 9% and 23% for group A and B, respectively (P = 0.03), while the 30-day mortality were 15% and 30% for group A and B, respectively (P = 0.05). Administration of oseltamivir within 24 h significantly affected 30-day mortality rates (adjust OR: 0.14, 95% CI: 0.47–0.04, P < 0.01), particularly among patients with respiratory failure at admission (adjust OR: 0.08, 95% CI: 0+.30–0.06, P < 0.01). Survival analysis of patient with influenza pneumonia and respiratory failure at admission demonstrated significant difference between those who received oseltamivir within and after 24 h (P = 0.002). The results indicated that early oseltamivir initiation within 24 h improved the survival outcome mainly among those with respiratory failure at admission.
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Cortés JA, Cuervo-Maldonado SI, Nocua-Báez LC, Valderrama MC, Sánchez EA, Saavedra A, Torres JV, Forero DP, Álvarez CA, Leal AL, Pérez JE, Rodríguez IA, Guevara FO, Saavedra CH, Vergara EP, Montúfar FE, Espinosa T, Chaves W, Carrizosa JA, Meléndez SDM, Espinosa CJ, García F, Guzmán IJ, Cortés SL, Díaz JA, González N. Guía de práctica clínica para el manejo de la neumonía adquirida en la comunidad. REVISTA DE LA FACULTAD DE MEDICINA 2021. [DOI: 10.15446/revfacmed.v70n2.93814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
La neumonía sigue siendo una de las principales causas de consulta y de hospitalización a la que, además de su un alto impacto en términos de morbilidad y mortalidad, se suma la actual problemática de resistencia a los antimicrobianos, por lo que establecer directrices que permitan su adecuado diagnóstico y tratamiento es de gran importancia para obtener mejores desenlaces clínicos y promover un uso racional de antibióticos en estos pacientes. La presente guía de práctica clínica (GPC) contiene recomendaciones basadas en la evidencia para el diagnóstico y tratamiento de la neumonía adquirida en la comunidad en adultos, las cuales fueron realizadas mediante el proceso de adaptación de GPC basadas en la evidencia para el contexto colombiano.
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Adams K, Tenforde MW, Chodisetty S, Lee B, Chow EJ, Self WH, Patel MM. A literature review of severity scores for adults with influenza or community-acquired pneumonia - implications for influenza vaccines and therapeutics. Hum Vaccin Immunother 2021; 17:5460-5474. [PMID: 34757894 DOI: 10.1080/21645515.2021.1990649] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Influenza vaccination and antiviral therapeutics may attenuate disease, decreasing severity of illness in vaccinated and treated persons. Standardized assessment tools, definitions of disease severity, and clinical endpoints would support characterizing the attenuating effects of influenza vaccines and antivirals. We review potential clinical parameters and endpoints that may be useful for ordinal scales evaluating attenuating effects of influenza vaccines and antivirals in hospital-based studies. In studies of influenza and community-acquired pneumonia, common physiologic parameters that predicted outcomes such as mortality, ICU admission, complications, and duration of stay included vital signs (hypotension, tachypnea, fever, hypoxia), laboratory results (blood urea nitrogen, platelets, serum sodium), and radiographic findings of infiltrates or effusions. Ordinal scales based on these parameters may be useful endpoints for evaluating attenuating effects of influenza vaccines and therapeutics. Factors such as clinical and policy relevance, reproducibility, and specificity of measurements should be considered when creating a standardized ordinal scale for assessment.
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Affiliation(s)
- Katherine Adams
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark W Tenforde
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shreya Chodisetty
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Benjamin Lee
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eric J Chow
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wesley H Self
- Department of Emergency Medicine and Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Manish M Patel
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Management of hospitalized influenza A patients during the season 2018/19 : Comparison of three medical departments and the effect on outcome and antibiotic usage. Wien Klin Wochenschr 2021; 133:1310-1317. [PMID: 34613478 DOI: 10.1007/s00508-021-01950-8] [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: 06/16/2021] [Accepted: 09/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Diagnosis and treatment of influenza patients are often provided across several medical specialties. We compared patient outcomes at an infectious diseases (ID), a rheumatology (Rheu) and a pulmonology (Pul) department. MATERIAL AND METHODS In this prospective observational multicenter study we included all influenza positive adults who were hospitalized and treated at flu isolation wards in three hospitals in Vienna during the season 2018/2019. RESULTS A total of 490 patients (49% female) with a median age of 73 years (interquartile range [IQR] 61-82) were included. No differences regarding age, sex and most underlying diseases were present at admission. Frequencies of the most common complications differed: acute kidney failure (ID 12.7%, Rheu 21.2%, Pulm 37.1%, p < 0.001), acute heart failure (ID 4.3%, Rheu 17.1%, Pulm 14.4%, p < 0.001) and respiratory insufficiency (ID 45.1%, Rheu 41.5%, Pulm 56.3%, p = 0.030). Oseltamivir prescription was lowest at the pulmonology flu ward (ID 79.6%, Rheu 90.5%, Pulm 61.7%, p < 0.001). In total 176 patients (35.9%) developed pneumonia. Antibiotic selection varied between the departments: amoxicillin/clavulanic acid (ID 28.9%, Rheu 63.8%, Pulm 5.9%, p < 0.001), cefuroxime (ID 28.9%, Rheu 1.3%, Pulm 0%, p < 0.001), 3rd generation cephalosporins (ID 4.4%, Rheu 5%, Pulm 72.5%, p < 0.001), doxycycline (ID 17.8%, Rheu 0%, Pulm 0%, p < 0.001). The median length of stay was significantly different between wards: ID 6 days (IQR 5-8), Rheu 6 days (IQR 5-7) and Pulm 7 days (IQR 5-9.5, p = 0.034). In-hospital mortality was 4.3% and did not differ between specialties. CONCLUSION We detected differences in oseltamivir usage, length of in-hospital stay and antibiotic choices for pneumonia. Influenza-associated mortality was unaffected by specialty.
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Fu B, Wu Z, Huang L, Chai Z, Zheng P, Sun Q, Gu S, Xu Q, Feng H, Tang L. A comparison of demographic, epidemiological and clinical characteristics of hospital influenza-related viral pneumonia patients. BMC Infect Dis 2021; 21:1002. [PMID: 34563110 PMCID: PMC8466655 DOI: 10.1186/s12879-021-06485-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 07/28/2021] [Indexed: 11/15/2022] Open
Abstract
Background Through the comparison of the demographic, epidemiological, and clinical characteristics of hospital human influenza (influenza A (H1N1) pdm09, H3N2, and B)-related and hospitalized avian-origin influenza A (H7N9)-related viral pneumonia patients, find the different between them. Methods A retrospective study was conducted in hospitalized influenza-related viral pneumonia patients. Results Human influenza A-related patients in the 35–49-year-old group were more than those with B pneumonia patients (p = 0.027), and relatively less in the ≥ 65-year-old group than B pneumonia patients (p = 0.079). The proportion of comorbid condition to human influenza A pneumonia was 58%, lower than B pneumonia and H7N9 pneumonia patients (78% vs. 77.8%; p = 0.013). The proportion of invasive mechanical ventilation (IMV), lymphocytopenia, elevated lactate dehydrogenase to hospitalized human influenza A-related viral pneumonia patients was higher than B pneumonia patients (p < 0.05), but lower than H7N9 pneumonia patients (p < 0.05). In the multivariate analysis, pulmonary consolidation (odds ratio (OR): 13.67; 95% confidence interval (CI) 1.54–121.12; p = 0.019) and positive bacterial culture (sputum) (OR: 7.71; 95% CI 2.48–24.03; p < 0.001) were independently associated with IMV, while shock (OR: 13.16; 95% CI 2.06–84.07; p = 0.006), white blood cell count > 10,000/mm3 (OR: 7.22; 95% CI 1.47–35.58; p = 0.015) and positive bacterial culture(blood or sputum) (OR: 6.27; 95% CI 1.36–28.85; p = 0.018) were independently associated with death in the three types hospitalized influenza-related viral pneumonia patients. Conclusions Hospital influenza B-related viral pneumonia mainly affects the elderly and people with underlying diseases, while human influenza A pneumonia mainly affects the young adults; however, the mortality was similar. The hospitalized human influenza A-related viral pneumonia patients was severer than B pneumonia patients, but milder than H7N9 pneumonia patients. Pulmonary consolidation and positive bacterial culture (sputum) were independently associated with IMV, while shock, white blood cell count > 10,000/mm3, and positive bacterial culture (blood or sputum) were independently associated with death to three types hospitalized influenza-related viral pneumonia patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06485-x.
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Affiliation(s)
- Bin Fu
- Department of Infectious Diseases, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, 310007, People's Republic of China
| | - Zhengjie Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Lingtong Huang
- Department of Critical Care Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, People's Republic of China
| | - Zhaohui Chai
- Department of Neurosurgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, People's Republic of China
| | - Peidong Zheng
- Department of Neurosurgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, People's Republic of China
| | - Qinmiao Sun
- Department of Dermatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, People's Republic of China
| | - Silan Gu
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Qiaomai Xu
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China
| | - Haiting Feng
- Department of Nosocomial Infection, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, People's Republic of China
| | - Lingling Tang
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, Zhejiang, People's Republic of China. .,Shulan(Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, 310006, People's Republic of China.
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Bolge SC, Gutierrez C, Kariburyo F, He D. Burden of Pneumonia Among Hospitalized Patients with Influenza: Real-World Evidence from a US Managed Care Population. Pulm Ther 2021; 7:517-532. [PMID: 34398424 PMCID: PMC8365129 DOI: 10.1007/s41030-021-00169-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/29/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Pneumonia is among the most prevalent complications of influenza. The purpose of this study is to quantify the burden of pneumonia among hospitalized patients with influenza. Methods Real-world retrospective data from 01JAN2014-30JUN2019 (study period) were obtained from Optum’s de-identified Clinformatics® Data Mart Database (2007–2020) for patients who had ≥ 1 diagnosis for influenza during the identification period and ≥ 1 all-cause inpatient visit within 1 day of diagnosis. Cases had ≥ 1 diagnosis claim for an influenza-related pneumonia within the 30 days after the initial influenza diagnosis date. Controls had no evidence of influenza-related pneumonia in the 30 days following the initial influenza diagnosis. Final 1:1 matching was determined using propensity score matching (PSM). Statistical significance between the cohorts was tested. Results After PSM, there were 4878 hospitalized patients with influenza in each of the case and control groups. During the index hospitalization, cases vs. controls had longer length of stay [Mean (standard deviation): 6.5 (8.3) vs. 1.9 (3.7)], greater intensive care unit (ICU) use (38.4 vs. 16.8%), and greater mechanical ventilation use (invasive: 11.4 vs. 2.3%; non-invasive: 6.8 vs. 2.6%) (all p < 0.001). Cases also had higher readmission rates than controls (12.3 vs. 3.5% within 30 days; 20.0 vs. 6.1% within 90 days; p < 0.001 for both). Post-index date direct all-cause healthcare costs were higher for cases than for controls (median total cost: $18,428 vs. $621 for 30 days; $21,774 vs. $3312 for 90 days; $25,960 vs. $8699 for 6 months; $35,875 vs. $21,619 for 1 year; all p < 0.001). Conclusions Pneumonia as a complication of influenza increases risk of mortality and leads to greater healthcare resource use and direct medical costs among patients hospitalized with influenza. These effects are seen early during the index hospitalization and within the first 30 days after diagnosis, but their impact continues throughout a year of follow-up. Supplementary Information The online version contains supplementary material available at 10.1007/s41030-021-00169-2.
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Affiliation(s)
| | | | | | - Ding He
- SIMR, LLC, 4110 Varsity Dr, Ann Arbor, MI, 48108, USA
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Brendish NJ, Malachira AK, Lillie PJ, Clark TW. Neuraminidase inhibitor use in adults presenting to hospital with suspected influenza: A questionnaire-based survey of practice among hospital physicians. CLINICAL INFECTION IN PRACTICE 2021. [DOI: 10.1016/j.clinpr.2021.100075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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O’Kelly B, Cronin C, Connellan D, Griffin S, Connolly SP, McGrath J, Cotter AG, McGinty T, Muldoon EG, Sheehan G, Cullen W, Doran P, McHugh T, Vidal L, Avramovic G, Lambert JS. Antibiotic prescribing patterns in patients hospitalized with COVID-19: lessons from the first wave. JAC Antimicrob Resist 2021; 3:dlab085. [PMID: 34223144 PMCID: PMC8242139 DOI: 10.1093/jacamr/dlab085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/25/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND A high proportion of hospitalized patients with COVID-19 receive antibiotics despite evidence to show low levels of true bacterial coinfection. METHODS A retrospective cohort study examining antibiotic prescribing patterns of 300 patients sequentially diagnosed with COVID-19. Patients were grouped into 3 sub-cohorts: Group 1 received no antibiotics, Group 2 received antibiotics for microbiologically confirmed infections and Group 3 was empirically treated with antibiotics for pneumonia. The primary aim was to identify factors that influenced prescription and continuation of antibiotics in Group 3. Secondary aims were to examine differences in outcomes between groups. RESULTS In total, 292 patients were included (63 Group 1, 35 Group 2, 194 Group 3), median age was 60 years (IQR 44-76) and the majority were ethnically Irish (62%). The median duration of antibiotics was 7 days (IQR 5-10). In Group 3, factors associated with prescription IV antibiotics on admission were raised C-reactive protein (CRP) (P = 0.024), increased age (P = 0.023), higher quick SOFA (P = 0.016) score and fever >37.5 °C (P = 0.011). Factors associated with duration of antibiotic course were duration of hypoxia (P < 0.001) and maximum respiratory support requirement (P = 0.013). Twenty-one patients in Group 3 had one or more antibiotic escalation events, most (n = 139) had no escalation or de-escalation of therapy. CONCLUSIONS Duration of hypoxia and need for respiratory support may have acted as surrogate measures of improvement where usual response measures (CRP, neutrophilia, culture clearance) were absent. Continuous review of antibiotic prescriptions should be at the forefront of clinical management of hospitalized patients with COVID-19.
