When should a diagnosis of influenza be considered in adults requiring intensive care unit admission? Results of population-based active surveillance in Toronto.
When should a diagnosis of influenza be considered in adults requiring intensive care unit admission? Results of population-based active surveillance in Toronto.
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DOI：
10.1186/cc10331
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发表时间：
2011-07-28
期刊：
影响因子：
--
通讯作者：
McGeer A
中科院分区：
文献类型：
--
作者：
Kuster SP;Katz KC;Blair J;Downey J;Drews SJ;Finkelstein S;Fowler R;Green K;Gubbay J;Hassan K;Lapinsky SE;Mazzulli T;McRitchie D;Pataki J;Plevneshi A;Powis J;Rose D;Sarabia A;Simone C;Simor A;McGeer A
目前缺乏关于临床特征的数据，这些数据有助于识别ICU入院时流感感染高风险患者。我们的目的是确定在2007/2008和2008/2009流感季节和2009年H1N1流感大流行的第二波期间入住ICU的患者中流感感染的预测因子，以及确定季节性和大流行性2009流感（pH 1 N1）感染可能性增加的人群。多伦多的6家急症护理医院参与了2007年至2009年流感活动期间需要入住ICU的实验室确诊流感的主动监测。鼻咽拭子取自因急性呼吸道或心脏疾病或发热性疾病来我院就诊但无明确非呼吸道病因的患者。流感的预测因素进行了评估，多变量逻辑回归分析和流感的可能性计算在不同的人群。在5，482名患者中，发现126名（2.3%）患有流感。入院时体温≥38°C（pH 1 N1的比值比（OR）为4.7，季节性流感为2.3）和入院时诊断为肺炎或呼吸道感染（pH 1 N1的OR为7.3，季节性流感为4.2）是流感的独立预测因素。在流感季节的高峰期，17%的无发热患者和27%的肺炎或呼吸道感染发热患者患有流感。在2009年第二波流感大流行期间，26%的无发热患者和70%的肺炎或呼吸道感染发热患者患有流感。我们的研究结果可能有助于临床医生在未来流感季节对入住ICU的成人患者进行最佳管理的决策。对于在流感季节因肺炎或呼吸道感染而入院的患者，以及发热或在流感活动高峰周期间入院的患者，应考虑进行流感检测、经验性抗病毒治疗和经验性感染控制预防措施。
There is a paucity of data about the clinical characteristics that help identify patients at high risk of influenza infection upon ICU admission. We aimed to identify predictors of influenza infection in patients admitted to ICUs during the 2007/2008 and 2008/2009 influenza seasons and the second wave of the 2009 H1N1 influenza pandemic as well as to identify populations with increased likelihood of seasonal and pandemic 2009 influenza (pH1N1) infection. Six Toronto acute care hospitals participated in active surveillance for laboratory-confirmed influenza requiring ICU admission during periods of influenza activity from 2007 to 2009. Nasopharyngeal swabs were obtained from patients who presented to our hospitals with acute respiratory or cardiac illness or febrile illness without a clear nonrespiratory aetiology. Predictors of influenza were assessed by multivariable logistic regression analysis and the likelihood of influenza in different populations was calculated. In 5,482 patients, 126 (2.3%) were found to have influenza. Admission temperature ≥38°C (odds ratio (OR) 4.7 for pH1N1, 2.3 for seasonal influenza) and admission diagnosis of pneumonia or respiratory infection (OR 7.3 for pH1N1, 4.2 for seasonal influenza) were independent predictors for influenza. During the peak weeks of influenza seasons, 17% of afebrile patients and 27% of febrile patients with pneumonia or respiratory infection had influenza. During the second wave of the 2009 pandemic, 26% of afebrile patients and 70% of febrile patients with pneumonia or respiratory infection had influenza. The findings of our study may assist clinicians in decision making regarding optimal management of adult patients admitted to ICUs during future influenza seasons. Influenza testing, empiric antiviral therapy and empiric infection control precautions should be considered in those patients who are admitted during influenza season with a diagnosis of pneumonia or respiratory infection and are either febrile or admitted during weeks of peak influenza activity.
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