Risk factors for nosocomial infection among hospitalised severe influenza A(H1N1)pdm09 patients

Zhou, Fei; Li, Hui; Gu, Li; Meng, Lei; Xue, Chunxue; Cao, Bin; Wang, Chen

doi:10.1016/j.rmed.2017.11.017

Cited by 33 publications

(48 citation statements)

References 42 publications

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“…Influenza virus infection alone can cause severe pneumonia and ARDS, but it can also act in conjunction with a bacterial infection (discussed below). It can precede a pneumonia episode caused by a secondary bacterial infection, most commonly by S. aureus and S. pneumoniae, or can be followed by an episode of nosocomial pneumonia [44]. Clinicians commonly fail to clinically diagnose influenza in up to two-thirds of patients whom have confirmed influenza virus infection [45].…”

Section: Influenza Clinical Progression To Pneumonia and Ardsmentioning

confidence: 99%

“…Viral infections presenting concurrently with bacterial CAP are now known to occur with a frequency of 30-50% in both adult and pediatric populations [64][65][66][67]. Interestingly, it would be more intuitive to assume that CAP would be the most severe manifestation of these co-infections, but more recently there have been several studies demonstrating these viral-bacterial infections also affect 10-20% of patients with hospital-acquired pneumonia (HAP) [44,[68][69][70]. In a large cohort study with over 2,000 patients hospitalized with severe H1N1pdm09 influenza, the following risk factors were identified for developing HAP: need for mechanical ventilation, sepsis, ICU admission on the first day, lymphocytopenia, older age, and anemia.…”

Section: Role Of Viral-bacterial Co-infections and Their Effect On Oumentioning

confidence: 99%

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Influenza virus-related critical illness: pathophysiology and epidemiology

2019

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Influenza virus affects the respiratory tract by direct viral infection or by damage from the immune system response. In humans, the respiratory epithelium is the only site where the hemagglutinin (HA) molecule is effectively cleaved, generating infectious virus particles. Virus transmission occurs through a susceptible individual’s contact with aerosols or respiratory fomites from an infected individual. The inability of the lung to perform its primary function of gas exchange can result from multiple mechanisms, including obstruction of the airways, loss of alveolar structure, loss of lung epithelial integrity from direct epithelial cell killing, and degradation of the critical extracellular matrix. Approximately 30–40% of hospitalized patients with laboratory-confirmed influenza are diagnosed with acute pneumonia. These patients who develop pneumonia are more likely to be < 5 years old, > 65 years old, Caucasian, and nursing home residents; have chronic lung or heart disease and history of smoking, and are immunocompromised. Influenza can primarily cause severe pneumonia, but it can also present in conjunction with or be followed by a secondary bacterial infection, most commonly by Staphylococcus aureus and Streptococcus pneumoniae . Influenza is associated with a high predisposition to bacterial sepsis and ARDS. Viral infections presenting concurrently with bacterial pneumonia are now known to occur with a frequency of 30–50% in both adult and pediatric populations. The H3N2 subtype has been associated with unprecedented high levels of intensive care unit (ICU) admission. Influenza A is the predominant viral etiology of acute respiratory distress syndrome (ARDS) in adults. Risk factors independently associated with ARDS are age between 36 and 55 years old, pregnancy, and obesity, while protective factors are female sex, influenza vaccination, and infections with Influenza A (H3N2) or Influenza B viruses. In the ICU, particularly during the winter season, influenza should be suspected not only in patients with typical symptoms and epidemiology, but also in patients with severe pneumonia, ARDS, sepsis with or without bacterial co-infection, as well as in patients with encephalitis, myocarditis, and rhabdomyolysis.

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Section: Influenza Clinical Progression To Pneumonia and Ardsmentioning

confidence: 99%

Section: Role Of Viral-bacterial Co-infections and Their Effect On Oumentioning

confidence: 99%

Influenza virus-related critical illness: pathophysiology and epidemiology

2019

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“…Sepsis is one of the leading causes of ICU admission, and through a number of mechanisms, it is also one of the most common causes of prolonged ICU stay. For instance, there is a large body of evidence showing that ICU-acquired infections occurred more frequently in patients with sepsis [4][5][6]. Sepsis is also a risk factor for ICU-acquired weakness and delirium [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Defining persistent critical illness based on growth trajectories in patients with sepsis

