1
|
Brehm TT, Heyer A, Woo MS, Fischer M, van der Meirschen M, Wichmann D, Jarczak D, Roedl K, Schmiedel S, Addo MM, Lütgehetmann M, Christner M, Huber S, Lohse AW, Kluge S, Schulze Zur Wiesch J. Comparative analysis of characteristics and outcomes in hospitalized COVID-19 patients infected with different SARS-CoV-2 variants between January 2020 and April 2022 - A retrospective single-center cohort study. J Infect Public Health 2023; 16:1806-1812. [PMID: 37741015 DOI: 10.1016/j.jiph.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/31/2023] [Accepted: 08/14/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, the roll-out of vaccines and therapeutic agents, as well as the emergence of novel SARS-CoV-2 variants, have shown significant effects on disease severity. METHODS Patients hospitalized at our center between January 2020 and April 2022 were attributed to subgroups depending on which SARS-CoV-2 variant was predominantly circulating in Germany: (i) Wild-type: January 1, 2020, to March 7, 2021, (ii) Alpha variant: August 3, 2021, to June 27, 2021, (iii) Delta variant: June 28, 2021, to December 26, 2021, and (iv) Omicron variant: December 27, 2021, to April 30, 2022. RESULTS Between January 2020 and April 2022, 1500 patients with SARS-CoV-2 infections were admitted to the University Medical Center Hamburg-Eppendorf. The rate of patients who were admitted to the intensive care unit (ICU) decreased from 31.2% (n = 223) in the wild-type group, 28.5% (n = 72) in the Alpha variant group, 18.8% (n = 67) in the Delta variant group, and 13.4% (n = 135) in the Omicron variant group. Also, in-hospital mortality decreased from 20.6% (n = 111) in the wild-type group, 17.5% (n = 30) in the Alpha variant group, 16.8% (n = 33) in the Delta variant group, and 6.6% (n = 39) in the Omicron variant group. The median duration of hospitalization was similar in all subgroups and ranged between 11 and 15 days throughout the pandemic. CONCLUSIONS In-hospital mortality and rate of ICU admission among hospitalized COVID-19 patients steadily decreased throughout the pandemic. However, the practically unchanged duration of hospitalization demonstrates the persistent burden of COVID-19 on the healthcare system.
Collapse
Affiliation(s)
- Thomas Theo Brehm
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Germany
| | - Andreas Heyer
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Marcel S Woo
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology Hamburg (ZMNH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marlene Fischer
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Marc van der Meirschen
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Dominic Wichmann
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Dominik Jarczak
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Kevin Roedl
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Stefan Schmiedel
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Germany
| | - Marylyn M Addo
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Germany; Institute for Infection Research and Vaccine Development (IIRVD), University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Marc Lütgehetmann
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Martin Christner
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Samuel Huber
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Ansgar W Lohse
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Julian Schulze Zur Wiesch
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Germany.
| |
Collapse
|
2
|
Extracorporeal Membrane Oxygenation Support for Influenza A: Retrospective Review of the Extracorporeal Life Support Organization Registry Comparing H1N1 With Other Subtypes. Crit Care Explor 2021; 3:e0598. [PMID: 34909701 PMCID: PMC8663836 DOI: 10.1097/cce.0000000000000598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Supplemental Digital Content is available in the text. OBJECTIVES: Although there is a substantial published experience of extracorporeal membrane oxygenation during the H1N1 pandemic, less is known about the use of extracorporeal membrane oxygenation in patients with other subtypes of the influenza A virus. We hypothesized that the severity of illness and survival of patients supported with extracorporeal membrane oxygenation would differ for those with H1N1 influenza A compared with other subtypes of influenza A. DESIGN, SETTING, PATIENTS: Retrospective study of extracorporeal membrane oxygenation–supported adults (> 18 yr) with influenza A viral infection reported to the Extracorporeal Life Support Organization Registry between 2009 and 2019. We describe the frequency and compare characteristics and factors associated with in-hospital survival using a least absolute shrinkage and selection operator regression analysis. MAIN OUTCOMES AND MEASURES: Of 2,461 patients supported with extracorporeal membrane oxygenation for influenza A, 445 had H1N1, and 2,004 had other subtypes of influenza A. H1N1 was the predominant subtype between 2009 and 2011. H1N1 patients were younger, with more severe illness at extracorporeal membrane oxygenation cannulation and higher reported extracorporeal membrane oxygenation complications than those with other influenza A subtypes. Patient characteristics including younger age and higher weight and patient management characteristics including longer ventilation duration before extracorporeal membrane oxygenation were associated with worse survival. Extracorporeal membrane oxygenation complications were associated with reduced survival. There was no difference in survival to hospital discharge according to influenza subtype after adjusting for other characteristics. CONCLUSIONS: Patients supported with extracorporeal membrane oxygenation for H1N1 were younger, with more severe illness than those supported for other influenza A subtypes. Survival to hospital discharge was associated with patient characteristics, management characteristics, and extracorporeal membrane oxygenation complications but was not impacted by the specific influenza A subtype.
