scholarly journals Invasive Aspergillosis After Influenza and Other Viral Respiratory Infections Among Intensive Care Unit Patients in a Commercially Insured Population in the United States, 2013–2018

2021 ◽  
Vol 8 (3) ◽  
Author(s):  
Mitsuru Toda ◽  
Kaitlin Benedict ◽  
Brendan R Jackson
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Infections ◽  
The United States ◽  
Medical Practices ◽  
Claims Database ◽  
Severe Influenza ◽  
Health Insurance Claims ◽  
Viral Respiratory Infections ◽  
Viral Respiratory

Abstract Influenza-associated aspergillosis (IAA) is an emerging phenomenon in intensive care unit patients with severe influenza. In a large US health insurance claims database, IAA was uncommon (0.3%) during 2013–2018. The low IAA frequency likely reflects underdiagnosis and differences in medical practices or epidemiologic differences.

scholarly journals Viral respiratory infections in very low birthweight infants at neonatal intensive care unit: prospective observational study

2020 ◽  
Vol 4 (1) ◽  
pp. e000661 ◽  
Author(s):  
Laura Sánchez García ◽  
Cristina Calvo ◽  
Inmaculada Casas ◽  
Francisco Pozo ◽  
Adelina Pellicer
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Low Birthweight ◽  
Respiratory Infections ◽  
Very Low Birthweight ◽  
Vlbw Infants ◽  
Viral Respiratory Infections ◽  
Viral Respiratory

Background and objectiveVery low birthweight (VLBW) infants are highly susceptible to respiratory infections. Information about prevalence of viral respiratory infections (VRIs) in neonatal intensive care unit (NICU) is scarce. Recent evidence suggests short-term and long-term impact of VRI in morbidity of VLBW infants. The goal of this study is to conduct a VRI surveillance in VLBW infants during NICU admission to address the prevalence, type of viruses and associated clinical features.MethodsProspective observational cohort study on infants below 32 gestational weeks admitted to a tertiary NICU during a 2-year period. Respiratory virus detection (influenza, parainfluenza, rhinovirus (hRV), enterovirus, respiratory syncytial virus, metapneumovirus, coronavirus, bocavirus and adenovirus) was performed by real time multiplex PCR assays in nasopharyngeal aspirates (NPAs), within the first 72 hours after birth and weekly, until discharge. Additional samples were taken if clinically indicated.Results147 out of 224 eligible infants were enrolled. At least one positive NPA was found in 38% of the study cohort. Main viruses identified were hRV (58%) and adenovirus (31%). Among the 56 infants with positive NPA, 26 showed non-specific respiratory features in 58% (increased respiratory workload, tachypnoea, apnoea) or typical cold features in 38% (rhinorrhea, cough, fever), at least in one episode. Antibiotics were prescribed in 29% of cases. Positive infants showed higher rates of bronchopulmonary dysplasia (BPD), need for supplemental oxygen and mechanical ventilation, and had longer hospital stay. Cox regression analysis found BPD as an independent risk factor for viral infection (p<0.001) and symptomatic VRI (p<0.04).ConclusionsSystematic surveillance in VLBW infants reports VRI is frequent, particularly by hRV. Asymptomatic infection is highly prevalent which is critical in the face of establishing appropriate preventive strategies. Infants with BPD are especially vulnerable to such infections.

Viral Respiratory Infections of Adults in the Intensive Care Unit

2016 ◽  
Vol 31 (7) ◽  
pp. 427-441 ◽  
Author(s):  
Christopher Nguyen ◽  
Shawn Kaku ◽  
Dominic Tutera ◽  
Ware G. Kuschner ◽  
Juliana Barr
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Infections ◽  
Viral Respiratory Infections ◽  
Viral Respiratory

scholarly journals Healthcare-Associated Viral Respiratory Infections in a Pediatric Intensive Care Unit and Cardiovascular Intensive Care Unit

2021 ◽  
Vol 1 (S1) ◽  
pp. s75-s76
Author(s):  
Kelly Feldman ◽  
Jasjit Singh ◽  
Wendi Gornick
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Respiratory Infections ◽  
Pediatric Intensive Care ◽  
Respiratory Support ◽  
Viral Respiratory Infections ◽  
Viral Diagnosis ◽  
Healthcare Associated ◽  
Viral Respiratory

Background: Healthcare-associated infections (HAIs) affect patient health and are tracked closely by infection prevention. Patients in a pediatric intensive care unit (PICU) acquired viral respiratory infections had longer use of respiratory support. We sought to determine the types of viral respiratory HAIs (VR-HAIs) acquired in the PICU and the characteristics of those affected. Methods: CHOC Children’s Hospital is a 334-bed tertiary-care center. Charts were reviewed on patients with VR-HAIs from fiscal years (FY) 2005–2020. High-risk VR-HAI (HR-VR-HAI) were influenza A and B, respiratory syncytial virus (RSV), adenovirus, parainfluenza, and human metapneumovirus (hMPV, added in FY 2014). Patients in the PICU, cardiovascular ICU (CVICU), and oncology ICU (OICU) with HR-VR-HAIs were reviewed. Patients were categorized according to underlying pathology, immunosuppression, and isolation prior to HR-VR-HAI. Increased respiratory support was defined as any increase from a patient’s baseline support ±24 hours of viral diagnosis: increase in oxygen flow or transition from nasal cannula to high-flow nasal cannula or ventilator support. Antibiotic escalation, defined as initiation of antibiotic therapy for ≥2 days ±24 hours of viral diagnosis or broadening the spectrum of antimicrobials for ≥2 days ±24 hours of viral diagnosis. Results: During FY 2005–2020, there were 204 VR-HAIs: 143 HR-VR-HAIs (70%), of which 39 (27.2%) occurred in ICUs (Figure 1). Most of the HR-VR-HAIs were RSV, parainfluenza, and hMPV (Figure 2). Of 39 patients, 10 (25.6%) had underlying oncologic conditions, 9 of whom were immunosuppressed. Of 39 patients, 16 (41%) had structural cardiac disease, 4 (10.3%) had pulmonary disease, 5 (12.8%) had neurologic disease, and the remaining 4 (10.3%) had other comorbidities. Of 39 patients, 12 (31%) required an increase in respiratory support and 13 (33%) had escalation of antibiotics. Of 39 HR-VR-HAI patients, 2 died within 2 weeks of acquisition. Conclusions: HR-VR-HAIs are uncommon in ICUs. RSV, parainfluenza, and hMPV are the most common, and 1 of 3 of patients required escalation in respiratory support and/or escalation in antibiotics. All patients had underlying comorbidities. In our series, there were 2 deaths within 2 weeks of infection.Funding: NoDisclosures: None

