广州某呼吸科病房2009年甲型H1N1大流行性流感医院感染的临床影响

Clinical impact of nosocomial infection with pandemic influenza A (H1N1) 2009 in a respiratory ward in Guangzhou.

作者信息

Zhan Yangqing, Chen Xiaojuan, Guan Weijie, Guan Wenda, Yang Chunguang, Pan Sihua, Wong Sook-San, Chen Rongchang, Ye Feng

机构信息

The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.

Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen Institute of Respiratory Diseases, Shenzhen, China.

出版信息

J Thorac Dis. 2021 Oct;13(10):5851-5862. doi: 10.21037/jtd-21-897.

DOI:10.21037/jtd-21-897

PMID:34795934

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8575854/

Abstract

BACKGROUND

Nosocomial outbreaks of pandemic influenza A (H1N1) 2009 virus [A(H1N1)pdm09] easily develop due to its high transmissibility. This study aimed to investigate the clinical impacts of a nosocomial outbreak of A(H1N1)pdm09 between 21 January and 17 February 2016.

METHODS

Patients who developed influenza-like illness (ILI) more than 48 hours after hospitalization in the index ward were enrolled as suspected patients, defined as group A and quarantined. Patients in other wards were defined as group B. A phylogenetic tree was constructed to determine the origins of the hemagglutinin and neuraminidase genes.

RESULTS

After the implementation of an infection control measure bundle, the outbreak was limited to eight patients with ILIs in group A. Nasal swabs from seven patients were positive for A(H1N1)pdm09. All the patients recovered after treatment. Prolonged viral shedding was observed in a patient with bronchiectasis and infection. Compared to the expected duration of hospitalization in patients without fever, those with fever had a median 7-day delay in discharge and a mean excess cost of 3,358 RMB. The four influenza strains identified were genetically identical to the A/California/115/2015 strain. Six of the 54 patients in group B who underwent bronchoscopy developed transient fever. These patients were hospitalized in various wards of the hospital and recovered after a short-term course of empirical antibiotics.

CONCLUSIONS

After the implementation of infection control measures, the nosocomial A(H1N1)pdm09 outbreak was rapidly contained; infected patients had a delay in discharge and excess costs, but no deaths occurred.

摘要

背景

2009年甲型H1N1流感大流行病毒[A(H1N1)pdm09]具有高传播性，容易引发医院内暴发。本研究旨在调查2016年1月21日至2月17日期间A(H1N1)pdm09医院内暴发的临床影响。

方法

将入住索引病房后48小时以上出现流感样疾病（ILI）的患者纳入疑似患者，定义为A组并进行隔离。其他病房的患者定义为B组。构建系统发育树以确定血凝素和神经氨酸酶基因的起源。

结果

实施一系列感染控制措施后，暴发仅限于A组的8例ILI患者。7例患者的鼻拭子A(H1N1)pdm09检测呈阳性。所有患者经治疗后康复。一名支气管扩张症合并感染患者出现病毒持续 shedding。与无发热患者的预期住院时间相比，发热患者的出院中位数延迟7天，平均额外费用为3358元人民币。鉴定出的4株流感病毒株在基因上与A/California/115/2015株相同。B组54例接受支气管镜检查的患者中有6例出现短暂发热。这些患者在医院的各个病房住院，经短期经验性抗生素治疗后康复。