Collapse
|
3
|
Geerdes-Fenge HF, Klein S, Schuldt HM, Löbermann M, Köller K, Däbritz J, Reisinger EC. Complications of influenza in 272 adult and pediatric patients in a German university hospital during the seasonal epidemic 2017-2018. Wien Med Wochenschr 2021; 172:280-286. [PMID: 34581968 PMCID: PMC8476975 DOI: 10.1007/s10354-021-00884-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/20/2021] [Indexed: 11/24/2022]
Abstract
Background The influenza season 2017–2018 of the northern hemisphere was the highest since 2001 and was caused predominantly by influenza B virus. Methods We performed a retrospective analysis of all patients in a university hospital in northern Germany with laboratory-confirmed influenza during the winter season 2017–2018 and analyzed underlying conditions, complications, and outcome. Results A total of 272 cases of influenza were diagnosed: 70 influenza A (25.7%), 201 influenza B (73.9%), and 1 co-infection. Of 182 adults, 145 were hospitalized, 73 developed pneumonia, 11 developed myocardial infarction, two a transient ischemic attack, one a stroke, and one perimyocarditis. Eleven of the 145 hospitalized adult patients (7.6%) died, ten of them because of pneumonia. All of them had preexisting diseases. Pneumonia was associated with a mortality of 13.7%. Underlying cardiac insufficiency was correlated with higher mortality (7/51 with versus 4/126 patients without cardiac insufficiency; p < 0.05). Ninety cases of influenza were diagnosed in 89 children (30 A, 60 B), one child had first influenza B, then influenza A. Twenty-eight children (31%) were hospitalized, 15 children developed one or more complications (lower respiratory tract infections, meningeal irritations, febrile seizures, otitis media, myositis). No child died. Influenza vaccination status was known in 149 adult patients, pneumonia occurred more frequently in non-vaccinated individuals (43/90; 47.8%) than in vaccinated patients (18/59; 30.5%, p < 0.05). Conclusion Patients with influenza should be monitored for secondary pneumonia and myocardial infarction, and vaccination should be enforced especially in patients with coronary heart disease and cardiac insufficiency.
Collapse
Affiliation(s)
- Hilte F Geerdes-Fenge
- Department of Tropical Medicine and Infectious Diseases, Centre of Internal Medicine, Rostock University Medical Centre, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany.
