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Management of hospitalized influenza A patients during the season 2018/19

Comparison of three medical departments and the effect on outcome and antibiotic usage

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Summary

Background

Diagnosis and treatment of influenza patients are often provided across several medical specialties. We compared patient outcomes at an infectious diseases (ID), a rheumatology (Rheu) and a pulmonology (Pul) department.

Material and methods

In this prospective observational multicenter study we included all influenza positive adults who were hospitalized and treated at flu isolation wards in three hospitals in Vienna during the season 2018/2019.

Results

A total of 490 patients (49% female) with a median age of 73 years (interquartile range [IQR] 61–82) were included. No differences regarding age, sex and most underlying diseases were present at admission.

Frequencies of the most common complications differed: acute kidney failure (ID 12.7%, Rheu 21.2%, Pulm 37.1%, p < 0.001), acute heart failure (ID 4.3%, Rheu 17.1%, Pulm 14.4%, p < 0.001) and respiratory insufficiency (ID 45.1%, Rheu 41.5%, Pulm 56.3%, p = 0.030).

Oseltamivir prescription was lowest at the pulmonology flu ward (ID 79.6%, Rheu 90.5%, Pulm 61.7%, p < 0.001).

In total 176 patients (35.9%) developed pneumonia. Antibiotic selection varied between the departments: amoxicillin/clavulanic acid (ID 28.9%, Rheu 63.8%, Pulm 5.9%, p < 0.001), cefuroxime (ID 28.9%, Rheu 1.3%, Pulm 0%, p < 0.001), 3rd generation cephalosporins (ID 4.4%, Rheu 5%, Pulm 72.5%, p < 0.001), doxycycline (ID 17.8%, Rheu 0%, Pulm 0%, p < 0.001).

The median length of stay was significantly different between wards: ID 6 days (IQR 5–8), Rheu 6 days (IQR 5–7) and Pulm 7 days (IQR 5–9.5, p = 0.034). In-hospital mortality was 4.3% and did not differ between specialties.

Conclusion

We detected differences in oseltamivir usage, length of in-hospital stay and antibiotic choices for pneumonia. Influenza-associated mortality was unaffected by specialty.

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Acknowledgements

Data were collected as a part of the diploma thesis of the author Hasan Kelani.

Funding

This work did not receive any funding.

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Authors and Affiliations

  1. Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Kundratstr. 3, 1100, Vienna, Austria

    Mario Karolyi, Erich Pawelka, Hasan Kelani, Sara Omid, Tamara Seitz, Marianna Traugott, Alexander Zoufaly & Christoph Wenisch

  2. Medical Department II and Karl-Landsteiner Institute for Lung Research and Pulmonary Oncology, Klinik Ottakring, Vienna, Austria

    Georg Christian Funk & Sabine Publig

  3. Medical Department II—Center for diagnosis and treatment of rheumatic diseases, Klinik Hietzing, Vienna, Austria

    Boris Lindner & Christoph Porpaczy

  4. Department for Rheumatology and Osteology, Klinik Favoriten, Vienna, Austria

    Michael Turner

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  1. Mario Karolyi
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Correspondence to Mario Karolyi.

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Conflict of interest

M. Karolyi, E. Pawelka, H. Kelani, G.C. Funk, B. Lindner, C. Porpaczy, S. Publig, S. Omid, T. Seitz, M. Traugott, M. Turner, A. Zoufaly and C. Wenisch declare that they have no competing interests.

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Karolyi, M., Pawelka, E., Kelani, H. et al. Management of hospitalized influenza A patients during the season 2018/19. Wien Klin Wochenschr 133, 1310–1317 (2021). https://doi.org/10.1007/s00508-021-01950-8

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