Is influenza an influenza-like illness?: Clinical presentation of influenza in hospitalized patients
Is influenza an influenza-like illness?: Clinical presentation of influenza in hospitalized patients
复制标题
DOI：
10.1086/501539
复制
发表时间：
2006-03-01
影响因子：
4.5
通讯作者：
Fraser, Victoria J.
中科院分区：
文献类型：
--
作者：
Babcock, Hilary M.;Merz, Liana R.;Fraser, Victoria J.
背景。住院患者流感病毒感染的早期识别可预防院内传播。目的：确定住院患者流行性感冒的临床表现。系列。回顾性收集医疗记录数据，包括人口统计信息、合并症、临床症状和体征、微生物学检测结果和结局（包括肺炎和重症监护病房[ICU]住院情况）。有1400张床位的教学医院。对2000 ~ 2003年3个季节诊断为流感病毒感染的住院患者207例进行分析。在3个季节中，207例患者被诊断为流感（186例感染甲型流感病毒，21例感染乙型流感病毒）。最常见的报告症状是咳嗽（186例[90%]）和主观发热（137例[66%]）；124名患者（60%）在诊断出流感之前记录的体温为37.8摄氏度或更高。喉咙痛不常见（44例[21%]）。107例（51%）患者符合疾病控制和预防中心（CDC）的流感样疾病（ILI）标准——体温37.8摄氏度或更高，咳嗽或喉咙痛。符合ILI标准的患者比例在年龄、性别、季节、流感病毒类型或住院诊断时间方面没有差异。大多数患者（150例[72%]）使用对乙酰氨基酚。临床培养阳性41例（20%）；178例患者（86%）接受抗生素治疗。56例（27%）患者有肺炎，36例（17%）需要进入ICU， 25例（12%）需要呼吸支持。肺部疾病患者更有可能需要呼吸支持（12 [26%]vs 13 [8%]; P = 0.003）。只有一半的流感住院患者符合疾病预防控制中心的ILI标准。这些标准可能更适合门诊设置。在住院病人中识别流感需要高度的怀疑指数。
Background. Early recognition of influenza virus infection in hospitalized patients can prevent nosocomial transmission.Objective. To determine the clinical presentation of influenza in hospitalized patients.Design. Case series. Data were collected retrospectively from medical records and included demographic information, comorbidities, clinical symptoms and signs, microbiologic test results, and outcomes ( including pneumonia and intensive care unit [ ICU] admission).Setting. A 1,400- bed teaching hospital.Patients. A total of 207 inpatients who received a diagnosis of influenza virus infection during 3 seasons from 2000 to 2003.Results. Over the course of 3 seasons, 207 patients received a diagnosis of influenza ( 186 were infected with influenza A virus, and 21 were infected with influenza B virus). The most commonly reported symptoms were cough ( 186 patients [ 90%]) and subjective fever ( 137 patients [ 66%]); 124 patients ( 60%) had a documented temperature of 37.8 degrees C or greater before influenza was diagnosed. Sore throat was uncommon ( 44 patients [ 21%]). Centers for Disease Control and Prevention ( CDC) criteria for influenza- like illness ( ILI) - temperature 37.8 degrees C or greater and either cough or sore throat - were met by 107 patients ( 51%). There were no differences in the proportion of patients who met ILI criteria with respect to age, sex, season, influenza virus type, or time to diagnosis in the hospital. Most patients ( 150 [ 72%]) received acetaminophen. Only 41 patients ( 20%) had positive results of clinical cultures; 178 patients ( 86%) received antibiotic therapy. Fifty- six patients ( 27%) had pneumonia: 36 ( 17%) required admission to the ICU, and 25 ( 12%) required ventilatory support. Patients with pulmonary disease were more likely to require ventilatory support ( 12 [ 26%] vs 13 [ 8%]; P = .003).Conclusions. Only half of hospitalized patients with influenza met CDC criteria for ILI. These criteria may be more appropriate in outpatient settings. A high index of suspicion is needed to recognize influenza in hospitalized patients.