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Erschienen in: Wiener klinische Wochenschrift 23-24/2021

06.10.2021 | original article

Management of hospitalized influenza A patients during the season 2018/19

Comparison of three medical departments and the effect on outcome and antibiotic usage

verfasst von: Mag. Dr. Mario Karolyi, Erich Pawelka, Hasan Kelani, Georg Christian Funk, Boris Lindner, Christoph Porpaczy, Sabine Publig, Sara Omid, Tamara Seitz, Marianna Traugott, Michael Turner, Alexander Zoufaly, Christoph Wenisch

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 23-24/2021

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Summary

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.
Literatur
1.
Zurück zum Zitat Paules CI, Sullivan SG, Subbarao K, et al. Chasing seasonal influenza—the need for a universal influenza vaccine. N Engl J Med. 2018;378:7–9. CrossRef Paules CI, Sullivan SG, Subbarao K, et al. Chasing seasonal influenza—the need for a universal influenza vaccine. N Engl J Med. 2018;378:7–9. CrossRef
2.
3.
Zurück zum Zitat Ryan J, Zoellner Y, Gradl B, et al. Establishing the health and economic impact of influenza vaccination within the European Union 25 countries. Vaccine. 2006;24(47–48):6812–22. CrossRef Ryan J, Zoellner Y, Gradl B, et al. Establishing the health and economic impact of influenza vaccination within the European Union 25 countries. Vaccine. 2006;24(47–48):6812–22. CrossRef
5.
Zurück zum Zitat Girard M, Cherian T, Pervikov Y, et al. A review of vaccine research and development: human acute respiratory infections. Vaccine. 2005;23:5708–24. CrossRef Girard M, Cherian T, Pervikov Y, et al. A review of vaccine research and development: human acute respiratory infections. Vaccine. 2005;23:5708–24. CrossRef
6.
Zurück zum Zitat Haviari S, Bénet T, Saadatian-Elahi M, et al. Vaccination of healthcare workers: a review. Hum Vaccin Immunother. 2015;11:2522–37. CrossRef Haviari S, Bénet T, Saadatian-Elahi M, et al. Vaccination of healthcare workers: a review. Hum Vaccin Immunother. 2015;11:2522–37. CrossRef
9.
Zurück zum Zitat Govaert TM, Dinant GJ, Aretz K, et al. The predictive value of influenza symptomatology in elderly people. Fam Pract. 1998;15:16–22. CrossRef Govaert TM, Dinant GJ, Aretz K, et al. The predictive value of influenza symptomatology in elderly people. Fam Pract. 1998;15:16–22. CrossRef
10.
Zurück zum Zitat Monto AS, Gravenstein S, Elliott M, et al. Clinical signs and symptoms predicting influenza infection. Arch Intern Med. 2000;160:3243–7. CrossRef Monto AS, Gravenstein S, Elliott M, et al. Clinical signs and symptoms predicting influenza infection. Arch Intern Med. 2000;160:3243–7. CrossRef
13.
Zurück zum Zitat Monmany J, Rabella N, Margall N, et al. Unmasking influenza virus infection in patients attended to in the emergency department. Infection. 2004;32:89–97. CrossRef Monmany J, Rabella N, Margall N, et al. Unmasking influenza virus infection in patients attended to in the emergency department. Infection. 2004;32:89–97. CrossRef
14.
Zurück zum Zitat Casalino E, Antoniol S, Fidouh N, et al. Influenza virus infections among patients attending emergency department according to main reason to presenting to ED: a 3-year prospective observational study during seasonal epidemic periods. PLoS ONE. 2017;12(8):e182191. CrossRef Casalino E, Antoniol S, Fidouh N, et al. Influenza virus infections among patients attending emergency department according to main reason to presenting to ED: a 3-year prospective observational study during seasonal epidemic periods. PLoS ONE. 2017;12(8):e182191. CrossRef
15.
Zurück zum Zitat Nguyen Van JC, Camelena F, Dahoun M, et al. Prospective evaluation of the Alere I Influenza A&B nucleic acid amplification versus Xpert Flu/RSV. Diagn Microbiol Infect Dis. 2016;2016(85):19–22. CrossRef Nguyen Van JC, Camelena F, Dahoun M, et al. Prospective evaluation of the Alere I Influenza A&B nucleic acid amplification versus Xpert Flu/RSV. Diagn Microbiol Infect Dis. 2016;2016(85):19–22. CrossRef
16.
Zurück zum Zitat Uyeki TM, Bernstein HH, Bradley JS, et al. Clinical practice guidelines by the infectious diseases society of america: 2018 update on diagnosis, treatment, chemoprophylaxis, and institutional outbreak management of seasonal influenza. Clin Infect Dis. 2019;68(6):e1–47. CrossRef Uyeki TM, Bernstein HH, Bradley JS, et al. Clinical practice guidelines by the infectious diseases society of america: 2018 update on diagnosis, treatment, chemoprophylaxis, and institutional outbreak management of seasonal influenza. Clin Infect Dis. 2019;68(6):e1–47. CrossRef
17.