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Affiliation(s)
- Brendan O’Kelly
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin 4, Ireland
| | - Colm Cronin
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - David Connellan
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Sean Griffin
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Stephen Peter Connolly
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin 4, Ireland
| | - Jonathan McGrath
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Aoife G Cotter
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin 4, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Tara McGinty
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin 4, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Eavan G Muldoon
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Gerard Sheehan
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Walter Cullen
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Peter Doran
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Tina McHugh
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Louise Vidal
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | | | - John S Lambert
- Infectious Diseases Department, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
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Mabayoje DA, Cutino-Moguel T, Haigh J, Wilks M, Welch CA, Melzer M. The difference in mortality between adult patients with laboratory documented influenza A and B, a single centre retrospective observational study. J Med Virol 2021; 93:3949-3954. [PMID: 33058290 DOI: 10.1002/jmv.26600] [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: 06/10/2020] [Revised: 10/10/2020] [Accepted: 10/13/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Seasonal influenza is an annual occurrence that leads to large community outbreaks and increased hospitalization. A number of studies have suggested that influenza A (FLUAV) is associated with increased rates of hospitalization and mortality compared with influenza B (FLUBV). This study compared demographic and clinical variables in patients diagnosed with FLUAV or FLUBV during the 2017-2018 UK Influenza season. METHODS Patient demographic and clinical information were obtained by accessing medical records of patients testing FLUAV or FLUBV positive using the Cepheid GXP. We used the χ2 test to compare variables in patients with laboratory-confirmed FLUAV and FLUBV. RESULTS One hundred and twenty-seven adult patients had confirmed Influenza, 71 (55.9%) had FLUAV, and 56 (44.1%) FLUBV. There was no significant difference between severity at presentation, admission to HDU/ITU or median length of stay. The overall mortality was 6 (4.5%) and 9 (7.1%) at 7 and 30 days, respectively. There was a statistically significant difference in 7-day mortality between patients with FLUAV and FLUBV, 1 (1.4%) versus 5 (8.9%), respectively, p = .047) although this became nonsignificant at 30 days. CONCLUSIONS With the exception of mortality, we did not observe significant differences between patients with FLUAV and FLUBV. Seven-day mortality in patients with FLUBV was significantly higher with FLUAV, although this was was not apparent at 30 days.
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Affiliation(s)
- Diana A Mabayoje
- Department of Infection, SpR in Microbiology/Infectious Diseases, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Teresa Cutino-Moguel
- Department of Infection, Consultant Virologist, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - John Haigh
- Department of Infection, Biomedical Scientist, Royal London and Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - Mark Wilks
- Department of Infection, Clinical Scientist, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Catherine A Welch
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Mark Melzer
- Department of Infection, Consultant in Microbiology and Infectious Diseases, Royal London and Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
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Ji H, Dai Q, Jin H, Xu K, Ai J, Fang X, Shi N, Huang H, Wu Y, Peng Z, Hu J, Zhu L, Bao C, Wu M. Epidemiology of 631 Cases of COVID-19 Identified in Jiangsu Province Between January 1st and March 20th 2020: Factors Associated with Disease Severity and Analysis of Zero Mortality. Med Sci Monit 2021; 27:e929986. [PMID: 33863868 PMCID: PMC8059346 DOI: 10.12659/msm.929986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/13/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND This retrospective study aimed to investigate the factors associated with disease severity and patient outcomes in 631 patients with COVID-19 who were reported to the Jiangsu Commission of Health between January 1 and March 20, 2020. MATERIAL AND METHODS We conducted an epidemiological investigation enrolling 631 patients with laboratory-confirmed COVID-19 from our clinic from January to March 2020. Patients' information was collected through a standard questionnaire. Then, we described the patients' epidemiological characteristics, analyzed risk factors associated with disease severity, and assessed causes of zero mortality. Additionally, some key technologies for epidemic prevention and control were identified. RESULTS Of the 631 patients, 8.46% (n=53) were severe cases, and no deaths were recorded (n=0). The epidemic of COVID-19 has gone through 4 stages: a sporadic phase, an exponential growth phase, a peak plateau phase, and a declining phase. The proportion of severe cases was significantly different among the 4 stages and 13 municipal prefectures (P<0.001). Factors including age >65 years old, underlying medical conditions, highest fever >39.0°C, dyspnea, and lymphocytopenia (<1.0×10⁹/L) were early warning signs of disease severity (P<0.05). In contrast, earlier clinic visits were associated with better patient outcomes (P=0.029). Further, the viral load was a potentially useful marker associated with COVID-19 infection severity. CONCLUSIONS The study findings from the beginning of the COVID-19 epidemic in Jiangsu Province, China showed that patients who were more than 65 years of age and with comorbidities and presented with a fever of more than 39.0°C developed more severe disease. However, mortality was prevented in this initial patient population by early supportive clinical management.
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Affiliation(s)
- Hong Ji
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, P.R. China
| | - Qigang Dai
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, P.R. China
| | - Hui Jin
- Public Health School, Southeast University, Nanjing, Jiangsu, P.R. China
| | - Ke Xu
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, P.R. China
| | - Jing Ai
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, P.R. China
| | - Xinyu Fang
- Public Health School, Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Naiyang Shi
- Public Health School, Southeast University, Nanjing, Jiangsu, P.R. China
| | - Haodi Huang
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, P.R. China
| | - Ying Wu
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, P.R. China
| | - Zhihang Peng
- Public Health School, Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Jianli Hu
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, P.R. China
| | - Liguo Zhu
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, P.R. China
| | - Changjun Bao
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, P.R. China
- National Health Commission Key Laboratory of Enteric Pathogenic Microbiology, Nanjing, Jiangsu, P.R. China
| | - Ming Wu
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, P.R. China
- Public Health Research Institute of Jiangsu Province, Nanjing, Jiangsu, P.R. China
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Rapoport BL, Cooksley T, Johnson DB, Anderson R, Shannon VR. Treatment of infections in cancer patients: an update from the neutropenia, infection and myelosuppression study group of the Multinational Association for Supportive Care in Cancer (MASCC). Expert Rev Clin Pharmacol 2021; 14:295-313. [PMID: 33517803 DOI: 10.1080/17512433.2021.1884067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Patients with hematological and advanced solid malignancies have acquired immune dysfunction, often exacerbated by treatment, posing a significant risk for the development of infections. This review evaluates the utility of current clinical and treatment guidelines, in the setting of management of infections in cancer patients. AREAS COVERED These include causes of infection in cancer patients, management of patients with high-risk and low-risk febrile neutropenia, management of low-risk patients in an outpatient setting, the role of granulocyte colony-stimulating factor (G-CSF) in the prevention and treatment of neutropenia-related infections, management of lung infections in various clinical settings, and emerging challenges surrounding the risk of infection in cancer patients treated with novel treatments. The literature search was performed by accessing PubMed and other databases, focusing on published clinical trials of relevant anti-cancer agents and diseases, primarily covering the recent past, but also including several key studies published during the last decade and, somewhat earlier in a few cases. EXPERT REVIEW Notwithstanding the promise of gene therapy/gene editing in hematological malignancies and some types of solid cancers, innovations introduced in clinical practice include more discerning clinical management such as the generalized use of biosimilar formulations of G-CSF and the implementation of novel, innovative immunotherapies.
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Affiliation(s)
- Bernardo L Rapoport
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,The Medical Oncology Centre of Rosebank, Saxonwold, Johannesburg, South Africa.,The Multinational Association for Supportive Care in Cancer (MASCC), Chair of the Neutropenia, Infection and Myelosuppression Study Group
| | - Tim Cooksley
- Manchester University Foundation Trust, Manchester, United Kingdom. The Christie, University of Manchester, Manchester, UK.,The Multinational Association for Supportive Care in Cancer (MASCC), Infection and Myelosuppression Study Group
| | - Douglas B Johnson
- Douglas B. Johnson, Department of Medicine, Vanderbilt University Medical Center and Vanderbilt Ingram Cancer Center, Nashville, Tennessee, USA
| | - Ronald Anderson
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Vickie R Shannon
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
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23
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Miyashita K, Nakatani E, Hozumi H, Sato Y, Miyachi Y, Suda T. Risk Factors for Pneumonia and Death in Adult Patients With Seasonal Influenza and Establishment of Prediction Scores: A Population-Based Study. Open Forum Infect Dis 2021; 8:ofab068. [PMID: 33738319 PMCID: PMC7953663 DOI: 10.1093/ofid/ofab068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/01/2021] [Indexed: 01/12/2023] Open
Abstract
Background Seasonal influenza remains a global health problem; however, there are limited data on the specific relative risks for pneumonia and death among outpatients considered to be at high risk for influenza complications. This population-based study aimed to develop prediction models for determining the risk of influenza-related pneumonia and death. Methods We included patients diagnosed with laboratory-confirmed influenza between 2016 and 2017 (main cohort, n = 25 659), those diagnosed between 2015 and 2016 (validation cohort 1, n = 16 727), and those diagnosed between 2017 and 2018 (validation cohort 2, n = 34 219). Prediction scores were developed based on the incidence and independent predictors of pneumonia and death identified using multivariate analyses, and patients were categorized into low-, medium-, and high-risk groups based on total scores. Results In the main cohort, age, gender, and certain comorbidities (dementia, congestive heart failure, diabetes, and others) were independent predictors of pneumonia and death. The 28-day pneumonia incidence was 0.5%, 4.1%, and 10.8% in the low-, medium-, and high-risk groups, respectively (c-index, 0.75); the 28-day mortality was 0.05%, 0.7%, and 3.3% in the low-, medium-, and high-risk groups, respectively (c-index, 0.85). In validation cohort 1, c-indices for the models for pneumonia and death were 0.75 and 0.87, respectively. In validation cohort 2, c-indices for the models were 0.74 and 0.87, respectively. Conclusions We successfully developed and validated simple-to-use risk prediction models, which would promptly provide useful information for treatment decisions in primary care settings.
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Affiliation(s)
- Koichi Miyashita
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.,Research Support Center, Shizuoka General Hospital, Shizuoka, Japan
| | - Eiji Nakatani
- Research Support Center, Shizuoka General Hospital, Shizuoka, Japan
| | - Hironao Hozumi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yoko Sato
- Research Support Center, Shizuoka General Hospital, Shizuoka, Japan
| | - Yoshiki Miyachi
- Research Support Center, Shizuoka General Hospital, Shizuoka, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
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24
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Daher A, Balfanz P, Aetou M, Hartmann B, Müller-Wieland D, Müller T, Marx N, Dreher M, Cornelissen CG. Clinical course of COVID-19 patients needing supplemental oxygen outside the intensive care unit. Sci Rep 2021; 11:2256. [PMID: 33500431 PMCID: PMC7838409 DOI: 10.1038/s41598-021-81444-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 01/07/2021] [Indexed: 01/10/2023] Open
Abstract
Patients suffering from CVOID-19 mostly experience a benign course of the disease. Approximately 14% of SARS-CoV2 infected patients are admitted to a hospital. Cohorts exhibiting severe lung failure in the form of acute respiratory distress syndrome (ARDS) have been well characterized. Patients without ARDS but in need of supplementary oxygen have received much less attention. This study describes the diagnosis, symptoms, treatment and outcomes of hospitalized patients with COVID-19 needing oxygen support during their stay on regular ward. All 133 patients admitted to the RWTH Aachen university hospital with the diagnosis of COVID-19 were included in an observational registry. Clinical data sets were extracted from the hospital information system. This analysis includes all 57 patients requiring supplemental oxygen not admitted to the ICU. 57 patients needing supplemental oxygen and being treated outside the ICU were analyzed. Patients exhibited the typical set of symptoms for COVID-19. Of note, hypoxic patients mostly did not suffer from clinically relevant dyspnea despite oxygen saturations below 92%. Patients had fever for 7 [2-11] days and needed supplemental oxygen for 8 [5-13] days resulting in an overall hospitalization time of 12 [7-20] days. In addition, patients had persisting systemic inflammation with CRP levels remaining elevated until discharge or death. This description of COVID-19 patients requiring oxygen therapy should be taken into account when planning treatment capacity. Patients on oxygen need long-term inpatient care.