| | - Saskia Klein
- Department of Tropical Medicine and Infectious Diseases, Centre of Internal Medicine, Rostock University Medical Centre, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Hans-Martin Schuldt
- Department of Tropical Medicine and Infectious Diseases, Centre of Internal Medicine, Rostock University Medical Centre, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Micha Löbermann
- Department of Tropical Medicine and Infectious Diseases, Centre of Internal Medicine, Rostock University Medical Centre, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Kerstin Köller
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Centre, Rostock, Schillingallee 70, 18057, Rostock, Germany
| | - Jan Däbritz
- Department of Paediatrics, Rostock University Medical Centre, Ernst-Heydemann-Str. 8, 18057, Rostock, Germany
| | - Emil Christian Reisinger
- Department of Tropical Medicine and Infectious Diseases, Centre of Internal Medicine, Rostock University Medical Centre, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| |
Collapse
|
4
|
Brehm TT, van der Meirschen M, Hennigs A, Roedl K, Jarczak D, Wichmann D, Frings D, Nierhaus A, Oqueka T, Fiedler W, Christopeit M, Kraef C, Schultze A, Lütgehetmann M, Addo MM, Schmiedel S, Kluge S, Schulze Zur Wiesch J. Comparison of clinical characteristics and disease outcome of COVID-19 and seasonal influenza. Sci Rep 2021; 11:5803. [PMID: 33707550 PMCID: PMC7970952 DOI: 10.1038/s41598-021-85081-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/22/2021] [Indexed: 02/07/2023] Open
Abstract
While several studies have described the clinical course of patients with coronavirus disease 2019 (COVID-19), direct comparisons with patients with seasonal influenza are scarce. We compared 166 patients with COVID-19 diagnosed between February 27 and June 14, 2020, and 255 patients with seasonal influenza diagnosed during the 2017-18 season at the same hospital to describe common features and differences in clinical characteristics and course of disease. Patients with COVID-19 were younger (median age [IQR], 59 [45-71] vs 66 [52-77]; P < 0001) and had fewer comorbidities at baseline with a lower mean overall age-adjusted Charlson Comorbidity Index (mean [SD], 3.0 [2.6] vs 4.0 [2.7]; P < 0.001) than patients with seasonal influenza. COVID-19 patients had a longer duration of hospitalization (mean [SD], 25.9 days [26.6 days] vs 17.2 days [21.0 days]; P = 0.002), a more frequent need for oxygen therapy (101 [60.8%] vs 103 [40.4%]; P < 0.001) and invasive ventilation (52 [31.3%] vs 32 [12.5%]; P < 0.001) and were more frequently admitted to the intensive care unit (70 [42.2%] vs 51 [20.0%]; P < 0.001) than seasonal influenza patients. Among immunocompromised patients, those in the COVID-19 group had a higher hospital mortality compared to those in the seasonal influenza group (13 [33.3%] vs 8 [11.6%], P = 0.01). In conclusion, we show that COVID-19 patients were younger and had fewer baseline comorbidities than seasonal influenza patients but were at increased risk for severe illness. The high mortality observed in immunocompromised COVID-19 patients emphasizes the importance of protecting these patient groups from SARS-CoV-2 infection.
Collapse
Affiliation(s)
- Thomas Theo Brehm
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany.
| | - Marc van der Meirschen
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Annette Hennigs
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Kevin Roedl
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Dominik Jarczak
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Dominic Wichmann
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Daniel Frings
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Axel Nierhaus
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Tim Oqueka
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Walter Fiedler
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Maximilian Christopeit
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Christian Kraef
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- CHIP (Centre of Excellence for Health, Immunity and Infections), Department of Infectious Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Alexander Schultze
- Department of Emergency Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Marc Lütgehetmann
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Marylyn M Addo
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Stefan Schmiedel
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Julian Schulze Zur Wiesch
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| |
Collapse
|
5
|
Brehm TT, van der Meirschen M, Hennigs A, Roedl K, Jarczak D, Wichmann D, Frings D, Nierhaus A, Oqueka T, Fiedler W, Christopeit M, Kraef C, Schultze A, Lütgehetmann M, Addo MM, Schmiedel S, Kluge S, Schulze Zur Wiesch J. Comparison of clinical characteristics and disease outcome of COVID-19 and seasonal influenza. Sci Rep 2021. [PMID: 33707550 DOI: 10.1038/s41598‐021‐85081‐0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
