title: Characterisation of nosocomial and community-acquired influenza in a large university hospital during two consecutive influenza seasons.
abstract: BACKGROUND
  Nosocomial influenza is increasingly recognized as an important public health threat causing considerable morbidity and mortality each year. However, data on nosocomial influenza is usually collected during outbreaks only and clinical information of nosocomial influenza is sparsely available.
  
  
  OBJECTIVE
  To systematically analyse the distribution of nosocomial and community-acquired influenza and epidemiological characteristics in a tertiary care unit in two consecutive seasons.
  
  
  METHODS
  A retrospective observational study was conducted to identify and characterise cases of nosocomial and community-acquired influenza at Freiburg University hospital from 1 January 2013 to 30 April 2014. A validated multiplex RT-PCR to detect influenza virus and other respiratory pathogens was used throughout. Clinical information was retrieved from the hospital-based information system.
  
  
  RESULTS
  Overall, 218 patients with laboratory-confirmed influenza were included (179 in the first, 39 patients in the second season). A rate of 20% of nosocomial influenza was observed throughout. A fatal outcome was recorded for 9% of nosocomial cases, which were mainly associated with influenza virus A(H1N1)pdm09. Nosocomial influenza occurred in all age groups, but fatalities were only observed in patients ≥18 years. Patients with nosocomial influenza were significantly older, underwent therapy for blood malignancies and immunosuppressive regimens more frequently, and received solid organ transplantation more often compared to community-acquired patients.
  
  
  CONCLUSIONS
  Despite the different distribution of virus subtypes and epidemiological properties between both influenza seasons, the rate of nosocomial cases remained similar. Systematic detection and targeted prevention measures seem mandatory to minimize nosocomial influenza.
authors.affiliation: Institute for Virology, Medical Center-University of Freiburg, Freiburg, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Huzly
authors.affiliation: Department for Environmental Health Sciences and Hospital Infection Control, Medical Center-University of Freiburg, Freiburg, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Kurz
authors.affiliation: Department for Environmental Health Sciences and Hospital Infection Control, Medical Center-University of Freiburg, Freiburg, Germany.
authors.forename: Winfried
authors.initials: W
authors.lastname: Ebner
authors.affiliation: Department for Environmental Health Sciences and Hospital Infection Control, Medical Center-University of Freiburg, Freiburg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Dettenkofer
authors.affiliation: Institute for Virology, Medical Center-University of Freiburg, Freiburg, Germany. Electronic address: marcus.panning@uniklinik-freiburg.de.
authors.forename: Marcus
authors.initials: M
authors.lastname: Panning
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000821:virology*; D003428:Cross Infection / Q000453:epidemiology / Q000821:virology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007223:Infant; D009980:Influenza A virus / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification; D009981:Influenza B virus / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification; D007251:Influenza, Human / Q000453:epidemiology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D055815:Young Adult
keywords: Hospital; Hygiene; Influenza virus; Multiplex PCR; Nosocomial influenza