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Affiliation(s)
- Ayham Daher
- Department of Pneumology and Internal Intensive Care Medicine, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Paul Balfanz
- Department of Cardiology, Angiology and Internal Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Maria Aetou
- Department of Pneumology and Internal Intensive Care Medicine, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Bojan Hartmann
- Department of Cardiology, Angiology and Internal Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Dirk Müller-Wieland
- Department of Cardiology, Angiology and Internal Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Tobias Müller
- Department of Pneumology and Internal Intensive Care Medicine, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Nikolaus Marx
- Department of Cardiology, Angiology and Internal Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Michael Dreher
- Department of Pneumology and Internal Intensive Care Medicine, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Christian G Cornelissen
- Department of Pneumology and Internal Intensive Care Medicine, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
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25
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Liu P, Ma Z, Deng Y, Li Y, Xia W, Liu Y, Wu X, Mou J, Li Q, Nie J, Zhou W, Fu X, Yu F, Li Y, Zhang Y, Xiang Q, Peng X, Jiang G. Characteristics and Effectiveness of the Coronavirus Disease 2019 (COVID-19) Prevention and Control in a Representative City in China. Med Sci Monit 2020; 26:e927472. [PMID: 33349626 PMCID: PMC7763915 DOI: 10.12659/msm.927472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND SARS-CoV-2 has caused a pandemic. Control measures differ among countries. It is necessary to assess the effectiveness of these control measures. MATERIAL AND METHODS We collected the data of COVID-19 patients and control measures between January 18, 2020 and September 18, 2020 from the Changshou District and analyzed the clinical characteristics, epidemiological data, and the adjustment of policies to assess the effectiveness of control measures. The control of COVID-19 was divided into 2 stages, with the lifting of lockdown in Hubei province (March 25, 2020) as a dividing line. RESULTS We identified 32 patients through different means in the first stage. All the imported patients entered this area before the lockdown. In 93.1% of patients, the last exposure occurred before the implementation of the stay-at-home order and centralized isolation. Tracing of high-risk people and RT-PCR screening identified 56.3% of cases. In the second stage, all the high-risk people were under centralized isolation. Nine asymptomatic patients were identified. City lockdown and stay-at-home orders were not issued again, and no second-generation patients were found. CONCLUSIONS We have provided a successful model to control the transmission of COVID-19 in a short period.
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Affiliation(s)
- Ping Liu
- Department of Respiratory and Critical Care Medicine, The People's Hospital of Changshou District, Chongqing, China (mainland)
| | - Zhoujun Ma
- Changshou Center for Disease Control and Prevention, Chongqing, China (mainland)
| | - Yu Deng
- Chongqing Medical and Pharmaceutical College, Chongqing, China (mainland)
| | - Yongpu Li
- Department of Respiratory and Critical Care Medicine, The People's Hospital of Changshou District, Chongqing, China (mainland)
| | - Wei Xia
- Department of Respiratory and Critical Care Medicine, The People's Hospital of Changshou District, Chongqing, China (mainland)
| | - Yu Liu
- Department of Respiratory and Critical Care Medicine, The People's Hospital of Changshou District, Chongqing, China (mainland)
| | - Xiaolan Wu
- Department of Infectious Disease, The People's Hospital of Changshou District, Chongqing, China (mainland)
| | - Junhuan Mou
- Department of Infectious Disease, The People's Hospital of Changshou District, Chongqing, China (mainland)
| | - Quan Li
- Department of Laboratory Medicine, The People's Hospital of Changshou District, Chongqing, China (mainland)
| | - Jianghua Nie
- Department of Radiology, The People's Hospital of Changshou District, Chongqing, China (mainland)
| | - Wenxiu Zhou
- Department of Outpatient Service, The People's Hospital of Changshou District, Chongqing, China (mainland)
| | - Xueqin Fu
- Department of Outpatient Service, The People's Hospital of Changshou District, Chongqing, China (mainland)
| | - Fei Yu
- The People's Hospital of Changshou District, Chongqing, China (mainland)
| | - Yan Li
- The People's Hospital of Changshou District, Chongqing, China (mainland)
| | - Yaling Zhang
- The People's Hospital of Changshou District, Chongqing, China (mainland)
| | - Qin Xiang
- The People's Hospital of Changshou District, Chongqing, China (mainland)
| | - Xiaobin Peng
- Changshou Center for Disease Control and Prevention, Chongqing, China (mainland)
| | - Guangqun Jiang
- Changshou Center for Disease Control and Prevention, Chongqing, China (mainland)
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26
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Ishida T, Seki M, Oishi K, Tateda K, Fujita J, Kadota JI, Kawana A, Izumikawa K, Kikuchi T, Ohmagari N, Yamada M, Maruyama T, Takazono T, Miki M, Miyazaki Y, Yamazaki Y, Kakeya H, Ogawa K, Nagai H, Watanabe A. Clinical manifestations of adult patients requiring influenza-associated hospitalization: A prospective multicenter cohort study in Japan via internet surveillance. J Infect Chemother 2020; 27:480-485. [PMID: 33189538 DOI: 10.1016/j.jiac.2020.10.021] [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: 08/14/2020] [Revised: 10/10/2020] [Accepted: 10/18/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Influenza remains a clinically heavy burden worldwide. The objective of this study was to clarify clinical manifestations of severely ill patients infected with influenza. METHODS The clinical data for patients who were severely ill with influenza, and required hospitalization were gathered and analyzed between November 2014 and August 2019 (5 influenza seasons) using an internet-surveillance system. RESULTS A total of 924 patients were enrolled and analyzed. The median age was 78 years (IQR, 67-84), and the patients in the 2015-2016 season were significantly younger than those in other seasons. Pneumonia was the most common disease indicated as a cause for hospitalization, followed by a poor general condition and exacerbation of underlying respiratory diseases. Antiviral drugs were administered in 97.0% of the patients with peramivir being the most-frequently use antiviral. In-hospital death was recorded for 44 patients (4.8%). Multivariate analysis indicated that nursing home resident (OR: 6.554) and obesity (OR: 24.343) were independent predictors of in-hospital mortality. CONCLUSIONS Complications of influenza infection remain a heavy burden especially among the elderly. Continuous nationwide surveillance will be required to grasp the actual situation of influenza epidemics. (UMIN000015989).
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Affiliation(s)
- Tadashi Ishida
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, 1-1-1, Kurashiki, Okayama, 710-8602, Japan.
| | - Masafumi Seki
- Department of Infectious Diseases, Tohoku Medical and Pharmaceutical University, 4-4-1, Komatsushima, Aobaku, Sendai, Miyagi, 981-8558, Japan
| | - Kazunori Oishi
- Toyama Institute of Health, 17-1, Nakataikouyama, Imizu, Toyama, 939-0363, Japan
| | - Kazuhiro Tateda
- Department of Microbiology and Infectious Diseases, Toho University, 5-21-6, Omorinishi, Ota-ku, Tokyo, 143-8540, Japan
| | - Jiro Fujita
- Department of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus, 207 Azaujihara, Nisiharacho, Nakatou, Okinawa, 903-0215, Japan
| | - Jun-Ichi Kadota
- Nagasaki City Hospital Organization, Nagasaki Harbor Medical Center, 6-39, Shinchicho, Nagasaki, 850-8555, Japan
| | - Akihiko Kawana
- Division of Infectious Diseases and Respiratory Medicine, National Defense Medical College, Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Koichi Izumikawa
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Toshiaki Kikuchi
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, 751, Ichibancho, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Mitsuhiro Yamada
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, 1-1, Seiryocho, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Takaya Maruyama
- Department of Respiratory Medicine, National Hospital Organization Mie National Hospital, 357, Kubotacho, Osato, Tsu, Mie, 514-0125, Japan
| | - Takahiro Takazono
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki, 852-8501, Japan
| | - Makoto Miki
- Department of Pulmonary and Respiratory Medicine, Japanese Red Cross Sendai Hospital, 2-43-3, Yamamotocho, Yagi, Taihaku-ku, Sendai, 982-8501, Japan
| | - Yoshitsugu Miyazaki
- Department of Chemotherapy and Mycoses, Leprosy Research Center, National Institute of Infectious Diseases, 1-23-1, Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan
| | - Yoshitaka Yamazaki
- Division of Infectious Diseases, Shinsyu Medical Center, 1332, Suzaka, Nagano, 382-0091, Japan
| | - Hiroshi Kakeya
- Department of Infectious Control Science, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Kenji Ogawa
- Department of Respiratory Medicine, National Hospital Organization Higashinagoya National Hospital, 5-101, Umemorizaka, Higashi-ku, Nagoya, Aichi, 465-8620, Japan
| | - Hideaki Nagai
- Department of Infectious Diseases, National Hospital Organization, Tokyo National Hospital, 3-1-1, Takeoka, Kiyose, Tokyo, 204-8585, Japan
| | - Akira Watanabe
- Division for Development of Anti-infective Agents, Faculty of Medical Science and Welfare, Tohoku Bunka Gakuen University, 6-45-1, Kunimi, Aoba-ku, Sendai, 981-8551, Japan
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27
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Karolyi M, Pawelka E, Kelani H, Funk GC, Lindner B, Porpaczy C, Publig S, Seitz T, Traugott M, Unterweger M, Zoufaly A, Wenisch C. Gender differences and influenza-associated mortality in hospitalized influenza A patients during the 2018/19 season. Infection 2020; 49:103-110. [PMID: 33090329 DOI: 10.1007/s15010-020-01537-x] [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: 05/08/2020] [Accepted: 10/05/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND In this study we analyzed gender differences in the clinical presentation of patients with molecular confirmed influenza A. Additionally, we tried to identify predictors of influenza-associated mortality. MATERIALS/METHODS In this prospective observational multi-center-study we included all influenza-positive patients ≥ 18 years who were hospitalized and treated on flu-isolation-wards in three hospitals in Vienna during the 2018/19 influenza season. Diagnoses were made via Cobas® Liat® POCT. RESULTS 490 Patients (48.8% female) tested positive for influenza A. Female patients were older (median age 76 years vs. 70 years, p < 0.001). Male patients had a higher rate of chronic liver disease in history (8.8% vs. 2.9%, p = 0.006), myositis (11.7% vs. 3.1%, p < 0.001) and ICU admissions (9.6% vs. 4.6%, p = 0.03). The in-hospital mortality rate was 4.3% and increased to 9.5% during the 90-day follow-up period. Female patients > 75 years had a significantly higher in-hospital mortality rate than ≤ 75-year-old females (9.2% vs. 1.7%, p = 0.019). This effect was not observed in male patients (5.4% vs. 1.9%, p = ns). Age > 75 years (OR 5.49, 95% CI 1.10-27.43), acute heart failure (OR 3.56, 95% CI 1.03-12.05) and ICU admission (OR 6.1, 95% CI 0.98-37.91) were predictors for in-hospital mortality for female patients, while any malignancy (OR 9.4, 95% CI 1.90-46.54) and ICU admission (OR 7.05, 95% CI 1.44-34.55) were predictors in male patients. CONCLUSIONS Gender is associated with differences in clinical presentation and complications of influenza A virus infection. Women with acute heart failure or aged > 75 years have an increased risk of influenza associated in-hospital mortality, while ICU admission and any malignancy are predictors for male patients. Mortality rates in patients > 75 years are 5-10 times higher compared to their non-hospitalized influenza-negative Austrian counterparts.