While several studies have described the clinical course of patients with coronavirus disease 2019 (COVID-19), direct comparisons with patients with seasonal influenza are scarce. We compared 166 patients with COVID-19 diagnosed between February 27 and June 14, 2020, and 255 patients with seasonal influenza diagnosed during the 2017-18 season at the same hospital to describe common features and differences in clinical characteristics and course of disease. Patients with COVID-19 were younger (median age [IQR], 59 [45-71] vs 66 [52-77]; P < 0001) and had fewer comorbidities at baseline with a lower mean overall age-adjusted Charlson Comorbidity Index (mean [SD], 3.0 [2.6] vs 4.0 [2.7]; P < 0.001) than patients with seasonal influenza. COVID-19 patients had a longer duration of hospitalization (mean [SD], 25.9 days [26.6 days] vs 17.2 days [21.0 days]; P = 0.002), a more frequent need for oxygen therapy (101 [60.8%] vs 103 [40.4%]; P < 0.001) and invasive ventilation (52 [31.3%] vs 32 [12.5%]; P < 0.001) and were more frequently admitted to the intensive care unit (70 [42.2%] vs 51 [20.0%]; P < 0.001) than seasonal influenza patients. Among immunocompromised patients, those in the COVID-19 group had a higher hospital mortality compared to those in the seasonal influenza group (13 [33.3%] vs 8 [11.6%], P = 0.01). In conclusion, we show that COVID-19 patients were younger and had fewer baseline comorbidities than seasonal influenza patients but were at increased risk for severe illness. The high mortality observed in immunocompromised COVID-19 patients emphasizes the importance of protecting these patient groups from SARS-CoV-2 infection.
Collapse
Affiliation(s)
- Thomas Theo Brehm
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany. .,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany.
| | - Marc van der Meirschen
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Annette Hennigs
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Kevin Roedl
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Dominik Jarczak
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Dominic Wichmann
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Daniel Frings
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Axel Nierhaus
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Tim Oqueka
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Walter Fiedler
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Maximilian Christopeit
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Christian Kraef
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,CHIP (Centre of Excellence for Health, Immunity and Infections), Department of Infectious Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Alexander Schultze
- Department of Emergency Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Marc Lütgehetmann
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany.,Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Marylyn M Addo
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Stefan Schmiedel
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Julian Schulze Zur Wiesch
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| |
Collapse
|
6
|
Karg MV, Alber B, Kuhn C, Bohlinger K, Englbrecht M, Dormann H. [SARS-CoV-2, influenza and norovirus infection : A direct epidemiologic comparison]. Med Klin Intensivmed Notfmed 2021; 117:209-217. [PMID: 33559700 PMCID: PMC7871315 DOI: 10.1007/s00063-021-00783-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/19/2020] [Accepted: 12/15/2020] [Indexed: 12/24/2022]
Abstract
Hintergrund Hospitalisierungsraten, Notaufnahmeprävalenzen und Fallsterblichkeiten (CFP) stationärer SARS-CoV-2-Patienten und wie sich diese von anderen pandemischen oder saisonalen Viruserkrankungen, wie Influenza A/B oder Norovirusinfektionen unterscheiden, wurden bisher nicht untersucht. Diese Arbeit gibt einen Überblick aus einer Kommune darüber und vergleicht diesen auch mit den negativ getesteten stationären Verdachtsfällen. Methoden Im Rahmen retrospektiver Kohortenanalysen von 67.000 Krankenhausfällen eines Klinikums mit umfassender Notfallversorgung und Meldedaten des regionalen Gesundheitsamts wurden für die Virusinfektionen SARS-CoV‑2, Influenza A/B und Norovirus Genotyp 1/2 Hospitalisierungsraten, Notaufnahmeprävalenzen und CFP berechnet. Ergebnisse In Fürth (Stadt‑/Landkreis) wurden 0,34 % der Bevölkerung, 824 Personen, bis 07.05.2020 positiv auf SARS-CoV‑2 getestet, wovon 162 (19,7 %) stationär behandelt wurden. 91 der Infizierten verstarben (CFP 11,0 %), davon 48 stationär. In der aktuellen Grippe‑/Norovirussaison wurden 992 Einwohner als influenzapositiv und 135 als noroviruspositiv gemeldet, davon 202 (20,3 %) bzw. 125 (91,9 %) stationär behandelt. Die Notaufnahmeprävalenzen waren 4,1 %, 2,0 % und 0,6 %. Die CFP der SARS-CoV-2-, influenza- und noroviruspositiven Krankenhauspopulationen betrugen 29,1 %, 3,0 % und 1,6 %, die der testnegativen Verdachtsfälle 5,9 %, 4,8 % und 6,9 % bei einer Krankenhausmortalität von 2,1 % für 2020. Schlussfolgerungen Bei gleichen Hospitalisierungsraten von SARS-CoV-2- und Influenzapatienten unterschieden sich die CFP massiv, während die CFP der testnegativen Verdachtsfälle aller 3 Infektionserkrankungen sich nicht signifikant unterschieden.
