Duration of influenza a virus shedding in hospitalized patients and implications for infection control
Duration of influenza a virus shedding in hospitalized patients and implications for infection control
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DOI：
10.1086/520101
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发表时间：
2007-09-01
影响因子：
4.5
通讯作者：
Sampathkumar, Priya
中科院分区：
文献类型：
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作者：
Leekha, Surbhi;Zitterkopf, Nicole L.;Sampathkumar, Priya
客观的。旨在评估通过聚合酶链反应（PCR）和细胞培养检测甲型流感病毒感染住院患者中甲型流感病毒排出的持续时间。梅奥诊所（明尼苏达州罗彻斯特）医院为社区和转诊人群提供服务。方法。连续纳入2004年12月1日至2005年3月15日期间住院且经实验室确诊（即基于PCR）的甲型流感病毒感染的18岁及以上患者。在初始样本后 2、3、5 和 7 天收集额外的咽拭子样本（如果患者仍在住院）。所有标本均通过 PCR 和培养（常规管培养和壳瓶测定）进行测试。通过访谈和病历审查获得有关人口特征、症状出现日期、合并症、免疫抑制、流感疫苗接种状况和接受抗病毒治疗的信息。如果无法获得知情同意或无法确定症状发作日期，则将患者排除在外。 结果。在 149 名因甲型流感病毒感染住院的患者中，有 50 名患者参与了这项研究。大多数患者年龄较大（中位年龄 76 岁），几乎所有患者 (96%) 都有潜在的慢性疾病。在纳入最终分析的 41 名患者中，症状出现后 7 天或超过 7 天时，通过 PCR 检测到 22 名患者（54%），通过培养方法检测到 12 名患者（29%）甲型流感病毒。通过培养鉴定出的所有 12 名患者的 PCR 结果均呈甲型流感病毒阳性。结论。甲型流感病毒感染的住院患者在传统上认为的感染持续时间超过 5 至 7 天后仍可能散发出可检测到的病毒。需要进行更多研究来评估是否有必要延长患者隔离时间以防止流感季节期间的院内疫情暴发。
OBJECTIVE. To assess the duration of shedding of influenza A virus detected by polymerase chain reaction (PCR) and cell culture among patients hospitalized with influenza A virus infection.SETTING. Mayo Clinic (Rochester, Minnesota) hospitals that cater to both the community and referral populations.METHODS. Patients 18 years old and older who were hospitalized between December 1, 2004, and March 15, 2005, with a laboratory-confirmed (ie, PCR-based) diagnosis of influenza A virus infection were consecutively enrolled. Additional throat swab specimens were collected at 2, 3, 5, and 7 days after the initial specimen (if the patient was still hospitalized). All specimens were tested by PCR and culture (both conventional tube culture and shell vial assay). Information on demographic characteristics, date of symptom onset, comorbidities, immunosuppression, influenza vaccination status, and receipt of antiviral treatment was obtained by interview and medical record review. Patients were excluded if informed consent could not be obtained or if the date of symptom onset could not be ascertained.RESULTS. Of 149 patients hospitalized with influenza A virus infection, 50 patients were enrolled in the study. Most patients were older (median age, 76 years), and almost all (96%) had underlying chronic medical conditions. Of 41 patients included in the final analysis, influenza A virus was detected in 22 (54%) by PCR and in 12 (29%) by culture methods at or beyond 7 days after symptom onset. All 12 patients identified by culture also had PCR results positive for influenza A virus.CONCLUSION. Hospitalized patients with influenza A virus infection can shed detectable virus beyond the 5- to 7-day period traditionally considered the duration of infectivity. Additional research is needed to assess whether prolonging the duration of patient isolation is warranted to prevent nosocomial outbreaks during the influenza season.