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Affiliation(s)
- Mario Karolyi
- Department for Infectious Diseases, Kaiser-Franz-Josef-Hospital (KFJ), Kundratstraße 3, 1100, Vienna, Austria.
| | - E Pawelka
- Department for Infectious Diseases, Kaiser-Franz-Josef-Hospital (KFJ), Kundratstraße 3, 1100, Vienna, Austria
| | - H Kelani
- Medical University of Vienna (MUW), Vienna, Austria
| | - G C Funk
- Medical Department II and Karl-Landsteiner Institute for Lung Research and Pulmonological Oncology, Wilheminen-Hospital (WSP), Vienna, Austria
| | - B Lindner
- Medical Department II, Center for Diagnosis and Treatment of Rheumatic Diseases, Hospital Hietzing, Vienna, Austria
| | - C Porpaczy
- Medical Department II, Center for Diagnosis and Treatment of Rheumatic Diseases, Hospital Hietzing, Vienna, Austria
| | - S Publig
- Medical Department II and Karl-Landsteiner Institute for Lung Research and Pulmonological Oncology, Wilheminen-Hospital (WSP), Vienna, Austria
| | - T Seitz
- Department for Infectious Diseases, Kaiser-Franz-Josef-Hospital (KFJ), Kundratstraße 3, 1100, Vienna, Austria
| | - M Traugott
- Department for Infectious Diseases, Kaiser-Franz-Josef-Hospital (KFJ), Kundratstraße 3, 1100, Vienna, Austria
| | - M Unterweger
- Department for Anesthesia and Surgical Intensive Care, Kaiser-Franz-Josef-Hospital (KFJ), Vienna, Austria
| | - A Zoufaly
- Department for Infectious Diseases, Kaiser-Franz-Josef-Hospital (KFJ), Kundratstraße 3, 1100, Vienna, Austria
| | - C Wenisch
- Department for Infectious Diseases, Kaiser-Franz-Josef-Hospital (KFJ), Kundratstraße 3, 1100, Vienna, Austria
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28
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Aliberti S, Amati F, Pappalettera M, Di Pasquale M, D'Adda A, Mantero M, Gramegna A, Simonetta E, Oneta AM, Privitera E, Gori A, Bozzi G, Peyvandi F, Minoia F, Filocamo G, Abbruzzese C, Vicenzi M, Tagliabue P, Alongi S, Blasi F. COVID-19 multidisciplinary high dependency unit: the Milan model. Respir Res 2020; 21:260. [PMID: 33036610 PMCID: PMC7545383 DOI: 10.1186/s12931-020-01516-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/21/2020] [Indexed: 12/14/2022] Open
Abstract
COVID-19 is a complex and heterogeneous disease. The pathogenesis and the complications of the disease are not fully elucidated, and increasing evidence shows that SARS-CoV-2 causes a systemic inflammatory disease rather than a pulmonary disease. The management of hospitalized patients in COVID-19 dedicated units is advisable for segregation purpose as well as for infection control. In this article we present the standard operating procedures of our COVID-19 high dependency unit of the Policlinico Hospital, in Milan. Our high dependency unit is based on a multidisciplinary approach. We think that the multidisciplinary involvement of several figures can better identify treatable traits of COVID-19 disease, early identify patients who can quickly deteriorate, particularly patients with multiple comorbidities, and better manage complications related to off-label treatments. Although no generalizable to other hospitals and different healthcare settings, we think that our experience and our point of view can be helpful for countries and hospitals that are now starting to face the COVID-19 outbreak.
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Affiliation(s)
- Stefano Aliberti
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Via Francesco Sforza 35, 20122, Milan, Italy.
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy.
| | - Francesco Amati
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Via Francesco Sforza 35, 20122, Milan, Italy
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Maria Pappalettera
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Via Francesco Sforza 35, 20122, Milan, Italy
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Marta Di Pasquale
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Via Francesco Sforza 35, 20122, Milan, Italy
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Alice D'Adda
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Via Francesco Sforza 35, 20122, Milan, Italy
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Marco Mantero
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Via Francesco Sforza 35, 20122, Milan, Italy
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Andrea Gramegna
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Via Francesco Sforza 35, 20122, Milan, Italy
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Edoardo Simonetta
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Via Francesco Sforza 35, 20122, Milan, Italy
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Anna Maria Oneta
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Via Francesco Sforza 35, 20122, Milan, Italy
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Emilia Privitera
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Via Francesco Sforza 35, 20122, Milan, Italy
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Andrea Gori
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
- Infectious Disease Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Bozzi
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
- Infectious Disease Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Flora Peyvandi
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Francesca Minoia
- Pediatric Rheumatology, Medium Intensity Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Filocamo
- Pediatric Rheumatology, Medium Intensity Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Abbruzzese
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
- Departement of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Vicenzi
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
- Cardiovascular Disease Unit, Internal Medicine Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dyspnea Lab, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paola Tagliabue
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
- Departement of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Salvatore Alongi
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
- Departement of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Blasi
- IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Via Francesco Sforza 35, 20122, Milan, Italy
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
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Chen L, Han X, Li YL, Zhang C, Xing X. The impact of early neuraminidase inhibitor therapy on clinical outcomes in patients hospitalised with influenza A-related pneumonia: a multicenter, retrospective study. BMC Infect Dis 2020; 20:628. [PMID: 32842994 PMCID: PMC7447583 DOI: 10.1186/s12879-020-05322-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 08/03/2020] [Indexed: 02/08/2023] Open
Abstract
Background Guidelines emphasize prompt antiviral treatment in severe influenza patients. Although nearly a 50% of severe influenza present with pneumonia, the effect of early (≤ 2 days after illness onset) neuraminidase inhibitor (NAI) use on the clinical outcomes of influenza A-related pneumonia (FluA-p) has rarely been assessed. Furthermore, data about the administration of NAIs in the real-world management of Flu-p in China are limited. Methods Data of patients hospitalised with FluA-p from five teaching hospitals in China from 1 January 2013 to 31 December 2018 were reviewed retrospectively. The impact of early NAI therapy on the outcomes in FluA-p patients, and the indications of early NAI administration by clinicians were evaluated by logistic regression analysis. Results In total, 693 FluA-p patients were included. Of these patients, 33.5% (232/693) were treated early. After adjusting for weighted propensity scores for treatment, systemic corticosteroid and antibiotic use, a multivariate logistic regression model showed that early NAI therapy was associated with decreased risk for invasive ventilation [odds ratio (OR) 0.511, 95% confidence interval (CI) 0.312–0.835, p = 0.007) and 30-day mortality (OR 0.533, 95% CI 0.210–0.807, p < 0.001) in FluA-p patients. A multivariate logistic regression model confirmed early NAI use (OR 0.415, 95% CI 0.195–0.858, p = 0.001) was a predictor for 30-day mortality in FluA-p patients and a positive rapid influenza diagnostic test was the only indication (OR 3.586, 95% CI 1.259–10.219, p < 0.001) related to the prescription of early NAI by clinicians. Conclusions Early NAI therapy is associated with better outcomes in FluA-p patients. Improved education and training of clinicians on the guidelines of influenza are needed.
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Affiliation(s)
- Liang Chen
- Department of Infectious Disease, Beijing Jishuitan Hospital, 4th Medical College of Peking University, Beijing, China.
| | - Xiudi Han
- Department of Pulmonary and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao City, Shandong Province, China
| | - Yan Li Li
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Chunxiao Zhang
- Department of Pulmonary and Critical Care Medicine, Beijing Huimin Hospital, Beijing, China
| | - Xiqian Xing
- Department of Pulmonary and Critical Care Medicine, the 2nd People's Hospital of Yunnan Province, Kunming City, Yunnan Province, China
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30
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Zhang Y, Wang Y, Zhao J, Xiong Z, Fan Y, Zhang W, Zou X, Wang C, Han J, Li B, Lu B, Cao B. Severity and mortality of respiratory syncytial virus vs influenza A infection in hospitalized adults in China. Influenza Other Respir Viruses 2020; 14:483-490. [PMID: 32449300 PMCID: PMC7431648 DOI: 10.1111/irv.12754] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 04/19/2020] [Accepted: 04/21/2020] [Indexed: 12/24/2022] Open
Abstract
Background Respiratory syncytial virus (RSV) is an important cause of medically attended acute respiratory illnesses in older adults but awareness of the relevance of RSV in older people remains lower than that of influenza, which exhibits similar clinical characteristics to those of RSV. Objectives This study was performed to assess the clinical significance of RSV in respiratory samples from hospitalized adults. Methods Characteristics and outcomes in adults (≥18 years) hospitalized for RSV infection (n = 51) were compared with a cohort hospitalized for influenza A infection (n = 279) in a single‐center retrospective cohort study in Beijing, China. Results Respiratory syncytial virus patients were slightly older, with no significant differences in underlying chronic conditions. Lower respiratory tract infection and cardiovascular complications were more frequent (P < .05) in RSV patients. Rates of mortality in the RSV cohorts were significantly higher within 30 days (13.7% vs 5.0%, P = .019) and 60 days (17.6% vs 7.5%, P = .021). Bacterial co‐infection in respiratory samples was associated with reduced survival among RSV patients (log rank, P = .013). Conclusions Respiratory syncytial virus is a common cause of serious illness among hospitalized adults in China with greater mortality than influenza A. Increased awareness and the availability of antiviral agents might increase the scope for successful management.
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Affiliation(s)
- Yulin Zhang
- Department of Pulmonary and Critical Care Medicine, Laboratory of Clinical Microbiology and Infectious Diseases, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Yeming Wang
- Department of Pulmonary and Critical Care Medicine, Laboratory of Clinical Microbiology and Infectious Diseases, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Jiankang Zhao
- Department of Pulmonary and Critical Care Medicine, Laboratory of Clinical Microbiology and Infectious Diseases, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Zhujia Xiong
- Department of Pulmonary and Critical Care Medicine, Laboratory of Clinical Microbiology and Infectious Diseases, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Yanyan Fan
- Department of Pulmonary and Critical Care Medicine, Laboratory of Clinical Microbiology and Infectious Diseases, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Wang Zhang
- Department of Pulmonary and Critical Care Medicine, Laboratory of Clinical Microbiology and Infectious Diseases, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Xiaohui Zou
- Department of Pulmonary and Critical Care Medicine, Laboratory of Clinical Microbiology and Infectious Diseases, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Chunlei Wang
- Department of Pulmonary and Critical Care Medicine, Laboratory of Clinical Microbiology and Infectious Diseases, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Jiajing Han
- Department of Pulmonary and Critical Care Medicine, Laboratory of Clinical Microbiology and Infectious Diseases, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Binbin Li
- Department of Pulmonary and Critical Care Medicine, Laboratory of Clinical Microbiology and Infectious Diseases, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | | | - Bin Cao
- Department of Pulmonary and Critical Care Medicine, Laboratory of Clinical Microbiology and Infectious Diseases, Center for Respiratory Diseases, National Clinical Research Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.,Clinical Center for Pulmonary Infections, Capital Medical University, Beijing, China.,Tsinghua University-Peking University Joint Center for Life Sciences, Beijing, China
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31
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Summary for Clinicians: Clinical Practice Guideline for the Diagnosis and Treatment of Community-acquired Pneumonia. Ann Am Thorac Soc 2020; 17:133-138. [PMID: 31770496 DOI: 10.1513/annalsats.201909-704cme] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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32
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Dou L, Reynolds D, Wallace L, O'Horo J, Kashyap R, Gajic O, Yadav H. Decreased Hospital Length of Stay With Early Administration of Oseltamivir in Patients Hospitalized With Influenza. Mayo Clin Proc Innov Qual Outcomes 2020; 4:176-182. [PMID: 32280928 PMCID: PMC7139986 DOI: 10.1016/j.mayocpiqo.2019.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective To evaluate the effects of timely oseltamivir administration in patients hospitalized with seasonal influenza. Patients and Methods We performed a single-center retrospective cohort study for hospitalized patients who tested positive for influenza between December 1, 2010, and July 1, 2014. We compared outcomes for patients who received antivirals within 48 hours of symptoms to those of patients who either received oseltamivir after 48 hours or never received oseltamivir. Hospital length of stay (LOS) and 90-day mortality were compared using Cox regression models. Antiviral administration was analyzed as a time-varying covariate. Results During the study period, 433 patients were hospitalized with laboratory-confirmed influenza. Of these patients, 146 (33.7%) received oseltamivir within 48 hours of symptoms, 202 (46.7%) received oseltamivir after 48 hours of symptoms, and 85 (19.6%) did not receive antivirals. Baseline characteristics were similar among these patient groups. Receiving oseltamivir within 48 hours was associated with shorter hospital LOS (5.9 days vs 7.2 days; P=.03) but no significant difference in 90-day mortality (13.7% vs 11.5%; P=.51). In a Cox regression analysis, patients who received antivirals within 48 hours had a 50% higher chance of being discharged (hazard ratio, 1.50; 95% CI, 1.14-1.98) on any given day during hospital stay. Conclusion In patients hospitalized with laboratory-confirmed influenza, timely administration of oseltamivir was associated with shorter hospital LOS.
