tetano
Editor, Senior Moderator
Clin Infect Dis. 2020 Feb 3. pii: ciaa108. doi: 10.1093/cid/ciaa108. [Epub ahead of print] [h=1]Extensive hospital in-ward clustering revealed by molecular characterization of influenza A virus infection.[/h]
Sansone M[SUP]1[/SUP], Andersson M[SUP]1,[/SUP][SUP]2[/SUP], Gustavsson L[SUP]3,[/SUP][SUP]2[/SUP], Andersson LM[SUP]3,[/SUP][SUP]2[/SUP], Nord?n R[SUP]1,[/SUP][SUP]2[/SUP], Westin J[SUP]1,[/SUP][SUP]3,[/SUP][SUP]2[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]OBJECTIVE:[/h] Nosocomial transmission of influenza A virus infection is not fully recognized. The aim of this study was to describe the characteristics of hospitalized patients with influenza A virus (InfA) infection during an entire season and to investigate in-ward transmission at a large acute-care hospital.
[h=4]METHODS:[/h] During the season 2016-17 all hospitalized patients ≥18 years old with laboratory-verified (real-time PCR) InfA were identified. Cases were characterized according to age, sex, co-morbidity, antiviral therapy, viral load expressed as cycle threshold (Ct) values, length of hospital stay (LOS), 30-day mortality and whether the InfA infection met criteria for a health-care-associated infection (HCAI). Respiratory samples positive for InfA collected at the same wards within 7 days were chosen for whole-genome sequencing (WGS) and phylogenetic analysis was performed to detect clustering. For reference, concurrent InfA strains from patients with community-acquired infection were included.
[h=4]RESULTS:[/h] We identified a total of 435 InfA cases, of which 114 (26%) met the HCAI-criteria. The overall 30-day mortality rate was higher among patients with HCAI (9.6% vs. 4.6% among non-HCAI), although the difference was not statistically significant in multivariable analysis, where age was the only independent risk factor for death (p<0.05). We identified 8 closely related clusters (involving ≥3 cases) and another 10 pairs of strains supporting in-ward transmission.
[h=4]CONCLUSION:[/h] We found that in-ward transmission of InfA occurs frequently and that health-care-associated influenza may have a severe outcome. WGS may be used for outbreak investigations as well as for evaluation of the effect of preventive measures.
? The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
[h=4]KEYWORDS:[/h] hospital outbreak; infection-control; influenza; nosocomial; phylogeny; polymerase chain reaction; transmission; whole-genome sequencing
PMID: 32011654 DOI: 10.1093/cid/ciaa108
Sansone M[SUP]1[/SUP], Andersson M[SUP]1,[/SUP][SUP]2[/SUP], Gustavsson L[SUP]3,[/SUP][SUP]2[/SUP], Andersson LM[SUP]3,[/SUP][SUP]2[/SUP], Nord?n R[SUP]1,[/SUP][SUP]2[/SUP], Westin J[SUP]1,[/SUP][SUP]3,[/SUP][SUP]2[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]OBJECTIVE:[/h] Nosocomial transmission of influenza A virus infection is not fully recognized. The aim of this study was to describe the characteristics of hospitalized patients with influenza A virus (InfA) infection during an entire season and to investigate in-ward transmission at a large acute-care hospital.
[h=4]METHODS:[/h] During the season 2016-17 all hospitalized patients ≥18 years old with laboratory-verified (real-time PCR) InfA were identified. Cases were characterized according to age, sex, co-morbidity, antiviral therapy, viral load expressed as cycle threshold (Ct) values, length of hospital stay (LOS), 30-day mortality and whether the InfA infection met criteria for a health-care-associated infection (HCAI). Respiratory samples positive for InfA collected at the same wards within 7 days were chosen for whole-genome sequencing (WGS) and phylogenetic analysis was performed to detect clustering. For reference, concurrent InfA strains from patients with community-acquired infection were included.
[h=4]RESULTS:[/h] We identified a total of 435 InfA cases, of which 114 (26%) met the HCAI-criteria. The overall 30-day mortality rate was higher among patients with HCAI (9.6% vs. 4.6% among non-HCAI), although the difference was not statistically significant in multivariable analysis, where age was the only independent risk factor for death (p<0.05). We identified 8 closely related clusters (involving ≥3 cases) and another 10 pairs of strains supporting in-ward transmission.
[h=4]CONCLUSION:[/h] We found that in-ward transmission of InfA occurs frequently and that health-care-associated influenza may have a severe outcome. WGS may be used for outbreak investigations as well as for evaluation of the effect of preventive measures.
? The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
[h=4]KEYWORDS:[/h] hospital outbreak; infection-control; influenza; nosocomial; phylogeny; polymerase chain reaction; transmission; whole-genome sequencing
PMID: 32011654 DOI: 10.1093/cid/ciaa108
