When should a diagnosis of influenza be considered in adults requiring intensive care unit admission? Results of population-based active surveillance in Toronto.
Identifieur interne : 000464 ( Main/Exploration ); précédent : 000463; suivant : 000465When should a diagnosis of influenza be considered in adults requiring intensive care unit admission? Results of population-based active surveillance in Toronto.
Auteurs : Stefan P. Kuster [Canada] ; Kevin C. Katz ; Joanne Blair ; James Downey ; Steven J. Drews ; Sandy Finkelstein ; Rob Fowler ; Karen Green ; Jonathan Gubbay ; Kazi Hassan ; Stephen E. Lapinsky ; Tony Mazzulli ; Donna Mcritchie ; Janos Pataki ; Agron Plevneshi ; Jeff Powis ; David Rose ; Alicia Sarabia ; Carmine Simone ; Andrew Simor ; Allison McgeerSource :
- Critical care (London, England) [ 1466-609X ] ; 2011.
Descripteurs français
- KwdFr :
- Admission du patient, Adolescent, Adulte, Adulte d'âge moyen, Femelle, Grippe humaine (diagnostic), Grippe humaine (physiopathologie), Grippe humaine (virologie), Grippe humaine (épidémiologie), Humains, Hôpitaux urbains, Jeune adulte, Modèles logistiques, Mâle, Ontario (épidémiologie), Prise de décision, Sous-type H1N1 du virus de la grippe A (isolement et purification), Sujet âgé, Sujet âgé de 80 ans ou plus, Surveillance de la population, Unités de soins intensifs, Virus de la grippe A (isolement et purification), Virus influenza B (isolement et purification).
- MESH :
- diagnostic : Grippe humaine.
- isolement et purification : Sous-type H1N1 du virus de la grippe A, Virus de la grippe A, Virus influenza B.
- physiopathologie : Grippe humaine.
- virologie : Grippe humaine.
- épidémiologie : Grippe humaine, Ontario.
- Admission du patient, Adolescent, Adulte, Adulte d'âge moyen, Femelle, Humains, Hôpitaux urbains, Jeune adulte, Modèles logistiques, Mâle, Prise de décision, Sujet âgé, Sujet âgé de 80 ans ou plus, Surveillance de la population, Unités de soins intensifs.
English descriptors
- KwdEn :
- Adolescent, Adult, Aged, Aged, 80 and over, Decision Making, Female, Hospitals, Urban, Humans, Influenza A Virus, H1N1 Subtype (isolation & purification), Influenza A virus (isolation & purification), Influenza B virus (isolation & purification), Influenza, Human (diagnosis), Influenza, Human (epidemiology), Influenza, Human (physiopathology), Influenza, Human (virology), Intensive Care Units, Logistic Models, Male, Middle Aged, Ontario (epidemiology), Patient Admission, Population Surveillance, Young Adult.
- MESH :
- geographic , epidemiology : Ontario.
- diagnosis : Influenza, Human.
- epidemiology : Influenza, Human.
- isolation & purification : Influenza A Virus, H1N1 Subtype, Influenza A virus, Influenza B virus.
- physiopathology : Influenza, Human.
- virology : Influenza, Human.
- Adolescent, Adult, Aged, Aged, 80 and over, Decision Making, Female, Hospitals, Urban, Humans, Intensive Care Units, Logistic Models, Male, Middle Aged, Patient Admission, Population Surveillance, Young Adult.
Abstract
INTRODUCTION
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.
METHODS
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.
RESULTS
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.
CONCLUSIONS
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.
DOI: 10.1186/cc10331
PubMed: 21798012
Affiliations:
Links toward previous steps (curation, corpus...)