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Affiliation(s)
- Lin Dou
- Division of Critical Care Medicine, Tianjin First Center Hospital, China
| | - Dan Reynolds
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Lindsey Wallace
- Critical Care Independent Multidisciplinary Program, Mayo Clinic, Rochester, MN
| | - John O'Horo
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN.,Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Rahul Kashyap
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Hemang Yadav
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
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Soldevila N, Toledo D, Ortiz de Lejarazu R, Tamames S, Castilla J, Astray J, Fernández MA, Martín V, Egurrola M, Morales Suárez-Varela M, Domínguez À. Effect of antiviral treatment in older patients hospitalized with confirmed influenza. Antiviral Res 2020; 178:104785. [PMID: 32234540 DOI: 10.1016/j.antiviral.2020.104785] [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: 10/29/2019] [Revised: 03/22/2020] [Accepted: 03/23/2020] [Indexed: 11/27/2022]
Abstract
Seasonal influenza causes significant morbidity and mortality in people aged ≥65 years. Antiviral treatment can reduce complications and disease severity. The objective of this study was to investigate the effect of antiviral treatment in patients aged ≥65 years hospitalized with confirmed influenza in preventing intensive care unit (ICU) admission or death. A retrospective cohort study was carried out in 20 hospitals from seven Spanish regions during 2013-2015 in patients aged ≥65 years. Hospitalized cases of laboratory-confirmed influenza were selected. To assess the association between antiviral treatment and ICU admission or death, the adjusted odds ratios (aOR) and their 95% confidence intervals (CI) were calculated using multivariate logistic regression. We included 715 hospitalized patients, of whom 640 (87.9%) received antiviral treatment, 77 (10.8%) required ICU admission and 66 (9.2%) died. In the 64-74 years age group, receipt of antiviral treatment ≤48 h (aOR 0.20; 95% CI 0.04-0.89), 3-4 days (aOR 0.23; 95% CI 0.05-0.92) and 5-7 days (aOR 0.24; 95% CI 0.03-0.91) after clinical symptom onset was associated with reduced mortality. Receipt of treatment >7 days after symptom onset was not associated with reduced mortality. No association of antiviral treatment with reduced mortality was observed in the >74 years age group or with the prevention of ICU admission in any age group. Antiviral treatment had a protective effect in avoiding death in patients aged 65-74 years hospitalized due to influenza when administered ≤48 h after symptom onset and when no more than 7 days had elapsed.
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Affiliation(s)
- Núria Soldevila
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Departament de Medicina, Universitat de Barcelona, Barcelona, Spain.
| | - Diana Toledo
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | | | - Sonia Tamames
- Direccion General de Salud Pública, Investigación, Desarrollo e Innovación, Junta de Castilla y León, León, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra (IdiSNA), Pamplona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jenaro Astray
- Dirección General de Salud Publica Comunidad de Madrid, Madrid, Spain
| | - Maria Amelia Fernández
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Vicente Martín
- Instituto de Biomedicina (BIOMED), Universidad de León, León, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Mikel Egurrola
- Servicio de Neumología, Hospital de Galdakao, Usansolo, Spain
| | - María Morales Suárez-Varela
- Departamento de Medicina Preventiva, Universidad de Valencia, Valencia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Àngela Domínguez
- Departament de Medicina, Universitat de Barcelona, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Papadimitriou-Olivgeris M, Gkikopoulos N, Wüst M, Ballif A, Simonin V, Maulini M, Nusbaumer C, Bertaiola Monnerat L, Tschopp J, Kampouri EE, Wilson P, Duplain H. Predictors of mortality of influenza virus infections in a Swiss Hospital during four influenza seasons: Role of quick sequential organ failure assessment. Eur J Intern Med 2020; 74:86-91. [PMID: 31899057 DOI: 10.1016/j.ejim.2019.12.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/18/2019] [Accepted: 12/24/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Influenza infections have been associated with high morbidity. The aims were to determine predictors of mortality among patients with influenza infections and to ascertain the role of quick Sequential Organ Failure Assessment (qSOFA) in predicting poor outcomes. METHODS All adult patients with influenza infection at the Hospital of Jura, Switzerland during four influenza seasons (2014/15 to 2017/18) were included. Cepheid Xpert Xpress Flu/RSV was used during the first three influenza seasons and Cobas Influenza A/B and RSV during the 2017/18 season. RESULTS Among 1684 influenza virus tests performed, 441 patients with influenza infections were included (238 for influenza A virus and 203 for B). The majority of infections were community onset (369; 83.7%). Thirty-day mortality was 6.0% (25 patients). Multivariate analysis revealed that infection due to A virus (P 0.035; OR 7.1; 95% CI 1.1-43.8), malnutrition (P < 0.001; OR 25.0; 95% CI 4.5-138.8), hospital-acquired infection (P 0.003; OR 12.2; 95% CI 2.3-65.1), respiratory insufficiency (PaO2/FiO2 < 300) (P < 0.001; OR 125.8; 95% CI 9.6-1648.7) and pulmonary infiltrate on X-ray (P 0.020; OR 6.0; 95% CI 1.3-27.0) were identified as predictors of mortality. qSOFA showed a very good accuracy (0.89) equivalent to other more specific and burdensome scores such as CURB-65 and Pneumonia Severity Index (PSI). CONCLUSION qSOFA performed similarly to specific severity scores (PSI, CURB-65) in predicting mortality. Infection by influenza A virus, respiratory insufficiency and malnutrition were associated with worse prognosis.
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Affiliation(s)
- Matthaios Papadimitriou-Olivgeris
- Department of Internal Medicine, Hospital of Jura, Delémont, Switzerland; Department of Infectious Diseases, University Hospital of Lausanne, Lausanne, Switzerland.
| | | | - Melissa Wüst
- Department of Internal Medicine, Hospital of Jura, Delémont, Switzerland
| | - Aurelie Ballif
- Department of Internal Medicine, Hospital of Jura, Delémont, Switzerland
| | - Valentin Simonin
- Department of Internal Medicine, Hospital of Jura, Delémont, Switzerland
| | - Marie Maulini
- Department of Internal Medicine, Hospital of Jura, Delémont, Switzerland
| | | | | | - Jonathan Tschopp
- Department of Infectious Diseases, University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Patrick Wilson
- Department of Internal Medicine, Hospital of Jura, Delémont, Switzerland
| | - Hervé Duplain
- Department of Internal Medicine, Hospital of Jura, Delémont, Switzerland; Faculty of biology and medicine, University of Lausanne, Lausanne, Switzerland
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35
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Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, Cooley LA, Dean NC, Fine MJ, Flanders SA, Griffin MR, Metersky ML, Musher DM, Restrepo MI, Whitney CG. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med 2020; 200:e45-e67. [PMID: 31573350 PMCID: PMC6812437 DOI: 10.1164/rccm.201908-1581st] [Citation(s) in RCA: 1752] [Impact Index Per Article: 438.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: This document provides evidence-based clinical practice guidelines on the management of adult patients with community-acquired pneumonia. Methods: A multidisciplinary panel conducted pragmatic systematic reviews of the relevant research and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology for clinical recommendations. Results: The panel addressed 16 specific areas for recommendations spanning questions of diagnostic testing, determination of site of care, selection of initial empiric antibiotic therapy, and subsequent management decisions. Although some recommendations remain unchanged from the 2007 guideline, the availability of results from new therapeutic trials and epidemiological investigations led to revised recommendations for empiric treatment strategies and additional management decisions. Conclusions: The panel formulated and provided the rationale for recommendations on selected diagnostic and treatment strategies for adult patients with community-acquired pneumonia.
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MESH Headings
- Adult
- Ambulatory Care
- Anti-Bacterial Agents/therapeutic use
- Antigens, Bacterial/urine
- Blood Culture
- Chlamydophila Infections/diagnosis
- Chlamydophila Infections/drug therapy
- Chlamydophila Infections/metabolism
- Community-Acquired Infections/diagnosis
- Community-Acquired Infections/drug therapy
- Culture Techniques
- Drug Therapy, Combination
- Haemophilus Infections/diagnosis
- Haemophilus Infections/drug therapy
- Haemophilus Infections/metabolism
- Hospitalization
- Humans
- Legionellosis/diagnosis
- Legionellosis/drug therapy
- Legionellosis/metabolism
- Macrolides/therapeutic use
- Moraxellaceae Infections/diagnosis
- Moraxellaceae Infections/drug therapy
- Moraxellaceae Infections/metabolism
- Pneumonia, Bacterial/diagnosis
- Pneumonia, Bacterial/drug therapy
- Pneumonia, Mycoplasma/diagnosis
- Pneumonia, Mycoplasma/drug therapy
- Pneumonia, Mycoplasma/metabolism
- Pneumonia, Pneumococcal/diagnosis
- Pneumonia, Pneumococcal/drug therapy
- Pneumonia, Pneumococcal/metabolism
- Pneumonia, Staphylococcal/diagnosis
- Pneumonia, Staphylococcal/drug therapy
- Pneumonia, Staphylococcal/metabolism
- Radiography, Thoracic
- Severity of Illness Index
- Sputum
- United States
- beta-Lactams/therapeutic use
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Impact of early neuraminidase inhibitor treatment on clinical outcomes in patients with influenza B-related pneumonia: a multicenter cohort study. Eur J Clin Microbiol Infect Dis 2020; 39:1231-1238. [PMID: 32026193 DOI: 10.1007/s10096-020-03835-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 01/29/2020] [Indexed: 02/05/2023]
Abstract
The aim of this study is to evaluate the impact of early (within 2 days after disease onset) neuraminidase inhibitor (NAI) administration on clinical outcomes in patients with laboratory-confirmed influenza B-related pneumonia (FluB-p). This was a multicenter study conducted from 1 January 2013 to 1 May 2019. Data of immunocompetent adult and adolescent FluB-p patients hospitalized at five different teaching hospitals in China were retrospectively collected, including demographic and clinical features as well as clinical and treatment outcomes. Univariate and multivariate logistic regression analyses were performed to assess the effects of early NAI administration on clinical outcomes in FluB-p patients. In total, 386 hospitalized patients with community-onset FluB-p were included in this study, of whom 39.6% (153/386) were treated with NAI early. After adjusting for the weighted propensity scores of treatment, systemic corticosteroid, and antibiotic uses, the results of multivariate logistic regression model indicated that early NAI treatment was associated with the decreased risks of invasive ventilation [odd ratio (OR) 0.325, 95% confidence interval (CI) 0.123-0.858; p = 0.023), admittance to intensive care unit (OR 0.425, 95% CI 0.204-0.882; p = 0.022), and 30-day mortality (OR 0.416, 95% CI 0.184-0.944, p = 0.036)] in FluB-p patients. In addition, the multivariate logistic regression analysis revealed that early NAI treatment (OR 0.306, 95% CI 0.063-0.618; p = 0.010) was an independent predictor for 30-day mortality in patients with FluB-p. Early NAI treatment was associated with better clinical outcomes in FluB-p patients, which supports the recommendations of its use in severe influenza illness.
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37
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Atamna A, Babitch T, Bracha M, Sorek N, Haim BZ, Elis A, Bishara J, Avni T. Statins and outcomes of hospitalized patients with laboratory-confirmed 2017-2018 influenza. Eur J Clin Microbiol Infect Dis 2019; 38:2341-2348. [PMID: 31463620 DOI: 10.1007/s10096-019-03684-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/15/2019] [Indexed: 01/26/2023]
Abstract
No studies evaluating the association between statins and outcomes of patients with seasonal influenza have been performed since the 2007-2008 and the 2009 pandemic H1N1 influenza seasons. All consecutive hospitalized patients between October 2017 and April 2018, diagnosed with laboratory-confirmed influenza A and B virus, were included. Patients were divided into two groups: statin and non-statin users. Outcomes were 30- and 90-day mortality, complications (pneumonia, myocarditis, encephalitis, intensive care unit (ICU) transfer, mechanical ventilation, vasopressor support), length of hospital stay, and readmission rates. A multivariate analysis was performed to adjust for mortality risk factors. To compare the groups, we matched patients to the nearest neighbor propensity score. Of the 526 patients ill with influenza A (201/526) and B (325/526), 36% (188/526) were statin users; 64% (338/526) were not. Statin users were older (78 vs.70; p = < 0.05) and suffered from more comorbidities (Charlson comorbidity scores of 6 vs.4; p < 0.005). The 30-day mortality rate among statin vs. non-statin users was 6% vs. 8% (p = 0.3). On multivariate analysis, statin use was not associated with mortality benefit (OR = 0.67 (0.29-1.36)). After propensity score matching, the results were unchanged (OR = 0.71 (0.29-1.71)). Statin users were diagnosed with less complicated diseases as they were less likely to receive vasopressor support, mechanical ventilation, and/or transfer to the ICU. Although statin users were significantly older and exhibited more comorbidities, 30-day mortality rates did not differ between statin users and non-users, which may signify a protective role of statins on seasonal influenza patients. Further studies performed during different influenza seasons and different subtypes are essential.
