Limiting severe outcomes and impact on intensive care units of moderate-intermediate 2009 pandemic influenza: role of infectious diseases units.
OBJECTIVE
The rate of severe outcomes of patients with 2009 pandemic (A/H1N1) influenza (2009pI) hospitalized in non-intensive care units (ICUs) has not been defined thus far. This study aims to assess the efficacy of the management of patients with influenza-like illness (ILI) of moderate intermediate severity in an infectious diseases unit (IDU) during the first wave of 2009pI and its influence on the burden of ICUs.


METHODS
All patients hospitalized from October 27, 2009, to February 5, 2010, with ILI were included in this prospective observational study. The IDU was organized and the staff was trained to provide intermediate care; patients were transferred to the ICU only if they required invasive ventilation, extracorporeal membrane oxygenation, or advanced cardiovascular support. Demographic data, clinical presentation, coexisting medical conditions, and laboratory and radiological findings were recorded and analyzed, as well as treatment and outcome data.


RESULTS
Overall, 108 patients (median age 36 years [IQR 27-54], 57.4% males) including 66.7% with ≥ 1 risk factor for severe influenza, 47.2% with confirmed 2009pI by RT-PCR and 63.9% with pneumonia, were enrolled in the study. All subjects received intravenous fluids and 83.3% were administered oseltamivir, 96.3% antibacterials, 19.4% oxygen therapy without ventilatory support, and 10.2% non-invasive ventilation. A total of 106 (98.1%) subjects were discharged after a 6-day median hospital stay [IQR 4-9]. Two patients (1.9%) were transferred to the ICU. There were no deaths.


CONCLUSIONS
These results suggest that the aggressive treatment of patients with moderate intermediate severity 2009 pandemic ILI in non-ICU wards may result in a low rate of severe outcomes and brief hospitalization. IDUs, if properly organized for intermediate care, may efficiently provide correct disease management, in addition to complying with infection control requirements, thus reducing the burden of the pandemic on ICUs. Further studies are warranted to evaluate the outcome of patients with moderate intermediate 2009pI in different non-ICU settings.
Clinic of Infectious Diseases, School of Medicine and Surgery, University of Bari, Bari, Italy. s_carbonara@yahoo.it
Sergio
S
Carbonara
Giuseppe
G
Bruno
Giuseppe Di
GD
Ciaula
Anna Donata
AD
Pantaleo
Gioacchino
G
Angarano
Laura
L
Monno
D000328:Adult; D003140:Communicable Disease Control / Q000379:methods; D003422:Critical Care / Q000379:methods*; D005260:Female; D006739:Hospital Administration; D006760:Hospitalization; D006801:Humans; D055552:Infectious Disease Medicine / Q000379:methods; D053118:Influenza A Virus, H1N1 Subtype / Q000378:metabolism; D007251:Influenza, Human / Q000453:epidemiology* / Q000628:therapy*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D058873:Pandemics; D012306:Risk; D012307:Risk Factors; D016896:Treatment Outcome