Should lower respiratory tract secretions from intensive care patients be systematically screened for influenza virus during the influenza season 英文参考文献.docVIP

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Should lower respiratory tract secretions from intensive care patients be systematically screened for influenza virus during the influenza season 英文参考文献.doc

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Should lower respiratory tract secretions from intensive care patients be systematically screened for influenza virus during the influenza season 英文参考文献

Giannellaetal.CriticalCare2012,16:R104 /content/16/3/R104 RESEARCH OpenAccess Shouldlowerrespiratorytractsecretionsfrom intensivecarepatientsbesystematicallyscreened forinfluenzavirusduringtheinfluenzaseason? MaddalenaGiannella1*,BelenRodríguez-Sánchez1,2,PaulaLópezRoa1,PilarCatalán1,2,PatriciaMu?oz1,2,3, DaríoGarcíadeViedma1,2 andEmilioBouza1,2,3,fortheGregorioMara?ónTaskForceforPneumonia(GANG) Abstract Introduction:Influenzaiseasilyoverlookedinintensivecareunits(ICUs),particularlyinpatientswithalternative causesofrespiratoryfailureorinthosewhoacquireinfluenzaduringtheirICUstay. Methods:WeperformedaprospectivestudyofpatientsadmittedtothreeadultICUsofourhospitalfrom December2010toFebruary2011.Alltrachealaspirate(TA)samplessenttothemicrobiologydepartmentwere systematicallyscreenedforinfluenza.Wedefinedinfluenzaasunsuspectediftestingwasnotrequestedandthe patientwasnotreceivingempiricalantiviraltherapyaftersamplecollection. Results:WereceivedTAsamplesfrom105patients.Influenzawasdetectedin31patientsandwasclassifiedas unsuspectedin15(48.4%)patients,andashospitalacquiredin13(42%)patients.Suspectedandunsuspected caseswerecompared,andsignificantdifferenceswerefoundforage(53versus69medianyears),severe respiratoryfailure(68.8%versus20%),surgery(6.3%versus60%),mediandaysofICUstaybeforediagnosis(1versus 4),nosocomialinfection(18.8%versus66.7%),cough(93.8%versus53.3%),localizedinfiltrateonchestradiograph (6.3%versus40%),mediandaystoantiviraltreatment(2versus9),pneumonia(93.8%versus53.3%),andacute respiratorydistresssyndrome(75%versus26.7%).MultivariateanalysisshowedadmissiontothesurgicalICU(odds ratio(OR),37.1;95%confidenceinterval(CI),2.1to666.6;P=0.01)andlocalizedinfiltrateonchestradiograph(OR, 27.8;95%CI,1.3to584.1;P=0.03)tobeindependentriskfactorsforunsuspectedinfluenza.Overallmortalityat30 dayswas29%.ICUadmissionforsevererespiratoryfailurewasanindependentriskfactorforpooroutcome. Conclusion:Duringtheinfluenzaseason,almostonethirdofcriticalpatientswithsuspectedlowerrespir