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Influenza Morbidity and Mortality in a Tertiary Care Academic Center FREE TO VIEW

Penchala Mittadodla; Deepak Chandra; Manish Joshi
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University of Arkansas for Medical Sciences, Little Rock, AR

Chest. 2014;146(4_MeetingAbstracts):213A. doi:10.1378/chest.1994667
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SESSION TITLE: ICU Infections Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: To assess inpatient Morbidity and Mortality associated with influenza in 2013-14 Flu season in an academic tertiary care center.

METHODS: We identified all patients admitted to our university medical center during October 2013 to February 2014 with lab proven influenza (rapid and/or PCR based test results). We collected the demographic data, co-morbidities, immune status, vaccination status, hospital course including ICU admission and LOS, treatment, and mortality. We also analyzed the risk factors associated with influenza mortality in those patients.

RESULTS: A total of 63 patients were admitted and all had Influenza A (36/63 were subtyped and all were H1N1). The median age was 52; 29 (46%) were females and among those 4 were pregnant. 25 of 63 (39.7%) were obese (BMI>= 30). 11/63 (17.5%) were immunocompromised and 46 (72%) had one or more co-morbidity. 19/63 (30.2 %) required ICU care and admissions rates were significantly different between immunocompromised v/s immunocompetent patients (45% v/s 26%). A total of 6 (9%) people died; 5/6 (83.3 %) people who died were immunocompromised and there was no death among the 4 pregnant women with influenza. The median hospital LOS was 7 days (range 1-61 days). A total of 11 (17%) patients required mechanical ventilation. 53 (84%) patients received treatment with Oseltamivir for influenza and 49 (77%) patients also received treatment for bacterial pneumonia; 37 (59%) patients had infiltrates on CXR. The influenza vaccination status was known only in 14 (4 received flu vaccine and 10 did not).

CONCLUSIONS: 1. The Influenza A (subtype H1N1) was the predominant virus detected in our inpatient group during 2013-14 season and matches with the CDC interim report [1]. 2. The circulating strain(s) mainly affected the middle aged people with co-morbidities. 3. Most deaths 5/6 (83.3 %) in influenza patients occurred in those with immuno-compromised status. 4. Almost all patients (98%; 51 /52) without any underlying immunocompromised status survived with appropriate treatment and supportive care in our tertiary care university medical center.

CLINICAL IMPLICATIONS: Early aggressive treatment in immunocompromised patients with influenza like illness during “the flu” season should be considered given the high mortality in this group. REFERENCES: 1. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6307a1.htm

DISCLOSURE: The following authors have nothing to disclose: Penchala Mittadodla, Deepak Chandra, Manish Joshi

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