1121. Influenza-associated Pneumonia among Adults Hospitalized with Laboratory-Confirmed Influenza United States, 2005-2008
Session: Poster Abstract Session: Influenza and H1N1 Diagnosis, Epidemiology, and Viral Outcome
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • EIP_PNA_IDSA_Poster_10_10_11.pdf (226.7 kB)
  • Background: Influenza and pneumonia combined is the leading cause of death due to infectious diseases in the U.S.  We describe factors associated with pneumonia among adults hospitalized with influenza during a non-pandemic period.

    Methods: Utilizing data from the Emerging Infections Program, which conducts surveillance in 10 states and represents 7% of the adult population, we identified adults ≥ 18 years old, who were hospitalized with laboratory-confirmed influenza between October 2005 and April 2008, and had a chest radiograph (CXR) performed. Pneumonia was defined as the presence of an infiltrate on CXR and either an ICD-9-CM code or discharge summary diagnosis of pneumonia. Bivariate and multivariable analyses were performed to identify factors associated with pneumonia.

    Results: Among 5,055 adults hospitalized with influenza, 1391 (29%) of 4765 adults with a CXR had pneumonia. In multivariable analysis, factors significantly associated with pneumonia included: age ≥ 75 years [adjusted odds ratio (AOR) 1.28; 95% confidence interval (CI) 1.06-1.54], male sex  (AOR 1.22; CI 1.07-1.39), white race (AOR 1.24; CI 1.03-1.49), nursing home residence (AOR 1.39; CI 1.16-1.68), chronic lung disease (AOR 1.37; CI 1.18-1.58), immunosuppression (AOR 1.43; CI 1.17-1.74), invasive bacterial coinfection (AOR 2.25; CI 1.57-3.23), and asthma (AOR 0.77; CI 0.63-0.93). Patients with pneumonia compared to those without pneumonia were significantly more likely to receive influenza antiviral therapy (59% vs. 54%), require intensive care unit (ICU) admission (27% vs. 10%), be mechanically ventilated (18% vs. 5%), and die (9% vs. 2%).

    Conclusion: Over three non-pandemic seasons, influenza-associated pneumonia developed in one-third of adults hospitalized with influenza and led to complications including ICU admission and death. The inverse association between asthma and pneumonia requires further exploration. Older adults, nursing home residents, and patients with certain underlying conditions who are hospitalized with suspected influenza should receive early screening and aggressive treatment to prevent complications from pneumonia.


    Subject Category: V. Virology including clinical and basic studies of viral infections, including hepatitis

    Shikha Garg, MD, MPH1, Seema Jain, MD2, Michael Jhung, MD, MPH2, Fatimah S. Dawood, MD1, Alejandro Perez, MPH2, Tiffany D'Mello, MPH, MBA3, Arthur Reingold, MD4, Ken Gershman, MD5, James Meek, MPH6, Kathryn E. Arnold, MD7, Monica Farley, MD8,9, Patricia Ryan, MS10, Ruth Lynfield, MD11, Craig Morin, MPH12, Joan Baumbach, MD, MPH13, Emily B. Hancock, MS13, Shelley Zansky, PhD14, Nancy Bennett, MD, MS15, Ann Thomas, MD, MPH16, William Schaffner, MD17, Laurie Kamimoto, MD, MPH18 and Lyn Finelli, DrPH, MS2, (1) , Centers for Disease Control and Prevention, Atlanta, GA, (2)Centers for Disease Control and Prevention, Atlanta, GA, (3)Centers for Disease Control and Prevention/ Battelle, Atlanta, GA, (4)Emerging Infections Program, Berkeley, CA, (5)Colorado EIP , Denver, CO, (6)CT EIP, New Haven, CT, (7)CDC, Atlanta, GA, (8)CDC, Emerging Infections Program, (9)Emory Univ. & VAMC, Decatur, GA, (10)MD Dept Health Mental Hygiene, Baltimore, MD, (11)MN Dept. Health, St. Paul, MN, (12)Infectious Disease Epidemiology Prevention and Control, Minnesota Department of Health, St. Paul, MN, (13)Emerging Infections Program, NM State Department of Health, Santa Fe, NM, (14)NYS Dept. of Health EIP, Albany, NY, (15)Emerging Infections Program, University of Rochester Medical Center, Rochester, NY, (16)Emerging Infections Program Network, CDC, Portland, OR, (17)Vanderbilt University School of Medicine, Nashville, TN, (18) Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA

    Disclosures:

    S. Garg, None

    S. Jain, None

    M. Jhung, None

    F. S. Dawood, None

    A. Perez, None

    T. D'Mello, None

    A. Reingold, None

    K. Gershman, None

    J. Meek, None

    K. E. Arnold, None

    M. Farley, None

    P. Ryan, None

    R. Lynfield, None

    C. Morin, None

    J. Baumbach, None

    E. B. Hancock, None

    S. Zansky, None

    N. Bennett, None

    A. Thomas, None

    W. Schaffner, None

    L. Kamimoto, None

    L. Finelli, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.