Le document en format XML
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Results of population-based active surveillance in Toronto.</title><author><name sortKey="Kuster, Stefan P" sort="Kuster, Stefan P" uniqKey="Kuster S" first="Stefan P" last="Kuster">Stefan P. Kuster</name><affiliation wicri:level="1"><nlm:affiliation>Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada.</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5</wicri:regionArea><wicri:noRegion>ON M5G 1X5</wicri:noRegion></affiliation></author><author><name sortKey="Katz, Kevin C" sort="Katz, Kevin C" uniqKey="Katz K" first="Kevin C" last="Katz">Kevin C. Katz</name></author><author><name sortKey="Blair, Joanne" sort="Blair, Joanne" uniqKey="Blair J" first="Joanne" last="Blair">Joanne Blair</name></author><author><name sortKey="Downey, James" sort="Downey, James" uniqKey="Downey J" first="James" last="Downey">James Downey</name></author><author><name sortKey="Drews, Steven J" sort="Drews, Steven J" uniqKey="Drews S" first="Steven J" last="Drews">Steven J. Drews</name></author><author><name sortKey="Finkelstein, Sandy" sort="Finkelstein, Sandy" uniqKey="Finkelstein S" first="Sandy" last="Finkelstein">Sandy Finkelstein</name></author><author><name sortKey="Fowler, Rob" sort="Fowler, Rob" uniqKey="Fowler R" first="Rob" last="Fowler">Rob Fowler</name></author><author><name sortKey="Green, Karen" sort="Green, Karen" uniqKey="Green K" first="Karen" last="Green">Karen Green</name></author><author><name sortKey="Gubbay, Jonathan" sort="Gubbay, Jonathan" uniqKey="Gubbay J" first="Jonathan" last="Gubbay">Jonathan Gubbay</name></author><author><name sortKey="Hassan, Kazi" sort="Hassan, Kazi" uniqKey="Hassan K" first="Kazi" last="Hassan">Kazi Hassan</name></author><author><name sortKey="Lapinsky, Stephen E" sort="Lapinsky, Stephen E" uniqKey="Lapinsky S" first="Stephen E" last="Lapinsky">Stephen E. 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Sarabia</name></author><author><name sortKey="Simone, Carmine" sort="Simone, Carmine" uniqKey="Simone C" first="Carmine" last="Simone">Carmine Simone</name></author><author><name sortKey="Simor, Andrew" sort="Simor, Andrew" uniqKey="Simor A" first="Andrew" last="Simor">Andrew Simor</name></author><author><name sortKey="Mcgeer, Allison" sort="Mcgeer, Allison" uniqKey="Mcgeer A" first="Allison" last="Mcgeer">Allison Mcgeer</name></author></analytic><series><title level="j">Critical care (London, England)</title><idno type="eISSN">1466-609X</idno><imprint><date when="2011" type="published">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Decision Making</term><term>Female</term><term>Hospitals, Urban</term><term>Humans</term><term>Influenza A Virus, H1N1 Subtype (isolation & purification)</term><term>Influenza A virus (isolation & purification)</term><term>Influenza B virus (isolation & purification)</term><term>Influenza, Human (diagnosis)</term><term>Influenza, Human (epidemiology)</term><term>Influenza, Human (physiopathology)</term><term>Influenza, Human (virology)</term><term>Intensive Care Units</term><term>Logistic Models</term><term>Male</term><term>Middle Aged</term><term>Ontario (epidemiology)</term><term>Patient Admission</term><term>Population Surveillance</term><term>Young Adult</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Admission du patient</term><term>Adolescent</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Femelle</term><term>Grippe humaine (diagnostic)</term><term>Grippe humaine (physiopathologie)</term><term>Grippe humaine (virologie)</term><term>Grippe humaine (épidémiologie)</term><term>Humains</term><term>Hôpitaux urbains</term><term>Jeune adulte</term><term>Modèles logistiques</term><term>Mâle</term><term>Ontario (épidémiologie)</term><term>Prise de décision</term><term>Sous-type H1N1 du virus de la grippe A (isolement et purification)</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Surveillance de la population</term><term>Unités de soins intensifs</term><term>Virus de la grippe A (isolement et purification)</term><term>Virus influenza B (isolement et purification)</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>Ontario</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Influenza, Human</term></keywords><keywords scheme="MESH" qualifier="diagnostic" xml:lang="fr"><term>Grippe humaine</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Influenza, Human</term></keywords><keywords scheme="MESH" qualifier="isolation & purification" xml:lang="en"><term>Influenza A Virus, H1N1 Subtype</term><term>Influenza A virus</term><term>Influenza B virus</term></keywords><keywords scheme="MESH" qualifier="isolement et purification" xml:lang="fr"><term>Sous-type H1N1 du virus de la grippe A</term><term>Virus de la grippe A</term><term>Virus influenza B</term></keywords><keywords scheme="MESH" qualifier="physiopathologie" xml:lang="fr"><term>Grippe humaine</term></keywords><keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Influenza, Human</term></keywords><keywords scheme="MESH" qualifier="virologie" xml:lang="fr"><term>Grippe humaine</term></keywords><keywords scheme="MESH" qualifier="virology" xml:lang="en"><term>Influenza, Human</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Grippe humaine</term><term>Ontario</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Aged</term><term>Aged, 80 and over</term><term>Decision Making</term><term>Female</term><term>Hospitals, Urban</term><term>Humans</term><term>Intensive Care Units</term><term>Logistic Models</term><term>Male</term><term>Middle Aged</term><term>Patient Admission</term><term>Population Surveillance</term><term>Young Adult</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Admission du patient</term><term>Adolescent</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Femelle</term><term>Humains</term><term>Hôpitaux urbains</term><term>Jeune adulte</term><term>Modèles logistiques</term><term>Mâle</term><term>Prise de décision</term><term>Sujet âgé</term><term>Sujet âgé de 80 ans ou plus</term><term>Surveillance de la population</term><term>Unités de soins intensifs</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>INTRODUCTION</b></p><p>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.