Zhang

et al. 2020

Crit Care

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Background: Persistent critical illness is common in critically ill patients and is associated with vast medical resource use and poor clinical outcomes. This study aimed to define when patients with sepsis would be stabilized and transitioned to persistent critical illness, and whether such transition time varies between latent classes of patients.Methods: This was a retrospective cohort study involving sepsis patients in the eICU Collaborative Research Database. Persistent critical illness was defined at the time when acute physiological characteristics were no longer more predictive of in-hospital mortality (i.e., vital status at hospital discharge) than antecedent characteristics. Latent growth mixture modeling was used to identify distinct trajectory classes by using Sequential Organ Failure Assessment score measured during intensive care unit stay as the outcome, and persistent critical illness transition time was explored in each latent class. Results: The mortality was 16.7% (3828/22,868) in the study cohort. Acute physiological model was no longer more predictive of in-hospital mortality than antecedent characteristics at 15 days after intensive care unit admission in the overall population. Only a minority of the study subjects (n = 643, 2.8%) developed persistent critical illness, but they accounted for 19% (15,834/83,125) and 10% (19,975/198,833) of the total intensive care unit and hospital beddays, respectively. Five latent classes were identified. Classes 1 and 2 showed increasing Sequential Organ Failure Assessment score over time and transition to persistent critical illness occurred at 16 and 27 days, respectively. The remaining classes showed a steady decline in Sequential Organ Failure Assessment scores and the transition to persistent critical illness occurred between 6 and 8 days. Elevated urea-to-creatinine ratio was a good biochemical signature of persistent critical illness. Conclusions: While persistent critical illness occurred in a minority of patients with sepsis, it consumed vast medical resources. The transition time differs substantially across latent classes, indicating that the allocation of medical resources should be tailored to different classes of patients.

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“…Severe complicated influenza has a significantly high mortality and morbidity [8,9]. Secondary bacterial pneumonia and acute respiratory distress syndrome (ARDS) are some of the common pulmonary complications of influenza, often followed by grave outcomes [10].…”

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics and Predictors of Mortality in Critically Ill Influenza Adult Patients

Hsu

Lee

Huang

et al. 2020

JCM

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Severe influenza is associated with high morbidity and mortality. The aim of this study was to investigate the factors affecting the clinical outcomes of critically ill influenza patients. In this retrospective study, we enrolled critically ill adult patients with influenza at the Kaohsiung Chang Gung Memorial Hospital in Taiwan. We evaluated the demographic, clinical, and laboratory findings and examined whether any of these measurements correlated with mortality. We then created an event-based algorithm as a simple predictive tool using two variables with statistically significant associations with mortality. Between 2015 and 2018, 102 critically ill influenza patients (median age, 62 years) were assessed; among them, 41 (40.1%) patients died. Of the 94 patients who received oseltamivir therapy, 68 (72.3%) began taking oseltamivir 48 h after the onset of illness. Of the 102 patients, the major influenza-associated complications were respiratory failure (97%), pneumonia (94.1%), acute kidney injury (65.7%), adult respiratory distress syndrome (ARDS) (51%), gastrointestinal bleeding (35.3%), and bacteremia (16.7%). In the multivariate regression model, high lactate levels, ARDS, acute kidney injury, and gastrointestinal bleeding were independent predictors of mortality in critically ill influenza patients. The optimal lactate level cutoff for predicting mortality was 3.7 mmol/L with an area under curve of 0.728. We constructed an event-associated algorithm that included lactate and ARDS. Fifteen (75%) of 20 patients with lactate levels 3.7 mmol/L and ARDS died, compared with only 1 (7.7%) of 13 patients with normal lactate levels and without ARDS. We identified clinical and laboratory predictors of mortality that could aid in the care of critically ill influenza patients. Identification of these prognostic markers could be improved to prioritize key examinations that might be useful in determining patient outcomes.

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Risk factors for nosocomial infection among hospitalised severe influenza A(H1N1)pdm09 patients

Abstract: Need for mechanical ventilation, sepsis, ICU admission on first day, lymphocytopenia, older age and anaemia were independent risk factors that can help clinicians identify severe influenza A(H1N1)pdm09 patients at high risk of nosocomial infection.

Cited by 33 publications

References 42 publications

Influenza virus-related critical illness: pathophysiology and epidemiology

Influenza virus-related critical illness: pathophysiology and epidemiology

Defining persistent critical illness based on growth trajectories in patients with sepsis

Clinical Characteristics and Predictors of Mortality in Critically Ill Influenza Adult Patients

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