Work

Clinical and Case Characteristics of Severe Acute Respiratory Illness Among Adult Hospitalized Patients, Minnesota, 2013–2015

Year: 2016

Type: article

Abstract: Background. While pneumonia has been established as the leading cause of hospitalization among older adults, surveillance for pneumonia and/or severe acute respiratory illness (SARI) with pathogen testing is not well established in the United States. The Minnesota Department of Health (MDH) conducts hospital-based surveillance to monitor SARI in the Minneapolis/St. Paul metropolitan area. Methods. From September 2013 through December 2015, two hospitals submitted residual upper respiratory specimens collected from routine diagnostic testing from hospitalized patients aged ≥18 years to MDH. Specimens were tested for 22 viral and bacterial pathogens by individual and multiplex RT-PCR assays. Medical records were reviewed to identify patients meeting SARI case criteria (new onset of cough and/or shortness of breath or other respiratory symptom with/without fever) and obtain demographic and clinical data. Results. During the surveillance period, 1069 (66%) specimens met SARI case criteria. Median age was 59.9 (IQR 49–74) years. Intensive care unit (ICU) admission occurred in 194 (18%) cases, 84 (43%) of whom received mechanical ventilation. Median length of stay (LOS) was 7 days (IQR 5–66) and 5 days (IQR 3–7), respectively, among those with and without ICU admission. Comorbid conditions were identified in 942 (88%) cases, most frequently asthma/COPD (39%), cardiovascular disease (37%), and chronic metabolic disease (33%); 12% were morbidly obese and 28% were reported smokers. A pathogen was detected in 403 (36%) specimens, including influenza virus (18%), rhinoviruses/enteroviruses (7%), coronaviruses (5%), RSV (3%), and hMPV (3%); 2% of specimens had ≥2 pathogens detected. Compared to cases aged 18–64 years, cases ≥80 years had greater odds of influenza detection (OR 2.5; p < 0.01) and cases 65–79 years had greater odds of RSV detection (OR 3.0; p = 0.03). Presence of comorbidity (OR 1.8; p < 0.05) and older age (p < 0.01) were associated with ICU admission, but detection of a pathogen was not significantly associated. Conclusion. SARI surveillance provides valuable data to understand the burden and etiology of respiratory infections among hospitalized adults. Targeted therapeutic and preventative interventions for respiratory infections in vulnerable adult populations may reduce burden. Disclosures. All authors: No reported disclosures.

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofw172.524