Zurück zum Zitat Ambrosch A, Rockmann F. Effect of two-step hygiene management on the prevention of nosocomial influenza in a season with high influenza activity. J Hosp Infect. 2016;94:143–9. CrossRef Ambrosch A, Rockmann F. Effect of two-step hygiene management on the prevention of nosocomial influenza in a season with high influenza activity. J Hosp Infect. 2016;94:143–9. CrossRef
18.
Zurück zum Zitat Lee N, Choi KW, Chan PKS, et al. Outcomes of adults hospitalised with severe influenza. Thorax. 2010;65:510–5. CrossRef Lee N, Choi KW, Chan PKS, et al. Outcomes of adults hospitalised with severe influenza. Thorax. 2010;65:510–5. CrossRef
22.
Zurück zum Zitat Mertz D, Kim TH, Johnstone J, et al. Populations at risk for severe or complicated influenza illness: systematic review and meta-analysis. BMJ. 2013;347:f5061. CrossRef Mertz D, Kim TH, Johnstone J, et al. Populations at risk for severe or complicated influenza illness: systematic review and meta-analysis. BMJ. 2013;347:f5061. CrossRef
28.
Zurück zum Zitat Davey P, Brown E, Charani E, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev. 2013;2:CD3543. Davey P, Brown E, Charani E, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev. 2013;2:CD3543.
30.
Zurück zum Zitat Fernandez-Lazaro CI, Brown KA, Langford BJ, et al. Late-career physicians prescribe longer courses of antibiotics. Clin Infect Dis. 2019;69(9):1467–75. CrossRef Fernandez-Lazaro CI, Brown KA, Langford BJ, et al. Late-career physicians prescribe longer courses of antibiotics. Clin Infect Dis. 2019;69(9):1467–75. CrossRef
31.
Zurück zum Zitat Dobson J, Whitley RJ, Pocock S, et al. Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trials. Lancet. 2015;385(9979):1729–37. CrossRef Dobson J, Whitley RJ, Pocock S, et al. Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trials. Lancet. 2015;385(9979):1729–37. CrossRef
33.
Zurück zum Zitat Muthuri SG, Venkatesan S, Myles PR, et al. Effectiveness of neuraminidase inhibitors in reducing mortality in patients admitted to hospital with influenza A H1N1pdm09 virus infection: a meta-analysis of individual participant data. Lancet Respir Med. 2014;2(5):395–404. CrossRef Muthuri SG, Venkatesan S, Myles PR, et al. Effectiveness of neuraminidase inhibitors in reducing mortality in patients admitted to hospital with influenza A H1N1pdm09 virus infection: a meta-analysis of individual participant data. Lancet Respir Med. 2014;2(5):395–404. CrossRef
37.
Zurück zum Zitat Metersky ML, Masterton RG, Lode H, et al. Epidemiology, microbiology, and treatment considerations for bacterial pneumonia complicating influenza. Int J Infect Dis. 2012;16:e321–e31. CrossRef Metersky ML, Masterton RG, Lode H, et al. Epidemiology, microbiology, and treatment considerations for bacterial pneumonia complicating influenza. Int J Infect Dis. 2012;16:e321–e31. CrossRef
38.
Zurück zum Zitat Podewils LJ, Liedtke LA, McDonald LC, et al. A national survey of severe influenza-associated complications among children and adults, 2003–2004. Clin Infect Dis. 2005;40:1693–6. CrossRef Podewils LJ, Liedtke LA, McDonald LC, et al. A national survey of severe influenza-associated complications among children and adults, 2003–2004. Clin Infect Dis. 2005;40:1693–6. CrossRef
39.
Zurück zum Zitat Kallen AJ, Brunkard J, Moore Z, et al. Staphylococcus aureus community-acquired pneumonia during the 2006 to 2007 influenza season. Ann Emerg Med. 2009;53:358–65. CrossRef Kallen AJ, Brunkard J, Moore Z, et al. Staphylococcus aureus community-acquired pneumonia during the 2006 to 2007 influenza season. Ann Emerg Med. 2009;53:358–65. CrossRef
41.
Zurück zum Zitat Prina E, Ranzani OT, Torres A. Community-acquired pneumonia. Lancet. 2015;386:1097–108. CrossRef Prina E, Ranzani OT, Torres A. Community-acquired pneumonia. Lancet. 2015;386:1097–108. CrossRef
45.
Zurück zum Zitat Allerberger F, Apfalter P, Bernig L, et al. Resistenzbericht Österreich AURES 2017. Antibiotikaresistenz und Verbrauch antimikrobieller Substanzen in Österreich. Wien: Bundesministerium für Arbeit, Soziales, Gesundheit und Konsumentenschutz; 2017. ISBN 978-3-85010-515‑6. Allerberger F, Apfalter P, Bernig L, et al. Resistenzbericht Österreich AURES 2017. Antibiotikaresistenz und Verbrauch antimikrobieller Substanzen in Österreich. Wien: Bundesministerium für Arbeit, Soziales, Gesundheit und Konsumentenschutz; 2017. ISBN 978-3-85010-515‑6.
Metadaten
Titel
Management of hospitalized influenza A patients during the season 2018/19
Comparison of three medical departments and the effect on outcome and antibiotic usage
verfasst von
Mag. Dr. Mario Karolyi
Erich Pawelka
Hasan Kelani
Georg Christian Funk
Boris Lindner
Christoph Porpaczy
Sabine Publig
Sara Omid
Tamara Seitz
Marianna Traugott
Michael Turner
Alexander Zoufaly
Christoph Wenisch
Publikationsdatum
06.10.2021
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 23-24/2021
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-021-01950-8

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