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Hospital-acquired influenza in an Australian tertiary Centre 2017: a surveillance based study

BACKGROUND: In 2017, Australia experienced its highest levels of influenza virus activity since the 2009 pandemic. This allowed detailed comparison of the characteristics of patients with community and hospital-acquired influenza, and infection control factors that contributed to influenza spread. M...

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Autores principales: Parkash, Nikita, Beckingham, Wendy, Andersson, Patiyan, Kelly, Paul, Senanayake, Sanjaya, Coatsworth, Nicholas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6469028/
https://www.ncbi.nlm.nih.gov/pubmed/30991976
http://dx.doi.org/10.1186/s12890-019-0842-6
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author Parkash, Nikita
Beckingham, Wendy
Andersson, Patiyan
Kelly, Paul
Senanayake, Sanjaya
Coatsworth, Nicholas
author_facet Parkash, Nikita
Beckingham, Wendy
Andersson, Patiyan
Kelly, Paul
Senanayake, Sanjaya
Coatsworth, Nicholas
author_sort Parkash, Nikita
collection PubMed
description BACKGROUND: In 2017, Australia experienced its highest levels of influenza virus activity since the 2009 pandemic. This allowed detailed comparison of the characteristics of patients with community and hospital-acquired influenza, and infection control factors that contributed to influenza spread. METHODS: A surveillance based study was conducted on hospitalised patients with laboratory-confirmed influenza at the Canberra Hospital during April–October 2017. Differences between the hospital-acquired and community-acquired patient characteristics and outcomes were assessed by univariate analysis. Epidemiologic curves were developed and cluster distribution within the hospital was determined. RESULTS: Two hundred and ninety-two patients were included in the study. Twenty-eight (9.6%) acquired influenza in hospital, representing a higher proportion than any of the previous 5 years (range 0.9–5.8%). These patients were more likely to have influenza A (p = 0.021), had higher rates of diabetes (p = 0.015), malignancy (p = 0.046) and chronic liver disease (p = 0.043). Patients acquiring influenza in hospital met clinical criteria for influenza like illness in 25% of cases, compared with 64.4% for community-acquired cases (p < 0.001). Hospital-acquired influenza cases occurred in two distinct clusters. Patients were moved an average of 5 times after diagnosis. Mean length of stay following diagnosis was 13 days compared to 5 days for community-acquired cases (p < 0.001). Of the patients with hospital-acquired influenza, 22 were in shared rooms during their incubation period and 9 were not isolated in single rooms following diagnosis. Treatment was initiated within the recommended 48 h period following symptom onset for 62.5% of hospital-acquired cases compared with 39.8% of community-acquired cases (p = 0.033). CONCLUSIONS: Our results show that clinical presentation differed between patients with hospital-acquired influenza compared with those who acquired influenza in the community. Cases occurred in two clusters suggesting intra-hospital transmission rather than random importation from the community, highlighting the importance of infection control measures to limit influenza spread. Patients with hospital-acquired influenza may present without classical features of an influenza-like illness and this should promote earlier diagnostic testing and isolation to limit spread. Movement of patients after diagnosis is likely to facilitate spread within the hospital.
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spelling pubmed-64690282019-04-23 Hospital-acquired influenza in an Australian tertiary Centre 2017: a surveillance based study Parkash, Nikita Beckingham, Wendy Andersson, Patiyan Kelly, Paul Senanayake, Sanjaya Coatsworth, Nicholas BMC Pulm Med Research Article BACKGROUND: In 2017, Australia experienced its highest levels of influenza virus activity since the 2009 pandemic. This allowed detailed comparison of the characteristics of patients with community and hospital-acquired influenza, and infection control factors that contributed to influenza spread. METHODS: A surveillance based study was conducted on hospitalised patients with laboratory-confirmed influenza at the Canberra Hospital during April–October 2017. Differences between the hospital-acquired and community-acquired patient characteristics and outcomes were assessed by univariate analysis. Epidemiologic curves were developed and cluster distribution within the hospital was determined. RESULTS: Two hundred and ninety-two patients were included in the study. Twenty-eight (9.6%) acquired influenza in hospital, representing a higher proportion than any of the previous 5 years (range 0.9–5.8%). These patients were more likely to have influenza A (p = 0.021), had higher rates of diabetes (p = 0.015), malignancy (p = 0.046) and chronic liver disease (p = 0.043). Patients acquiring influenza in hospital met clinical criteria for influenza like illness in 25% of cases, compared with 64.4% for community-acquired cases (p < 0.001). Hospital-acquired influenza cases occurred in two distinct clusters. Patients were moved an average of 5 times after diagnosis. Mean length of stay following diagnosis was 13 days compared to 5 days for community-acquired cases (p < 0.001). Of the patients with hospital-acquired influenza, 22 were in shared rooms during their incubation period and 9 were not isolated in single rooms following diagnosis. Treatment was initiated within the recommended 48 h period following symptom onset for 62.5% of hospital-acquired cases compared with 39.8% of community-acquired cases (p = 0.033). CONCLUSIONS: Our results show that clinical presentation differed between patients with hospital-acquired influenza compared with those who acquired influenza in the community. Cases occurred in two clusters suggesting intra-hospital transmission rather than random importation from the community, highlighting the importance of infection control measures to limit influenza spread. Patients with hospital-acquired influenza may present without classical features of an influenza-like illness and this should promote earlier diagnostic testing and isolation to limit spread. Movement of patients after diagnosis is likely to facilitate spread within the hospital. BioMed Central 2019-04-16 /pmc/articles/PMC6469028/ /pubmed/30991976 http://dx.doi.org/10.1186/s12890-019-0842-6 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Parkash, Nikita
Beckingham, Wendy
Andersson, Patiyan
Kelly, Paul
Senanayake, Sanjaya
Coatsworth, Nicholas
Hospital-acquired influenza in an Australian tertiary Centre 2017: a surveillance based study
title Hospital-acquired influenza in an Australian tertiary Centre 2017: a surveillance based study
title_full Hospital-acquired influenza in an Australian tertiary Centre 2017: a surveillance based study
title_fullStr Hospital-acquired influenza in an Australian tertiary Centre 2017: a surveillance based study
title_full_unstemmed Hospital-acquired influenza in an Australian tertiary Centre 2017: a surveillance based study
title_short Hospital-acquired influenza in an Australian tertiary Centre 2017: a surveillance based study
title_sort hospital-acquired influenza in an australian tertiary centre 2017: a surveillance based study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6469028/
https://www.ncbi.nlm.nih.gov/pubmed/30991976
http://dx.doi.org/10.1186/s12890-019-0842-6
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