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>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.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>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.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>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.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">21798012</PMID><DateCompleted><Year>2012</Year><Month>08</Month><Day>21</Day></DateCompleted><DateRevised><Year>2018</Year><Month>11</Month><Day>13</Day></DateRevised><Article PubModel="Electronic"><Journal><ISSN IssnType="Electronic">1466-609X</ISSN><JournalIssue CitedMedium="Internet"><Volume>15</Volume><Issue>4</Issue><PubDate><Year>2011</Year><Month>Jul</Month><Day>28</Day></PubDate></JournalIssue><Title>Critical care (London, England)</Title><ISOAbbreviation>Crit Care</ISOAbbreviation></Journal><ArticleTitle>When should a diagnosis of influenza be considered in adults requiring intensive care unit admission? Results of population-based active surveillance in Toronto.</ArticleTitle><Pagination><MedlinePgn>R182</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1186/cc10331</ELocationID><Abstract><AbstractText Label="INTRODUCTION" NlmCategory="BACKGROUND">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.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">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.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">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.</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">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.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Kuster</LastName><ForeName>Stefan P</ForeName><Initials>SP</Initials><AffiliationInfo><Affiliation>Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Katz</LastName><ForeName>Kevin C</ForeName><Initials>KC</Initials></Author><Author ValidYN="Y"><LastName>Blair</LastName><ForeName>Joanne</ForeName><Initials>J</Initials></Author><Author ValidYN="Y"><LastName>Downey</LastName><ForeName>James</ForeName><Initials>J</Initials></Author><Author ValidYN="Y"><LastName>Drews</LastName><ForeName>Steven J</ForeName><Initials>SJ</Initials></Author><Author ValidYN="Y"><LastName>Finkelstein</LastName><ForeName>Sandy</ForeName><Initials>S</Initials></Author><Author ValidYN="Y"><LastName>Fowler</LastName><ForeName>Rob</ForeName><Initials>R</Initials></Author><Author ValidYN="Y"><LastName>Green</LastName><ForeName>Karen</ForeName><Initials>K</Initials></Author><Author ValidYN="Y"><LastName>Gubbay</LastName><ForeName>Jonathan</ForeName><Initials>J</Initials></Author><Author ValidYN="Y"><LastName>Hassan</LastName><ForeName>Kazi</ForeName><Initials>K</Initials></Author><Author ValidYN="Y"><LastName>Lapinsky</LastName><ForeName>Stephen E</ForeName><Initials>SE</Initials></Author><Author ValidYN="Y"><LastName>Mazzulli</LastName><ForeName>Tony</ForeName><Initials>T</Initials></Author><Author ValidYN="Y"><LastName>McRitchie</LastName><ForeName>Donna</ForeName><Initials>D</Initials></Author><Author ValidYN="Y"><LastName>Pataki</LastName><ForeName>Janos</ForeName><Initials>J</Initials></Author><Author ValidYN="Y"><LastName>Plevneshi</LastName><ForeName>Agron</ForeName><Initials>A</Initials></Author><Author ValidYN="Y"><LastName>Powis</LastName><ForeName>Jeff</ForeName><Initials>J</Initials></Author><Author ValidYN="Y"><LastName>Rose</LastName><ForeName>David</ForeName><Initials>D</Initials></Author><Author ValidYN="Y"><LastName>Sarabia</LastName><ForeName>Alicia</ForeName><Initials>A</Initials></Author><Author ValidYN="Y"><LastName>Simone</LastName><ForeName>Carmine</ForeName><Initials>C</Initials></Author><Author ValidYN="Y"><LastName>Simor</LastName><ForeName>Andrew</ForeName><Initials>A</Initials></Author><Author ValidYN="Y"><LastName>McGeer</LastName><ForeName>Allison</ForeName><Initials>A</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2011</Year><Month>07</Month><Day>28</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>Crit Care</MedlineTA><NlmUniqueID>9801902</NlmUniqueID><ISSNLinking>1364-8535</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><CommentsCorrectionsList><CommentsCorrections RefType="CommentIn"><RefSource>Crit Care. 2012;16(1):401; author reply 401</RefSource><PMID Version="1">22236868</PMID></CommentsCorrections></CommentsCorrectionsList><MeshHeadingList><MeshHeading><DescriptorName UI="D000293" MajorTopicYN="N">Adolescent</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000369" MajorTopicYN="N">Aged, 80 and over</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D003657" MajorTopicYN="N">Decision Making</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006786" MajorTopicYN="N">Hospitals, Urban</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D053118" MajorTopicYN="N">Influenza A Virus, H1N1 Subtype</DescriptorName><QualifierName UI="Q000302" MajorTopicYN="N">isolation & purification</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D009980" MajorTopicYN="N">Influenza A virus</DescriptorName><QualifierName UI="Q000302" MajorTopicYN="N">isolation & purification</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D009981" MajorTopicYN="N">Influenza B virus</DescriptorName><QualifierName UI="Q000302" MajorTopicYN="N">isolation & 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