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Affiliation(s)
- Alaa Atamna
- Infectious Disease Unit, Rabin Medical Center, Beilinson Hospital, 49100, Petah Tikva, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Tanya Babitch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Internal Medicine Department E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Mayaan Bracha
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nadav Sorek
- Clinical Microbiology Laboratory, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Ben-Zvi Haim
- Clinical Microbiology Laboratory, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Avishay Elis
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Internal Medicine Department C, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Jihad Bishara
- Infectious Disease Unit, Rabin Medical Center, Beilinson Hospital, 49100, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Avni
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Internal Medicine Department E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
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38
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Beigel JH, Aga E, Elie-Turenne MC, Cho J, Tebas P, Clark CL, Metcalf JP, Ozment C, Raviprakash K, Beeler J, Holley HP, Warner S, Chorley C, Lane HC, Hughes MD, Davey RT. Anti-influenza immune plasma for the treatment of patients with severe influenza A: a randomised, double-blind, phase 3 trial. THE LANCET. RESPIRATORY MEDICINE 2019; 7:941-950. [PMID: 31582360 PMCID: PMC6941345 DOI: 10.1016/s2213-2600(19)30199-7] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/30/2019] [Accepted: 05/31/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Infection with influenza virus causes substantial morbidity and mortality globally, although antiviral treatments are available. Previous studies have suggested that anti-influenza immune plasma could be beneficial as treatment, but they were not designed as randomised, blinded, placebo-controlled trials. Therefore, we aimed to prospectively evaluate the clinical efficacy of high-titre immune plasma compared with standard low-titre plasma to improve outcomes in patients with severe influenza A infection. METHODS We did this randomised, double-blind, phase 3 trial at 41 US medical centres to assess the efficacy of high-titre anti-influenza plasma (haemagglutination inhibition antibody titre ≥1:80) compared with low-titre plasma (≤1:10). Children and adults with PCR-confirmed influenza A infection, a National Early Warning score of 3 or greater, and onset of illness within 6 days before randomisation were eligible. Patients were randomly assigned (2:1) using an interactive web response system to receive either two units (or paediatric equivalent) of high-titre plasma (high-titre group) or low-titre plasma (low-titre group), and were followed up for 28 days from randomisation. High-titre and low-titre plasma had the same appearance. Randomisation was stratified by severity (in intensive care unit, not in intensive care but requiring supplemental oxygen, or not in intensive care and not requiring supplemental oxygen) and age (<18 years and ≥18 years). All participants, site staff, and the study team were masked to treatment allocation until after the final database lock. The primary endpoint was clinical status assessed by a six-point ordinal scale on day 7 (death, in intensive care, hospitalised but requiring supplemental oxygen, hospitalised not requiring supplemental oxygen, discharged but unable to resume normal activities, and discharged with full resumption of normal activities) analysed in a proportional odds model (an odds ratio [OR] >1 indicates improvement in clinical status across all categories for the high-titre vs the low-titre group). The primary analysis was done in the intention-to-treat population, excluding two participants who did not receive plasma. This trial is registered with ClinicalTrials.gov, NCT02572817. FINDINGS Participants were recruited between Jan 26, 2016, and April 19, 2018. Of 200 participants enrolled (177 adults and 23 children), 140 met the criteria for randomisation and were assigned to the high-titre group (n=92) or to the control low-titre group (n=48). One participant from each group did not receive plasma. At baseline, 60 (43%) of 138 participants were in intensive care and 55 (71%) of 78 participants who were not in intensive care required oxygen. 93% of planned plasma infusions were completed. The study was terminated in July, 2018, when independent efficacy analysis showed low conditional power to detect an effect of high-titre plasma even if full accrual (150 participants) was achieved. The proportional OR for improved clinical status on day 7 was 1·22 (95% CI 0·65-2·29, p=0·54). 47 (34%) of 138 participants experienced 88 serious adverse events: 32 (35%) with 60 events in the high-titre group and 15 (32%) with 28 events in the low-titre group. The most common serious adverse events were acute respiratory distress syndrome (ARDS; four [4%] vs two [4%]), allergic transfusion reactions (two [2%] vs two [4%]), and respiratory distress (three [3%] vs none). 65 (47%) participants experienced 183 adverse events: 42 (46%) with 126 events in the high-titre group and 23 (49%) with 57 events in the low-titre group. The most common adverse events were anaemia (four [3%] vs two [4%]) and ARDS (four [3%] vs three [5%]). Ten patients died during the study (six [7%] in the high-titre group vs four [9%] in the low-titre group, p=0·73). The most common cause of death was worsening of acute respiratory distress syndrome (two [2%] vs two [4%] patients). INTERPRETATION High-titre anti-influenza plasma conferred no significant benefit over non-immune plasma. Although our study did not have the precision to rule out a small, clinically relevant effect, the benefit is insufficient to justify the use of immune plasma for treating patients with severe influenza A. FUNDING National Institute of Allergy and Infectious Diseases of the National Institutes of Health (Bethesda, MD, USA).
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Affiliation(s)
- John H Beigel
- National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA.
| | - Evgenia Aga
- Harvard TH Chan School of Public Health, Boston, MA, USA
| | | | - Josalyn Cho
- Massachusetts General Hospital, Boston, MA, USA
| | - Pablo Tebas
- University of Pennsylvania, Philadelphia, PA, USA
| | | | - Jordan P Metcalf
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | | | - Joy Beeler
- Leidos Biomedical Research, Frederick, MD, USA
| | | | | | | | - H Clifford Lane
- National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | | | - Richard T Davey
- National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
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Ramirez J, Peyrani P, Wiemken T, Chaves SS, Fry AM. A Randomized Study Evaluating the Effectiveness of Oseltamivir Initiated at the Time of Hospital Admission in Adults Hospitalized With Influenza-Associated Lower Respiratory Tract Infections. Clin Infect Dis 2019; 67:736-742. [PMID: 29659754 DOI: 10.1093/cid/ciy163] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 04/03/2018] [Indexed: 12/15/2022] Open
Abstract
Background Influenza-associated hospitalizations result in high morbidity and mortality. We sought to determine if early empiric anti-influenza therapy improves outcomes of hospitalized patients with influenza-associated lower respiratory tract infections (I-LRTIs). Methods This was a randomized, unblinded, trial of adult patients hospitalized with I-LRTIs in Kentucky during 2009-2012. Patients were randomized to group A (standard of care) or group B (standard of care plus oseltamivir as early as possible but within 24 hours of enrollment). The primary outcome was development of clinical failure (composite variable including failure to reach clinical improvement within 7 days, transfer to intensive care 24 hours after admission, or rehospitalization or death within 30 days). Intent-to-treat (ITT) (all LRTI) and per-protocol (PP) (I-LRTI) analyses were done. Results A total of 1107 patients were enrolled and included in the ITT analysis, 556 in group A and 551 in group B. The median time from symptom onset to hospital admission was 5 days (interquartile range, 5) for both groups; oseltamivir was initiated median day 6 in group B. There was no difference in the development of clinical failure (group A, 25%, and group B, 24%; P = .561). In the PP analysis, 11 of 45 (24%) patients in group A and 4 of 29 (14%) patients in group B had clinical failure (P = .414). Conclusions Initiation of oseltamivir more than 5 days after illness onset did not reduce clinical failures among hospitalized patients with I- LRTIs. However, we did not enroll our projected sample size of I-LRTI. Clinical Trials Registration NCT01248715.
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Affiliation(s)
- Julio Ramirez
- Division of Infectious Diseases, School of Medicine, Kentucky
| | - Paula Peyrani
- Division of Infectious Diseases, School of Medicine, Kentucky
| | - Timothy Wiemken
- Department of Epidemiology and Population Health, School of Public Health and Information Sciences, University of Louisville, Kentucky
| | - Sandra S Chaves
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alicia M Fry
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Abstract
PURPOSE OF REVIEW Seasonal and pandemic influenza are major causes of morbidity and mortality globally. Neuraminidase inhibitors (NAIs) are the only class of antiviral agent recommended for the treatment of currently circulating strains of influenza. There has previously been controversy over the level of evidence for patient benefit with NAIs. We review here the current evidence base for the clinical impact of treatment of influenza with NAIs. RECENT FINDINGS Meta-analysis of pharma-sponsored studies (including previously unpublished data) shows that NAIs reduce the duration of illness in influenza-infected patients, and suggest a possible reduction in the rate of complications and hospitalization. Meta-analysis of observational studies examining oseltamivir use during the H1N1 2009 pandemic, suggest a reduction in hospitalization rate in community-dwelling patients and a reduction in mortality in hospitalized adults treated with NAIs. Current NAI use in the community and hospitals varies widely but in general they are underutilized. SUMMARY Although there has been controversy over the level of evidence for patient benefit, a growing body of evidence suggests that treatment of influenza with NAIs is associated with improved outcomes for both patients in the community and more severely unwell patients in hospital. Clinical outcomes are optimal with earlier use and strategies to improve early widespread NAI utilization are needed.
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Bloom AS, Suchindran S, Steinbrink J, McClain MT. Utility of predictive tools for risk stratification of elderly individuals with all-cause acute respiratory infection. Infection 2019; 47:617-627. [PMID: 30929142 DOI: 10.1007/s15010-019-01299-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 03/18/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE A number of scoring tools have been developed to predict illness severity and patient outcome for proven pneumonia, however, less is known about the utility of clinical prediction scores for all-cause acute respiratory infection (ARI), especially in elderly subjects who are at increased risk of poor outcomes. METHODS We retrospectively analyzed risk factors and outcomes of individuals ≥ 60 years of age presenting to the emergency department with a clinical diagnosis of ARI. RESULTS Of 276 individuals in the study, 40 had proven viral infection and 52 proven bacterial infection, but 184 patients with clinically adjudicated ARI (67%) remained without a proven microbial etiology despite extensive clinical (and expanded research) workup. Patients who were older, had multiple comorbidities, or who had proven bacterial infection were more likely to require hospital and ICU admission. We identified a novel model based on 11 demographic and clinical variables that were significant risk factors for ICU admission or mortality in elderly subjects with all-cause ARI. As comparators, a modified PORT score was found to correlate more closely with all-cause ARI severity than a modified CURB-65 score (r, 0.54, 0.39). Interestingly, modified Jackson symptom scores were found to inversely correlate with severity (r, - 0.34) but show potential for differentiating viral and bacterial etiologies. CONCLUSIONS Modified PORT, CURB-65, Jackson symptom scores, and a novel ARI scoring tool presented herein all offer predictive ability for all-cause ARI in elderly subjects. Such broadly applicable scoring metrics have the potential to assist in treatment and triage decisions at the point of care.
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Affiliation(s)
| | - Sunil Suchindran
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University, Durham, NC, USA
| | - Julie Steinbrink
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - Micah T McClain
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University, Durham, NC, USA.
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA.
- Durham Veteran's Affairs Medical Center, Durham, NC, USA.
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Weng TC, Chiu HYR, Chen SY, Shih FY, King CC, Fang CC. National retrospective cohort study to identify age-specific fatality risks of comorbidities among hospitalised patients with influenza-like illness in Taiwan. BMJ Open 2019; 9:e025276. [PMID: 31239301 PMCID: PMC6597649 DOI: 10.1136/bmjopen-2018-025276] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES This study aimed to examine comprehensively the prognostic impact of underlying comorbidities among hospitalised patients with influenza-like illness (ILI) in different age groups and provide recommendations targeting the vulnerable patients. SETTING AND PARTICIPANTS A retrospective cohort of 83 227 hospitalised cases with ILI were identified from Taiwan's National Health Insurance Research Database from January 2005 to December 2010. Cases were stratified into three different age groups: paediatric (0-17 years), adult (18-64 years) and elderly (≧65 years), and their age, sex, comorbidity and past healthcare utilisation were analysed for ILI-associated fatality. MAIN OUTCOME MEASURES ORs for ILI-related fatality in different age groups were performed using multivariable analyses with generalised estimating equation models and adjusted by age, sex and underlying comorbidities. RESULTS Hospitalised ILI-related fatality significantly increased with comorbidities of cancer with metastasis (adjusted OR (aOR)=3.49, 95% CI: 3.16 to 3.86), haematological malignancy (aOR=3.02, 95% CI: 2.43 to 3.74), cancer without metastasis (aOR=1.72, 95% CI: 1.54 to 1.91), cerebrovascular (aOR=1.24, 95% CI: 1.15 to 1.33) and heart diseases (aOR=1.19, 95% CI: 1.11 to 1.27) for all age groups. Adult patients with AIDS; adult and elderly patients with chronic kidney disease, tuberculosis and diabetes were significantly associated with elevated risk of death. Severe liver diseases and hypothyroidism among elderly, and dementia/epilepsy among elderly and paediatrics were distinctively associated with likelihood of ILI-related fatality. CONCLUSIONS Different age-specific comorbidities were associated with increasing risk of death among hospitalised ILI patients. These findings may help update guidelines for influenza vaccination and other prevention strategies in high-risk groups for minimising worldwide ILI-related deaths.
