1 Division of Infectious Diseases, Department of Medicine, Duke University Hospital, Durham, North Carolina.
2 Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina.
Ann Am Thorac Soc. 2017 Dec;14(12):1810-1817. doi: 10.1513/AnnalsATS.201609-721OC.
Existing real-time surveillance of influenza morbidity, based primarily on time-trended U.S. hospitalization and death data, is inadequate. These surveillance methods do not accurately predict hospital resource requirements or sufficiently capture the public health impact of the current influenza season.
To determine the feasibility and potential usefulness of tracking surrogate markers of influenza morbidity among patients hospitalized with influenza.
We performed a pilot study at three tertiary care referral hospitals and retrospectively collected and analyzed data on patients admitted with influenza during the 2013-2014 influenza season. We analyzed traditional influenza surveillance metrics, including weekly statistics on admissions and deaths, as well as weekly rates and trends of intensive care unit (ICU), mechanical ventilation, and extracorporeal membrane oxygenation (ECMO) utilization.
In our three-hospital cohort, 431 patients were hospitalized with influenza and spent a total of 1,520 days in ICUs. Eighty-six (20%) of these patients required 1,080 days of mechanical ventilation, and 17 patients (4%) received 229 days of ECMO. Trends of ICU and mechanical ventilation use were similar but differed notably from trends of ECMO use, hospitalization, and death. In particular, at two hospitals, increases in utilization of ICU and mechanical ventilation among patients with influenza occurred several weeks after increases in hospitalization rates. Furthermore, ICU, mechanical ventilation, and ECMO utilization rates at the three-hospital network remained elevated for several weeks after the influenza-associated hospitalization rate declined.
Surrogate markers of influenza severity were feasible to collect and revealed trends of ICU resource utilization that differed notably from trends of hospitalization and death given by traditional influenza surveillance metrics. A national network of sentinel hospitals that prospectively collects, time-trends, and reports additional influenza morbidity data would be useful to hospital administrators, hospital epidemiologists, infection preventionists, and public health officials.
现有的流感发病率实时监测主要基于美国住院和死亡数据的时间趋势，其并不充分。这些监测方法不能准确预测医院资源需求，也不能充分捕捉当前流感季节对公共卫生的影响。
确定在因流感住院的患者中跟踪流感发病率替代指标的可行性和潜在用途。
我们在 3 家三级保健转诊医院进行了一项试点研究，回顾性地收集并分析了 2013-2014 年流感季节因流感住院患者的数据。我们分析了传统的流感监测指标，包括每周的住院和死亡统计数据，以及每周重症监护病房（ICU）、机械通气和体外膜肺氧合（ECMO）使用率的趋势。
在我们的三院队列中，431 例患者因流感住院，总计在 ICU 中度过了 1520 天。其中 86 例（20%）患者需要 1080 天的机械通气，17 例（4%）患者接受了 229 天的 ECMO。ICU 和机械通气使用率的趋势相似，但与 ECMO 使用率、住院和死亡的趋势明显不同。特别是在 2 家医院，流感患者 ICU 和机械通气使用率的增加发生在住院率增加数周后。此外，在流感相关住院率下降后，3 家医院网络的 ICU、机械通气和 ECMO 使用率仍持续数周升高。
流感严重程度的替代指标易于收集，并揭示了 ICU 资源利用趋势，与传统流感监测指标所反映的住院和死亡趋势明显不同。一个前瞻性收集、时间趋势和报告额外流感发病率数据的哨兵医院网络将对医院管理人员、医院流行病学家、感染预防专家和公共卫生官员有用。
