Late diagnosis of influenza in adult patients during a seasonal outbreak = Late diagnosis of influenza in adult patients during a seasonal outbreak

다국어 초록 (Multilingual Abstract)

Background/Aims: Due to advances in diagnostic techniques, clinicians are more frequently performing influenza diagnostic tests and referring to their test results ahead of the administration of neuraminidase inhibitors (NAIs). To investigate the clinical significance of the time from symptom onset to laboratory diagnosis, we reviewed the clinical characteristics of adult patients with influenza who had an early laboratory diagnosis (ED) or a late laboratory diagnosis (LD) at one of four tertiary care centers during a seasonal outbreak of influenza.
Methods: Clinical data were collected from 1,405 adults during the 2013 to 2014 influenza season. A patient was regarded as receiving an ED or LD if he/she received an influenza diagnostic test at 0 to 1 or 4 to 7 days after symptom onset, respectively. Early NAI therapy and late NAI therapy were defined as the administration of NAI ≤ 2 or > 2 days after symptom onset, respectively.
Results: Nearly half of the patients (47.0%) received an ED (n = 661), whereas 13.5% (n = 190) received a LD. Patients with a LD had initial symptoms of cough, sputum production, and dyspnea and experienced pneumonia, antibiotic therapy, hospitalization, and admission to the intensive care unit more often than those with an ED. NAI therapy and early NAI therapy were less frequent in patients with a LD than those with an ED. Of the analyzed baseline characteristics, age ≥ 50 years, influenza B infection, and diagnosis using a polymerase chain reaction test were significantly associated with a LD.
Conclusions: LD was associated with inappropriate antiviral therapy and complicated presenting features in adult patients with seasonal influenza. ED of influenza should be emphasized, especially for older adults.

참고문헌 (Reference)

1 Harper SA, "Seasonal influenza in adults and children: diagnosis, treatment, chemoprophylaxis, and institutional outbreak management: clinical practice guidelines of the Infectious Diseases Society of America" 48 : 1003-1032, 2009

2 Dobson J, "Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trials" 385 : 1729-1737, 2015

3 Crossley KB, "Infections in the elderly;Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 8th ed" Elsevier Saunders 3459-3465, 2014

4 Muthuri SG, "Impact of neuraminidase inhibitor treatment on outcomes of public health importance during the 2009-2010 influenza A(H1N1) pandemic: a systematic review and meta-analysis in hospitalized patients" 207 : 553-563, 2013

5 Muthuri SG, "Effectiveness of neuraminidase inhibitors in reducing mortality in patients admitted to hospital with influenza A H1N1pdm09 virus infection: a meta-analysis of individual participant data" 2 : 395-404, 2014

6 Chan MC, "Clinical and virologic factors associated with reduced sensitivity of rapid influenza diagnostic tests in hospitalized elderly patients and young children" 52 : 497-501, 2014

7 Chartrand C, "Accuracy of rapid influenza diagnostic tests: a meta-analysis" 156 : 500-511, 2012