Epidemiological and clinical characteristics of community‐acquired and nosocomial influenza cases and risk factors associated with complications: A four season analysis of all adult patients admitted in a tertiary hospital

• Published in: Influenza and Other Respiratory Viruses Vol. 15; no. 3; pp. 352 - 360
• Main Authors: Fullana Barceló, Maria Isabel, Asensio Rodriguez, Javier, Artigues Serra, Francisca, Ferre Beltran, Adrian, Salva D’agosto, Pilar, Almodovar Garcia, Maria, Lopez Bilbao, Maria del Carmen, Sanchis Cortés, Pilar, Reina Prieto, Jorge, Riera Jaume, Melchor
• Format: Journal Article Web Resource
• Language: English
• Published: England John Wiley & Sons, Inc 01.05.2021; John Wiley and Sons Inc
• Subjects: Adults; Antibiotics; Cardiovascular disease; community‐acquired influenza; Comparative analysis; Complications; Diabetes; Diabetes mellitus; Dyspnea; Epidemics; Epidemiology; Hospitals; hospital‐acquired influenza; Immunization; Influenza; Influenza viruses; Kidney diseases; Laboratories; Mechanical ventilation; Medical research; Medicine, Experimental; Mortality; Nosocomial infection; Nosocomial infections; Original; Oseltamivir; Patients; Pneumonia; Respiration; Respiratory diseases; Risk analysis; Risk factors; Sepsis; Septic shock; Vaccination; Variables; Ventilators; Viruses; Spain; community-acquired influenza; epidemiology; hospital-acquired influenza; complications
• ISSN: 1750-2640; 1750-2659
• DOI: 10.1111/irv.12823

Background Information on the characteristics of patients with nosocomial influenza and associated complications is scarce. This study compared epidemiological and clinical characteristics of patients admitted with hospital‐acquired influenza (HAI) to those with community‐acquired influenza (CAI) and analyzed risk factors associated with complications. Methods This retrospective, observational study included all adult patients with confirmed influenza virus infection admitted to Son Espases University Hospital during the influenza season in Spain (October to May) from 2012‐2013 to 2015‐2016. Symptom onset before admission was included as CAI, and 2 days after admission or within 48 hours after previous discharge were considered as HAI. Results Overall, 666 patients with laboratory‐confirmed influenza were included; 590 (88.6%) and 76 (11.4%) had CAI and HAI, respectively. Baseline characteristics and vaccination rates were similar in both groups. Patients with HAI had significantly fewer symptoms, less radiological alterations, and earlier microbiological diagnosis than those with CAI. Eighty‐five (14.4%) and 20 (27.6%) CAI and HAI patients, respectively, experienced at least one complication, including septic shock, admission to the intensive care unit, mechanical ventilation or evolution to death (any one, P = .003). Univariate and multivariate binary logistic regression was performed to assess independent risk factors associated with the occurrence of complications: nosocomial infection, diabetes, oseltamivir treatment, having received no vaccination, microbiological delay, dyspnea, and the state of confusion were the most important significant factors. Conclusions Our study shows the need to implement microbiological diagnostic measures in the first 48 hours to reduce HAI frequency and associated complications.