Characteristics of patients with hospital-acquired influenza A (H1N1)pdm09 virus admitted to the intensive care unit

Summary Background Influenza A (H1N1)pdm09 virus infection acquired in the hospital and in critically ill patients admitted to the intensive care unit (ICU) has been poorly characterized. Aim To assess the clinical impact of hospital-acquired infection with influenza A (H1N1)pdm09 virus in criticall...

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Published in:	The Journal of hospital infection Vol. 95; no. 2; pp. 200 - 206
Main Authors:	Álvarez-Lerma, F, Marín-Corral, J, Vilà, C, Masclans, J.R, Loeches, I.M, Barbadillo, S, González de Molina, F.J, Rodríguez, A
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-02-2017 Elsevier
Subjects:	Adolescent Adult Aged Aged, 80 and over Cohort Studies Community-acquired infections Critically ill Cross Infection - epidemiology Cross Infection - mortality Cross Infection - pathology Cross Infection - virology Female H1N1 subtype Hospitals Humans Infeccions nosocomials Infectious Disease Influenza A Virus, H1N1 Subtype - isolation & purification Influenza, Human - epidemiology Influenza, Human - mortality Influenza, Human - pathology Influenza, Human - virology Infuenza A virus Intensive Care Units Male Middle Aged Mortality Nosocomial infection Spain Survival Analysis Virus Young Adult Spain Nosocomial infection Community-acquired infections Critically ill Infuenza A virus H1N1 subtype Mortality
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Summary:	Summary Background Influenza A (H1N1)pdm09 virus infection acquired in the hospital and in critically ill patients admitted to the intensive care unit (ICU) has been poorly characterized. Aim To assess the clinical impact of hospital-acquired infection with influenza A (H1N1)pdm09 virus in critically ill patients. Methods Analysis of a prospective database of the Spanish registry (2009–2015) of patients with severe influenza A admitted to the ICU. Infection was defined as hospital-acquired when diagnosis and starting of treatment occurred from the seventh day of hospital stay with no suspicion on hospital admission, and community-acquired when diagnosis was established within the first 48 h of admission. Findings Of 2421 patients with influenza A (H1N1)pdm09 infection, 224 (9.3%) were classified as hospital-acquired and 1103 (45.6%) as community-acquired (remaining cases unclassified). Intra-ICU mortality was higher in the hospital-acquired group (32.9% vs 18.8%, P < 0.001). Independent factors associated with mortality were hospital-acquired influenza A (H1N1)pdm09 infection (odds ratio: 1.63, 95% confidence interval: 1.37–1.99), APACHE II score on ICU admission (1.09; 1.06–1.11), underlying haematological disease (3.19; 1.78–5.73), and need of extrarenal depuration techniques (4.20; 2.61–6.77) and mechanical ventilation (4.34; 2.62–7.21). Conclusion Influenza A (H1N1)pdm09 infection acquired in the hospital is an independent factor for death in critically ill patients admitted to the ICU.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Undefined-2 ObjectType-Article-2 ObjectType-Feature-1
ISSN:	0195-6701 1532-2939
DOI:	10.1016/j.jhin.2016.12.017