Collapse
Affiliation(s)
- M V Karg
- Zentrale Notaufnahme, Klinikum Fürth, Jakob-Henle-Str. 1, 90766, Fürth, Deutschland.
| | - B Alber
- Institut für Labormedizin, Klinikum Fürth, Fürth, Deutschland
| | - C Kuhn
- Gesundheitsamt, Landratsamt Fürth, Zirndorf, Deutschland
| | - K Bohlinger
- Gesundheitsamt, Landratsamt Fürth, Zirndorf, Deutschland
| | | | - H Dormann
- Zentrale Notaufnahme, Klinikum Fürth, Jakob-Henle-Str. 1, 90766, Fürth, Deutschland.
| |
Collapse
|
7
|
Flick H. [Fatality and risk factors for severe courses of COVID-19 pneumonia]. DER PNEUMOLOGE 2020; 17:385-393. [PMID: 33132796 PMCID: PMC7585743 DOI: 10.1007/s10405-020-00349-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia, the course, fatality and mortality are multifactorial and attributable to the immediate parenchymal damage in the region of the lungs (including pulmonary vessels), pre-existing comorbidities, extrapulmonary complications, secondary infections and the quality of the available medical care. In this respect, coronavirus disease 2019 (COVID-19) is comparable with other severe community-acquired forms of pneumonia caused by conventional pathogens, even if the pathogenesis is different. The fatality of hospitalized COVID-19 patients is approximately 20% (and therefore higher than for other pneumonia pathogens), in intensive care patients 30-40% and in invasively ventilated patients ca. 50%. Risk factors that are decisive for the fatality are old age, overweight, male gender and typical age-related cardiopulmonary underlying diseases. The clinical risk estimation in hospital should essentially be carried out in accordance with the valid guidelines on pneumonia. The value of laboratory surrogate markers specific for COVID-19 for risk estimation and treatment optimization cannot yet be adequately assessed.
Collapse
Affiliation(s)
- Holger Flick
- Universitätsklinik für Innere Medizin, Klinische Abteilung für Pulmonologie, LKH-Univ. Klinikum Graz, Augenbruggerplatz 15, 8036 Graz, Österreich
| |
Collapse
|
8
|
Flick H, Arns BM, Bolitschek J, Bucher B, Cima K, Gingrich E, Handzhiev S, Hochmair M, Horak F, Idzko M, Jaksch P, Kovacs G, Kropfmüller R, Lamprecht B, Löffler-Ragg J, Meilinger M, Olschewski H, Pfleger A, Puchner B, Puelacher C, Prior C, Rodriguez P, Salzer H, Schenk P, Schindler O, Stelzmüller I, Strenger V, Täubl H, Urban M, Wagner M, Wimberger F, Zacharasiewicz A, Zwick RH, Eber E. Management of patients with SARS-CoV-2 infections and of patients with chronic lung diseases during the COVID-19 pandemic (as of 9 May 2020) : Statement of the Austrian Society of Pneumology (ASP). Wien Klin Wochenschr 2020; 132:365-386. [PMID: 32533443 PMCID: PMC7291190 DOI: 10.1007/s00508-020-01691-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is currently a challenge worldwide. In Austria, a crisis within the healthcare system has so far been prevented. The treatment of patients with community-acquired pneumonia (CAP), including SARS-CoV‑2 infections, should continue to be based on evidence-based CAP guidelines during the pandemic; however, COVID-19 specific adjustments are useful. The treatment of patients with chronic lung diseases has to be adapted during the pandemic but must still be guaranteed.