scholarly journals Burden of Healthcare-Associated Viral Respiratory Infections in Children’s Hospitals

2016 ◽  
Vol 7 (1) ◽  
pp. 18-24 ◽  
Author(s):  
Caroline Quach ◽  
Rita Shah ◽  
Lorry G Rubin
Keyword(s):  
New York ◽  
Intensive Care ◽  
Respiratory Infections ◽  
Medical Center ◽  
Incidence Rates ◽  
Children's Hospitals ◽  
Children’S Hospitals ◽  
Viral Respiratory Infections ◽  
Healthcare Associated ◽  
Viral Respiratory

Abstract Objective Although healthcare-associated (HA) viral respiratory infections (VRIs) are common in pediatrics, no benchmark for comparison exists. We aimed to determine, compare, and assess determinants of unit-specific HA-VRI incidence rates in 2 children’s hospitals. Methods This study was a retrospective comparison of prospective cohorts. The Montreal Children’s Hospital and the Cohen Children’s Medical Center of New York perform prospective surveillance for HA-VRI using standardized definitions that require the presence of symptoms compatible with VRI and virus detection. Cases detected between April 1, 2010, and March 31, 2013, were identified using surveillance databases. Annual incidence rates were calculated, and a generalized estimating equation model was used to assess determinants of HA-VRI rates. Results The overall HA-VRI rate during the 3-year study period was significantly higher at Montreal Children’s Hospital than that at Cohen Children’s Medical Center of New York (1.91 vs 0.80 per 1000 patient-days, respectively;P &lt; .0001). Overall, the HA-VRI incidence rate was lowest in the neonatal intensive care unit. Rates in the pediatric intensive care, oncology, and medical/surgical units were similar. The most common etiology of HA-VRI at both institutions was rhinovirus (49% of cases), followed by parainfluenza virus and respiratory syncytial virus. Hospitals with less than 50% single rooms had HA-VRI rates 1.33 (95% confidence interval, 1.29–1.37) times higher than hospitals with more than 50% single rooms for a given unit type. Conclusions HA-VRI rates were substantial but different among 2 children’s hospitals. Future studies should examine the effect of HA-VRI and evaluate best practices for preventing such infections.

scholarly journals Development of secondary bacterial pneumonia in adults presenting with influenza versus noninfluenza viral respiratory infection

2020 ◽  
Vol 14 ◽  
pp. 175346662096302
Author(s):  
Kathryn H. Melamed ◽  
Justin Williams ◽  
Xiaoyan Wang ◽  
Scott Hu ◽  
Christopher Nguyen ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Viral Infections ◽  
Respiratory Infections ◽  
Medical Center ◽  
Adult Patients ◽  
Gram Negative ◽  
Secondary Infections ◽  
Respiratory Viral Infections ◽  
Viral Respiratory

Background: Respiratory viral infections, particularly influenza, are known to cause significant morbidity and mortality, often due to secondary infections. Our aim was to comparatively analyze the incidence, epidemiology, and outcomes of secondary pneumonia in adult patients hospitalized with influenza versus noninfluenza viral infections and determine whether influenza particularly predisposes to secondary infections. Methods: This was a retrospective analysis from a single tertiary medical center of adult patients admitted to the hospital between 2008 and 2010 with respiratory viral infections. Microbiological patterns and clinical outcomes were compared between those with influenza (VI, n = 57) and those with noninfluenza (NI, n = 77) respiratory viral infections. Results: The NI group was older (60.6 ± 14.0 versus 53.3 ± 19.7 years, p = 0.019) with higher rates of lung transplantation (29% versus 9%, p = 0.009) than VI. Overall, 35% developed secondary pneumonia, higher among NI (44%) than VI (23%, p = 0.017). Staphylococcus aureus was the most common cause of pneumonia in VI, whereas Gram-negative rods were most frequently identified in NI. The NI group had longer hospital [median 10 (interquartile range (IQR) 6–19) versus 6 (IQR 4–15) days, p = 0.019] and intensive care unit [median 4 (IQR 0–12) versus 0 (IQR 0–8) days, p = 0.029] stays compared with VI. Further, the NI group was more likely to be admitted to the intensive care unit compared with VI (62% versus 39%, p = 0.011). A trend towards increased mortality was observed in viral infections complicated by secondary pneumonia than primary viral infections (28% versus 15%, p = 0.122). Conclusion: Secondary pneumonia is common among adults hospitalized with viral respiratory infections. Within our population, NI results in more frequent secondary pneumonia and longer hospital stays than those with VI. Given the high number of infections caused by Gram-negative rods, monitoring local epidemiology is critical for guiding initial antibiotic selection in empirical treatment of secondary infections. The reviews of this paper are available via the supplemental material section.

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