468. Influenza Infection and Antiviral Treatment among Adults Hospitalized with Acute Respiratory Illness
Session: Poster Abstract Session: Prevention and Treatment of Viral Infections
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
  • IDSA_RTI poster_9.25.13_final.pdf (779.6 kB)
  • Background:  Despite substantial influenza-related morbidity and mortality, antiviral treatment is often delayed or not initiated. We assessed the clinical characteristics associated with influenza and described the use of antiviral treatment in hospitalized adults.

    Methods:  Adults aged >18 years hospitalized with acute respiratory illness (ARI) or a clinical positive influenza test were prospectively enrolled from hospitals in Atlanta, GA, Durham, NC, and Nashville, TN, during 4 influenza seasons between 2008-2012. Nasopharyngeal or combined nasal and oral swabs were collected for influenza diagnostic research testing by RT-PCR. Clinical data were obtained via screening interview and chart abstraction. Characteristics were compared among patients with and without laboratory-confirmed influenza infection.

    Results:  Among 3324 eligible patients, 1464 were enrolled and 1424 (43%) had complete data; 1297 (91%) were enrolled because of ARI and 127 (9%) because of an influenza-positive test. Among 1297 ARI patients, 1230 (95%) were enrolled in seasons 2–4, and 88 (7%) were positive for influenza. Those with influenza were younger (median, 54 vs. 62 years, p=0.001), with a trend toward fewer underlying medical conditions (70% vs. 78%, p=0.09), than patients without influenza. At admission, patients with influenza were more likely to have fever (89% vs. 66%), cough (94% vs. 81%), and increased sputum (83% v. 66%). For all 215 influenza-positive patients, 206 had typing: 174 (84%) had influenza A, 32 (16%) had influenza B. Hospital clinical influenza tests were performed and results reported to clinicians for 144 (67%) patients. Of these, 111 (77%) patients, including 26/32 (81%) admitted to the intensive care unit, and 4/6 (67%) who died, received antiviral treatment. Median time from illness onset to treatment was 2 days (IQR 1, 4 days). In contrast, for the 71 (33%) patients for whom influenza results were research only and not reported to clinicians, 14 (20%) were treated, including 1/6 (17%) admitted to the ICU. Overall, 90/215 (42%) influenza patients did not receive antiviral treatment.

    Conclusion: During 2008-2012, many hospitalized adults with influenza infection were not recognized or treated. Clinicians should have a high index of suspicion for influenza during the season and use appropriate antiviral therapy.

    Angela P. Campbell, MD, MPH1, Su Su, MSc, MPH1,2, Marie R. Griffin, MD, MPH3, Laura Strange4, Holly A. Hill4, Lisa Kilpatrick4, H. Keipp Talbot, MD, MPH3, Mark G. Thompson, PhD1, Paul Gargiullo, PhD1 and Alicia Fry, MD, MPH5, (1)Epidemiology and Prevention Branch, Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, (2)Atlanta Research and Education Foundation, Atlanta, GA, (3)Vanderbilt University School of Medicine, Nashville, TN, (4)RTI International, Atlanta, GA, (5)Centers for Disease Control and Prevention (CDC), Atlanta, GA


    A. P. Campbell, None

    S. Su, None

    M. R. Griffin, MedImmune: Grant Investigator, Grant recipient

    L. Strange, None

    H. A. Hill, None

    L. Kilpatrick, None

    H. K. Talbot, Sanofi Pasteur: Grant Investigator, Research grant
    Wyeth (Pfizer): Grant Investigator, Research grant
    MedImmune (AstraZeneca): Grant Investigator, Research grant
    Protein Sciences: Grant Investigator, Research grant
    Vaxxinate: Grant Investigator, Research grant

    M. G. Thompson, None

    P. Gargiullo, None

    A. Fry, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.