Collapse
Affiliation(s)
- Holger Flick
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | | | | | - Brigitte Bucher
- Department of Pulmonology, Tirol Kliniken, Hospital Hochzirl-Natters, Natters, Austria
| | - Katharina Cima
- Department of Pulmonology, Tirol Kliniken, Hospital Hochzirl-Natters, Natters, Austria
| | | | - Sabin Handzhiev
- Department of Pulmonology, University Hospital Krems, Krems, Austria
| | - Maximilian Hochmair
- Respiratory Oncology Unit, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Department of Internal and Respiratory Medicine, Krankenhaus Nord-Klinik Floridsdorf, Vienna, Austria
| | | | - Marco Idzko
- Division of Pulmonology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Peter Jaksch
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Gabor Kovacs
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Roland Kropfmüller
- Department of Pulmonology, Kepler University Hospital, Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Bernd Lamprecht
- Department of Pulmonology, Kepler University Hospital, Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Judith Löffler-Ragg
- Department of Internal Medicine II (Infectious Diseases, Pneumology, Rheumatology), Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Meilinger
- Department of Internal and Respiratory Medicine, Krankenhaus Nord-Klinik Floridsdorf, Vienna, Austria
| | - Horst Olschewski
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Andreas Pfleger
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria
| | | | | | | | - Patricia Rodriguez
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria
| | - Helmut Salzer
- Department of Pulmonology, Kepler University Hospital, Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Peter Schenk
- Department of Pulmonology, Landesklinikum Hochegg, Grimmenstein, Austria
| | - Otmar Schindler
- Department of Internal, Respiratory and Critical Care Medicine, State Hospital II, Location Enzenbach, Gratwein-Straßengel, Austria
| | | | - Volker Strenger
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria
| | - Helmut Täubl
- Department of Pulmonology, Tirol Kliniken, Hospital Hochzirl-Natters, Natters, Austria
| | - Matthias Urban
- Department of Internal and Respiratory Medicine, Krankenhaus Nord-Klinik Floridsdorf, Vienna, Austria
| | - Marlies Wagner
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria
| | | | - Angela Zacharasiewicz
- Department of Paediatrics, Teaching Hospital of the Medical University of Vienna, Wilhelminen Hospital, Vienna, Austria
| | | | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria.
| |
Collapse
|
9
|
Flick H, Arns BM, Bolitschek J, Bucher B, Cima K, Gingrich E, Handzhiev S, Hochmair M, Horak F, Idzko M, Jaksch P, Kovacs G, Kropfmüller R, Lamprecht B, Löffler-Ragg J, Meilinger M, Olschewski H, Pfleger A, Puchner B, Puelacher C, Prior C, Rodriguez P, Salzer H, Schenk P, Schindler O, Stelzmüller I, Strenger V, Täubl H, Urban M, Wagner M, Wimberger F, Zacharasiewicz A, Zwick RH, Eber E. [Statement of the Austrian Society of Pneumology (ASP)]. WIENER KLINISCHES MAGAZIN : BEILAGE ZUR WIENER KLINISCHEN WOCHENSCHRIFT 2020; 23:92-115. [PMID: 32427192 PMCID: PMC7232599 DOI: 10.1007/s00740-020-00350-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The COVID-19 pandemic is currently a challenge worldwide. In Austria, a crisis within the health care system has so far been avoided. The treatment of patients with community-acquired pneumonia (CAP), including SARS-CoV‑2 infections, should continue to be based on evidence-based CAP guidelines during the pandemic. However, COVID-19-specific adjustments are useful. The treatment of patients with chronic lung diseases must be adapted during the pandemic, but must still be guaranteed.