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Affiliation(s)
- Ting-Chia Weng
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Han-Yi Robert Chiu
- Technical Mission of Republic of China (Taiwan) to the Republic of the Marshall Islands, International Cooperation and Development Fund, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shey-Ying Chen
- Department of Emergency Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Fuh-Yuan Shih
- Department of Emergency Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chwan-Chuen King
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Cheng-Chung Fang
- Department of Emergency Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
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Pawelka E, Karolyi M, Daller S, Kaczmarek C, Laferl H, Niculescu I, Schrader B, Stütz C, Zoufaly A, Wenisch C. Influenza virus infection: an approach to identify predictors for in-hospital and 90-day mortality from patients in Vienna during the season 2017/18. Infection 2019; 48:51-56. [PMID: 31203513 DOI: 10.1007/s15010-019-01335-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 06/08/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Seasonal influenza outbreaks are associated with increased mortality and hospitalisation rates. Herein we tried to identify predictors of mortality in hospitalised patients with influenza virus infection. MATERIALS/METHODS In this exploratory retrospective observational single-centre-study we included all influenza-positive patients older than 18 years who were hospitalised and treated at the flu-isolation-ward during the influenza season 2017/18. Diagnosis was based on point-of-care-test with the Alere™ i. First we performed χ2 tests and Mann-Whitney U tests to identify predictors of mortality. Significant variables were used in a stepwise-forward-logistic-regression-model to predict in-hospital and 90-day mortality. RESULTS Of the 396 patients who tested positive for influenza 96 (24.2%) had influenza A and 300 (75.8%) influenza B. Twenty-two (5.6%) died in hospital and the 90-day mortality rate was 9.4%. In the stepwise logistic regression older age (OR 1.1 per year 95% CI 1.03-1.17), history of atrial fibrillation (OR 5.91 95% CI 1.91-18.34), dementia (OR 3.98 95% CI 1.24-12.78), leucocyte count (OR 1.11 per G/L 95% CI 1.03-1.20), pneumonia (OR 4.39 95% CI 1.44-13.39) and acute heart failure (OR 23.15 95% CI 4.33-123.76) increased the risk of in-hospital mortality. The risk for 90-day mortality was increased by older age (OR 1.04 per year 95% CI 1.01-1.07), history of atrial fibrillation (OR 3.1, 95% CI 1.36-7.05), history of congestive heart failure (OR 4.7 95% CI 1.94-11.48), pneumonia (OR 3.2 95% CI 1.45-6.91) and decreased by statin use (OR 0.28 95% CI 0.10-0.78). CONCLUSIONS Older age, history of atrial fibrillation and pneumonia are associated with increased risk of influenza-associated in-hospital and 90-day mortality. Statin use may decrease 90-day mortality.
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Affiliation(s)
- E Pawelka
- Department for Infectious Diseases, Kaiser-Franz-Josef-Hospital (KFJ), Kundratstraße 3, 1100, Vienna, Austria
| | - Mario Karolyi
- Department for Infectious Diseases, Kaiser-Franz-Josef-Hospital (KFJ), Kundratstraße 3, 1100, Vienna, Austria.
| | - S Daller
- Medical University Vienna (MUW), Spitalgasse 23, 1090, Vienna, Austria
| | - C Kaczmarek
- Medical University Vienna (MUW), Spitalgasse 23, 1090, Vienna, Austria
| | - H Laferl
- Department for Infectious Diseases, Kaiser-Franz-Josef-Hospital (KFJ), Kundratstraße 3, 1100, Vienna, Austria
| | - I Niculescu
- Department for Infectious Diseases, Kaiser-Franz-Josef-Hospital (KFJ), Kundratstraße 3, 1100, Vienna, Austria
| | - B Schrader
- Medical University Vienna (MUW), Spitalgasse 23, 1090, Vienna, Austria
| | - C Stütz
- Medical University Vienna (MUW), Spitalgasse 23, 1090, Vienna, Austria
| | - A Zoufaly
- Department for Infectious Diseases, Kaiser-Franz-Josef-Hospital (KFJ), Kundratstraße 3, 1100, Vienna, Austria
| | - C Wenisch
- Department for Infectious Diseases, Kaiser-Franz-Josef-Hospital (KFJ), Kundratstraße 3, 1100, Vienna, Austria
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Abstract
Annual seasonal influenza epidemics of variable severity result in significant morbidity and mortality in the United States (U.S.) and worldwide. In temperate climate countries, including the U.S., influenza activity peaks during the winter months. Annual influenza vaccination is recommended for all persons in the U.S. aged 6 months and older, and among those at increased risk for influenza-related complications in other parts of the world (e.g. young children, elderly). Observational studies have reported effectiveness of influenza vaccination to reduce the risks of severe disease requiring hospitalization, intensive care unit admission, and death. A diagnosis of influenza should be considered in critically ill patients admitted with complications such as exacerbation of underlying chronic comorbidities, community-acquired pneumonia, and respiratory failure during influenza season. Molecular tests are recommended for influenza testing of respiratory specimens in hospitalized patients. Antigen detection assays are not recommended in critically ill patients because of lower sensitivity; negative results of these tests should not be used to make clinical decisions, and respiratory specimens should be tested for influenza by molecular assays. Because critically ill patients with lower respiratory tract disease may have cleared influenza virus in the upper respiratory tract, but have prolonged influenza viral replication in the lower respiratory tract, an endotracheal aspirate (preferentially) or bronchoalveolar lavage fluid specimen (if collected for other diagnostic purposes) should be tested by molecular assay for detection of influenza viruses.Observational studies have reported that antiviral treatment of critically ill adult influenza patients with a neuraminidase inhibitor is associated with survival benefit. Since earlier initiation of antiviral treatment is associated with the greatest clinical benefit, standard-dose oseltamivir (75 mg twice daily in adults) for enteric administration is recommended as soon as possible as it is well absorbed in critically ill patients. Based upon observational data that suggest harms, adjunctive corticosteroid treatment is currently not recommended for children or adults hospitalized with influenza, including critically ill patients, unless clinically indicated for another reason, such as treatment of asthma or COPD exacerbation, or septic shock. A number of pharmaceutical agents are in development for treatment of severe influenza.
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Affiliation(s)
- Eric J Chow
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Mailstop H24-7, 1600 Clifton Road, N.E., Atlanta, GA, 30329, USA
| | - Joshua D Doyle
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Mailstop H24-7, 1600 Clifton Road, N.E., Atlanta, GA, 30329, USA
| | - Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Mailstop H24-7, 1600 Clifton Road, N.E., Atlanta, GA, 30329, USA.
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Chow EJ, Doyle JD, Uyeki TM. Influenza virus-related critical illness: prevention, diagnosis, treatment. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:214. [PMID: 31189475 PMCID: PMC6563376 DOI: 10.1186/s13054-019-2491-9] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 05/26/2019] [Indexed: 01/20/2023]
Abstract
Annual seasonal influenza epidemics of variable severity result in significant morbidity and mortality in the United States (U.S.) and worldwide. In temperate climate countries, including the U.S., influenza activity peaks during the winter months. Annual influenza vaccination is recommended for all persons in the U.S. aged 6 months and older, and among those at increased risk for influenza-related complications in other parts of the world (e.g. young children, elderly). Observational studies have reported effectiveness of influenza vaccination to reduce the risks of severe disease requiring hospitalization, intensive care unit admission, and death. A diagnosis of influenza should be considered in critically ill patients admitted with complications such as exacerbation of underlying chronic comorbidities, community-acquired pneumonia, and respiratory failure during influenza season. Molecular tests are recommended for influenza testing of respiratory specimens in hospitalized patients. Antigen detection assays are not recommended in critically ill patients because of lower sensitivity; negative results of these tests should not be used to make clinical decisions, and respiratory specimens should be tested for influenza by molecular assays. Because critically ill patients with lower respiratory tract disease may have cleared influenza virus in the upper respiratory tract, but have prolonged influenza viral replication in the lower respiratory tract, an endotracheal aspirate (preferentially) or bronchoalveolar lavage fluid specimen (if collected for other diagnostic purposes) should be tested by molecular assay for detection of influenza viruses.Observational studies have reported that antiviral treatment of critically ill adult influenza patients with a neuraminidase inhibitor is associated with survival benefit. Since earlier initiation of antiviral treatment is associated with the greatest clinical benefit, standard-dose oseltamivir (75 mg twice daily in adults) for enteric administration is recommended as soon as possible as it is well absorbed in critically ill patients. Based upon observational data that suggest harms, adjunctive corticosteroid treatment is currently not recommended for children or adults hospitalized with influenza, including critically ill patients, unless clinically indicated for another reason, such as treatment of asthma or COPD exacerbation, or septic shock. A number of pharmaceutical agents are in development for treatment of severe influenza.
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Affiliation(s)
- Eric J Chow
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Mailstop H24-7, 1600 Clifton Road, N.E., Atlanta, GA, 30329, USA
| | - Joshua D Doyle
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Mailstop H24-7, 1600 Clifton Road, N.E., Atlanta, GA, 30329, USA
| | - Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Mailstop H24-7, 1600 Clifton Road, N.E., Atlanta, GA, 30329, USA.
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Madan A, Chen S, Yates P, Washburn ML, Roberts G, Peat AJ, Tao Y, Parry MF, Barnum O, McClain MT, Roy-Ghanta S. Efficacy and Safety of Danirixin (GSK1325756) Co-administered With Standard-of-Care Antiviral (Oseltamivir): A Phase 2b, Global, Randomized Study of Adults Hospitalized With Influenza. Open Forum Infect Dis 2019; 6:ofz163. [PMID: 31041358 PMCID: PMC6483311 DOI: 10.1093/ofid/ofz163] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/29/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Excessive neutrophil migration has been correlated with influenza symptom severity. Danirixin (GSK1325756), a selective and reversible antagonist of C-X-C chemokine receptor 2, decreases neutrophil activation and transmigration to areas of inflammation. This study evaluated the efficacy and safety of intravenous (IV) danirixin co-administered with oseltamivir for the treatment of adults hospitalized with influenza. METHODS In this phase 2b, double-blind, 3-arm study (NCT02927431), influenza-positive participants were randomized 2:2:1 to receive danirixin 15mg intravenously (IV) twice daily (bid) + oral oseltamivir 75mg bid (OSV), danirixin 50mg IV bid + OSV, or placebo IV bid + OSV, for up to 5 days. The primary endpoint was time to clinical response (TTCR). RESULTS In total, 10 participants received study treatment (danirixin 15mg + OSV, n = 4; danirixin 50mg + OSV, n = 4; placebo + OSV, n = 2) before the study was terminated early due to low enrollment. All participants achieved a clinical response. Median (95% confidence interval) TTCR was 4.53 days (2.95, 5.71) for danirixin 15mg + OSV, 4.76 days (2.71, 5.25) for danirixin 50mg + OSV, and 1.33 days (0.71, 1.95) for placebo + OSV. Adverse events (AEs) were generally of mild or moderate intensity; no serious AEs were considered treatment-related. Interleukin-8 levels increased in nasal samples (using synthetic absorptive matrix strips) and decreased serum neutrophil-elastase-mediated degradation of elastin decreased in danirixin-treated participants, suggesting effective target engagement. CONCLUSIONS Interpretation of efficacy results is restricted by the low participant numbers. The safety and tolerability profile of danirixin was consistent with previous studies. CLINICAL TRIAL INFORMATION The registration data for the trial are in the ClinicalTrials.gov database, number NCT02927431, and in the EU Clinical Trials Register (https://www.clinicaltrialsregister.eu/) as GSK study 201023, EudraCT 2016-002512-40. Anonymized individual participant data and study documents can be requested for further research from www.clinicalstudydatarequest.com.
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Affiliation(s)
| | | | | | | | - Grace Roberts
- GlaxoSmithKline, Research Triangle Park, North Carolina
| | | | - Yu Tao
- GlaxoSmithKline, Upper Providence, Pennsylvania
| | | | - Otis Barnum
- Natchitoches Regional Medical Center, Natchitoches, Louisiana
| | - Micah T McClain
- Duke University Center for Applied Genomics and Precision Medicine, Durham, North Carolina
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Fica A, Sotomayor V, Fasce R, Dabanch J, Soto A, Charpentier P, Guerrero G, Olivares F, Triantafilo V, Omeiri NE, Gaínza-Lein M. Severe acute respiratory infections (SARI) from influenza in adult patients in Chile: the experience of a sentinel hospital. Rev Panam Salud Publica 2019; 43:e1. [PMID: 31093225 PMCID: PMC6393720 DOI: 10.26633/rpsp.2019.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 06/16/2018] [Indexed: 12/16/2022] Open
Abstract
Objective To 1) describe clinical characteristics of adult patients in Chile with severe acute respiratory infections (SARI) associated with influenza viruses, and 2) analyze virus subtypes identified in specimens collected from those patients, hospital resources used in clinical management, clinical evolution, and risk factors associated with a fatal outcome, using observational data from the SARI surveillance network (SARInet). Methods Adults hospitalized from 1 July 2011 to 31 December 2015 with influenza-associated SARI at a SARI sentinel surveillance hospital in Santiago were identified and the presence of influenza in all cases confirmed by reverse transcription polymerase chain reaction (RT-PCR), using respiratory samples. Results A total of 221 patients (mean age: 74.1 years) were hospitalized with influenza-associated SARI during the study period. Of this study cohort, 91.4% had risk factors for complications and 34.3% had been vaccinated during the most recent campaign. Pneumonia was the most frequent clinical manifestation, occurring in 57.0% of the cohort; other manifestations included influenza-like illness, exacerbated chronic bronchitis, decompensated heart failure, and asthmatic crisis. Cases occurred year-round, with an epidemic peak during autumn–winter. Both influenza A (H1N1pdm09 and H3N2) and B virus co-circulated. Critical care beds were required for 26.7% of the cohort, and 19.5% needed ventilatory assistance. Multivariate analysis identified four significant factors associated with in-hospital mortality: 1) being bedridden (adjusted odds ratio (aOR): 22.3; 95% confidence interval (CI): 3.0–164); 2) admission to critical care unit (aOR: 8.9; CI: 1.44–55); 3) Pa02/Fi02 ratio < 250 (aOR: 5.8; CI: 1.02–33); and 4) increased serum creatinine concentration (> 1 mg/dL) (aOR: 5.47; CI: 1.20–24). Seasonal influenza vaccine was identified as a significant protective factor (aOR: 0.14; CI: 0.021–0.90). Conclusions Influenza-associated SARI affected mainly elderly patients with underlying conditions. Most patients evolved to respiratory failure and more than one-quarter required critical care beds. Clinical presentation was variable. Death was associated with host characteristics and disease-associated conditions, and vaccine was protective. Virus type did not influence outcome.
