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Observational Study
. 2021 May;15(3):352-360.
doi: 10.1111/irv.12823. Epub 2020 Oct 30.

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

Maria Isabel Fullana Barceló  1 , Javier Asensio Rodriguez  1 , Francisca Artigues Serra  1 , Adrian Ferre Beltran  1 , Pilar Salva D'agosto  1 , Maria Almodovar Garcia  2 , Maria Del Carmen Lopez Bilbao  3 , Pilar Sanchis Cortés  4 , Jorge Reina Prieto  5 , Melchor Riera Jaume  6
Affiliations
Observational Study

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

Maria Isabel Fullana Barceló et al. Influenza Other Respir Viruses. 2021 May.

Abstract

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.

Keywords: community-acquired influenza; complications; epidemiology; hospital-acquired influenza.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

Figure 1
Figure 1
Distribution of community‐acquired influenza cases in each season based on the flu subtype. At the bars are indicated the cases in absolute numbers. CAI, Community‐acquired influenza; S, season
Figure 2
Figure 2
Distribution of hospital‐acquired influenza cases in each season based on the flu subtype. At the bars are indicated the cases in absolute numbers. HAI, Hospital‐acquired influenza; S, season
Figure 3
Figure 3
Distribution of nosocomial cases in the most frequent departments based on season. The x‐axis shows the number of the department and the y‐axis displays the absolute number of patients with nosocomial infection. S: season; 1: Internal medicine; 2: Pneumology; 4: Cardiology; 5: Intensive medicine (ICU); 6: Hematology; 10: Traumatology; 11: Cardiac surgery; 19: Psychiatry
See this image and copyright information in PMC

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