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Affiliation(s)
- Alberto Fica
- Infectious Disease Service, Hospital Militar de Santiago, Santiago, Chile
| | | | - Rodrigo Fasce
- Viral Hepatitis and Emerging Diseases Section, Viral Diseases Subdepartment, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Jeannette Dabanch
- Infectious Disease Service, Hospital Militar de Santiago, Santiago, Chile
| | - Andrés Soto
- Infectious Disease Service, Hospital Militar de Santiago, Santiago, Chile
| | - Paulo Charpentier
- Infectious Disease Service, Hospital Militar de Santiago, Santiago, Chile
| | - Gonzalo Guerrero
- Infectious Disease Service, Hospital Militar de Santiago, Santiago, Chile
| | - Felipe Olivares
- Infectious Disease Service, Hospital Militar de Santiago, Santiago, Chile
| | | | - Nathalie El Omeiri
- Comprehensive Family Immunization Unit, Pan American Health Organization, Washington, D.C., United States of America
| | - Marina Gaínza-Lein
- School of Medicine, Universidad Austral de Chile-Campus Isla Teja, Valdivia, Chile
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Tekin S, Keske S, Alan S, Batirel A, Karakoc C, Tasdelen-Fisgin N, Simsek-Yavuz S, Isler B, Aydin M, Kapmaz M, Yilmaz-Karadag F, Ergonul O. Predictors of fatality in influenza A virus subtype infections among inpatients in the 2015-2016 season. Int J Infect Dis 2019; 81:6-9. [PMID: 30641199 DOI: 10.1016/j.ijid.2019.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 01/02/2019] [Accepted: 01/05/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Infection with the influenza A virus can cause severe disease and mortality. The effect of the different subtypes of influenza on morbidity and mortality is not yet known in Turkey. The aim of this study was to describe the predictors of fatality related to influenza A infection among hospitalized patients in Istanbul during the 2015-2016 influenza season, and to detail the differences between infections caused by H3N2 and H1N1. METHODS This was a multicenter study performed by the Istanbul Respiratory Infections Study Group of The Turkish Society of Clinical Microbiology and Infectious Diseases (KLİMİK), among patients hospitalized for influenza in Istanbul during the 2015-2016 influenza season. RESULTS A total of 222 patients hospitalized with laboratory-confirmed influenza during the 2015-2016 season were included in the study, of whom 25 (11.2%) died. The fatality rate was significantly higher among patients older than 65 years of age and those with chronic heart and kidney diseases (p<0.001), chronic neurological diseases (p=0.009), and malignancies (p=0.021). Thrombocyte counts were lower in those who died than in those who survived (p<0.004). The median alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, creatinine phosphokinase, and C-reactive protein levels were higher among fatal cases. In the multivariate analysis for the prediction of fatality, being >65years old (odds ratio (OR) 6.9, 95% confidence interval (CI) 2.07-23.08, p=0.002), being infected with influenza A(H3N2) (OR 4.2, 95% CI 1.27-14.38, p=0.019), and a 1-day delay in antiviral use (OR 1.28, 95% CI 1.01-1.63, p=0.036) were found to be associated with an increased likelihood of fatality. CONCLUSIONS The case fatality rate of influenza A(H3N2) was significantly higher than that of influenza A(H1N1). Detection of the infection, allowing the opportunity for the early use of antiviral agents, was found to be important for the prevention of fatality. The vaccination should be prioritized for at-risk groups.
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Affiliation(s)
- S Tekin
- Department of Infectious Diseases and Clinical Microbiology, Koç University Hospital, Istanbul, Turkey
| | - S Keske
- Department of Infectious Diseases and Clinical Microbiology, American Hospital, Istanbul, Turkey
| | - S Alan
- Department of Infectious Diseases and Clinical Microbiology, Memorial Hospital, Istanbul, Turkey
| | - A Batirel
- Department of Infectious Diseases and Clinical Microbiology, Kartal Training and Research Hospital, Ministry of Health, Istanbul, Turkey
| | - C Karakoc
- Department of Infectious Diseases and Clinical Microbiology, Liv Hospital, Istanbul, Turkey
| | - N Tasdelen-Fisgin
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, Ministry of Health, Istanbul, Turkey
| | - S Simsek-Yavuz
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - B Isler
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Training and Research Hospital, Ministry of Health, Istanbul, Turkey
| | - M Aydin
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Hospital, Baskent University, Istanbul, Turkey
| | - M Kapmaz
- Department of Infectious Diseases and Clinical Microbiology, Safa Hospital, Istanbul, Turkey
| | - F Yilmaz-Karadag
- Department of Infectious Diseases and Clinical Microbiology, Goztepe Training and Research Hospital, Medeniyet University, Ministry of Health, Istanbul, Turkey
| | - O Ergonul
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul, Turkey.
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Martínez A, Soldevila N, Romero-Tamarit A, Torner N, Godoy P, Rius C, Jané M, Domínguez À. Risk factors associated with severe outcomes in adult hospitalized patients according to influenza type and subtype. PLoS One 2019; 14:e0210353. [PMID: 30633778 PMCID: PMC6329503 DOI: 10.1371/journal.pone.0210353] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/20/2018] [Indexed: 01/07/2023] Open
Abstract
Seasonal influenza is a cause of hospitalization, especially in people with underlying disease or extreme age, and its severity may differ depending on the types and subtypes of circulating viruses. We investigated the factors associated with ICU admission or death in hospitalized patients with severe laboratory-confirmed influenza according to the viral type and subtype. An observational epidemiological study was carried out in patients aged ≥18 years from 12 Catalan hospitals between 2010 and 2016. For each reported case we collected demographic, virological and clinical characteristics. A mixed-effects logistic regression model was used to estimate crude and adjusted ORs. 1726 hospitalized patients were included: 595 (34.5%) were admitted to the ICU and 224 (13.0%) died. Lower ICU admission was associated with age ≥75 years in all influenza types and subtypes and with age 65-74 years for type A. In contrast, the 65-74 and ≥75 years age groups were associated with an increased risk of death in all types and subtypes, especially for type B (aOR 27.42, 95% CI: 4.95-151.93 and 15.96; 95% CI: 3.01-84.68). The comorbidity most closely associated with severe outcomes was immune deficiency, which was associated with death for type B (aOR 9.02, 95% CI: 3.05-26.69) and subtype A(H1N1)pdm09 (aOR 3.16, 95% CI: 1.77-5.66). Older age was a differential factor for ICU admission and death: it was associated with lower ICU admission but a risk factor for death. The comorbidity with the closest association with death was immune deficiency, mainly in influenza type B patients.
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Affiliation(s)
- Ana Martínez
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Núria Soldevila
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | | | - Núria Torner
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Pere Godoy
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Cristina Rius
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Mireia Jané
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Àngela Domínguez
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
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50
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Kockuzu E, Bayrakcı B, Kesici S, Cıtak A, Karapınar B, Emeksiz S, Anıl AB, Kendirli T, Yukselmis U, Sevketoglu E, Paksu Ş, Kutlu O, Agın H, Yıldızdas D, Keskin H, Kalkan G, Hasanoglu A, Yazıcı MU, Sık G, Kılınc A, Durak F, Perk O, Talip M, Yener N, Uzuner S. Comprehensive Analysis of Severe Viral Infections of Respiratory Tract admitted to PICUs during the Winter Season in Turkey. Indian J Crit Care Med 2019; 23:263-269. [PMID: 31435144 PMCID: PMC6698354 DOI: 10.5005/jp-journals-10071-23177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objectives To analyze the course of seasonal viral infections of respiratory tract in patients hospitalized in pediatric intensive care units (PICU) of 16 centers in Turkey. Materials and methods It is a retrospective, observational, and multicenter study conducted in 16 tertiary PICUs in Turkey includes a total of 302 children with viral cause in the nasal swab which required PICU admission with no interventions. Results Median age of patients was 12 months. Respiratory syncytial virus (RSV) was more common in patients over one year of age whereas influenza, human Bocavirus in patients above a year of age was more common (p <0.05). Clinical presentations influencing mortality were neurologic symptoms, tachycardia, hypoxia, hypotension, elevated lactate, and acidosis. The critical pH value related with mortality was ≤7.10, and critical PCO2 ≥60 mm Hg. Conclusion Our findings demonstrate that patients with neurological symptoms, tachycardia, hypoxia, hypotension, acidosis, impaired liver, and renal function at the time of admission exhibit more severe mortal progressions. Presence of acidosis and multiorgan failure was found to be predictor for mortality. Knowledge of clinical presentation and age-related variations among seasonal viruses may give a clue about severe course and prognosis. By presenting the analyzed data of 302 PICU admissions, current study reveals severity of viral respiratory tract infections and release tips for handling them. How to cite this article Kockuzu E, Bayrakcı B, Kesici S, Cıtak A, Karapınar K, Emeksiz S, et al. Comprehensive Analysis of Severe Viral Infections of Respiratory Tract admitted to PICUs During the Winter Season in Turkey. Indian J Crit Care Med 2019;23(6):263–269.
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Affiliation(s)
- Esra Kockuzu
- Department of Pediatric Intensive Care Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Benan Bayrakcı
- Department of Pediatric Intensive Care Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Selman Kesici
- Clinic of Pediatric Intensive Care Unit, Dr. Sami Ulus Child Health and Disease Training and Research Hospital, Ankara, Turkey
| | - Agop Cıtak
- Department of Pediatric Intensive Care Unit, Acıbadem University Faculty of Medicine, Istanbul, Turkey
| | - Bulent Karapınar
- Department of Pediatric Intensive Care Unit, Ege University Faculty of Medicine, Izmir, Turkey
| | - Serhat Emeksiz
- Clinic of Pediatric Intensive Care Unit, Ankara Pediatric Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Ayşe Berna Anıl
- Clinic of Pediatric Intensive Care Unit, Ankara Tepecik Training and Research Hospital, Izmir, Turkey
| | - Tanıl Kendirli
- Department of Pediatric Intensive Care Unit, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ufuk Yukselmis
- Clinic of Pediatric Intensive Care Unit, Kartal Lutfi Kırdar Education Research Hospital, Istanbul, Turkey
| | - Esra Sevketoglu
- Clinic of Pediatric Intensive Care Unit, Bakırkoy Sadi Konuk Education Research Hospital, Istanbul, Turkey
| | - Şukru Paksu
- Department of Pediatric Intensive Care Unit, Ondokuz Mayıs University, Faculty of Medicine, Samsun, Turkey
| | - Onur Kutlu
- Department of Pediatric Intensive Care Unit, Bezmialem University Faculty of Medicine, Istanbul, Turkey
| | - Hasan Agın
- Clinic of Pediatric Intensive Care Unit Dr. Behcet Uz Education Research Hospital, Izmir, Turkey
| | - Dincer Yıldızdas
- Department of Pediatric Intensive Care Unit, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Halil Keskin
- Department of Pediatric Intensive Care Unit, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Gokhan Kalkan
- Department of Pediatric Intensive Care Unit, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Arzu Hasanoglu
- Department of Pediatric Intensive Care Unit, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Mutlu Uysal Yazıcı
- Department of Pediatric Intensive Care Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Guntulu Sık
- Clinic of Pediatric Intensive Care Unit, Dr. Sami Ulus Child Health and Disease Training and Research Hospital, Ankara, Turkey
| | - Arda Kılınc
- Department of Pediatric Intensive Care Unit, Ege University Faculty of Medicine, Izmir, Turkey
| | - Fatih Durak
- Department of Pediatric Intensive Care Unit, Ege University Faculty of Medicine, Izmir, Turkey
| | - Oktay Perk
- Department of Pediatric Intensive Care Unit, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mey Talip
- Clinic of Pediatric Intensive Care Unit, Bakırkoy Sadi Konuk Education Research Hospital, Istanbul, Turkey
| | - Nazik Yener
- Department of Pediatric Intensive Care Unit, Ondokuz Mayıs University, Faculty of Medicine, Samsun, Turkey
| | - Selcuk Uzuner
- Department of Pediatric Intensive Care Unit, Bezmialem University Faculty of Medicine, Istanbul, Turkey
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