Collapse
Affiliation(s)
- H. Flick
- Klinische Abteilung für Pulmonologie, Univ. Klinik für Innere Medizin, Medizinische Universität Graz/LKH Graz Ost, Graz, Österreich
| | - B. M. Arns
- 1. Medizinische Abteilung, Hanusch Krankenhaus, Wien, Österreich
| | | | - B. Bucher
- Abteilung für Pneumologie, Tirol Kliniken, Landeskrankenhaus Hochzirl-Natters, Natters, Österreich
| | - K. Cima
- Abteilung für Pneumologie, Tirol Kliniken, Landeskrankenhaus Hochzirl-Natters, Natters, Österreich
| | - E. Gingrich
- Lungenfachärztliche Ordination, Wien, Österreich
| | - S. Handzhiev
- Klinische Abteilung für Pneumologie, Universitätsklinikum Krems, Krems, Österreich
| | - M. Hochmair
- Karl Landsteiner Institut für Lungenforschung und pneumologische Onkologie, Krankenhaus Nord – Klinik Floridsdorf, Wien, Österreich
| | - F. Horak
- Allergiezentrum Wien West, Wien, Österreich
| | - M. Idzko
- Klinische Abteilung für Pulmologie, Univ. Klinik für Innere Medizin II, Medizinische Universität Wien/AKH Wien, Wien, Österreich
| | - P. Jaksch
- Klinische Abteilung für Thoraxchirurgie, Univ. Klinik für Chirurgie, Medizinische Universität Wien/AKH Wien, Wien, Österreich
| | - G. Kovacs
- Klinische Abteilung für Pulmonologie, Univ. Klinik für Innere Medizin, Medizinische Universität Graz/LKH Graz Ost, Graz, Österreich
- Ludwig Boltzmann Institut für Lungengefäßforschung Graz, Graz, Österreich
| | - R. Kropfmüller
- Klinik für Lungenheilkunde/Pneumologie, Medizinische Fakultät, Johannes Kepler Universität, Linz, Österreich
| | - B. Lamprecht
- Klinik für Lungenheilkunde/Pneumologie, Medizinische Fakultät, Johannes Kepler Universität, Linz, Österreich
| | - J. Löffler-Ragg
- Pneumologische Ambulanz, Univ. Klinik für Innere Medizin II, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - M. Meilinger
- Abteilung für Innere Medizin und Pneumologie, Krankenhaus Nord – Klinik Floridsdorf, Wien, Österreich
| | - H. Olschewski
- Klinische Abteilung für Pulmonologie, Univ. Klinik für Innere Medizin, Medizinische Universität Graz/LKH Graz Ost, Graz, Österreich
- Ludwig Boltzmann Institut für Lungengefäßforschung Graz, Graz, Österreich
| | - A. Pfleger
- Klinische Abteilung für pädiatrische Pulmonologie und Allergologie, Univ. Klinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Auenbruggerplatz 34/2, 8036 Graz, Österreich
| | - B. Puchner
- Department für Pneumologie, Reha Zentrum Münster, Münster, Österreich
| | - C. Puelacher
- Interdisziplinäres Schlaflabor, Telfs, Österreich
| | - C. Prior
- Lungenfachärztliche Ordination, Innsbruck, Österreich
| | - P. Rodriguez
- Klinische Abteilung für pädiatrische Pulmonologie und Allergologie, Univ. Klinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Auenbruggerplatz 34/2, 8036 Graz, Österreich
| | - H. Salzer
- Klinik für Lungenheilkunde/Pneumologie, Medizinische Fakultät, Johannes Kepler Universität, Linz, Österreich
| | - P. Schenk
- Abteilung Pulmologie, Landesklinikum Hochegg, Grimmenstein, Österreich
| | - O. Schindler
- Abteilung für Innere Medizin und Pneumologie, LKH Graz II, Standort Enzenbach, Gratwein, Österreich
| | | | - V. Strenger
- Klinische Abteilung für pädiatrische Pulmonologie und Allergologie, Univ. Klinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Auenbruggerplatz 34/2, 8036 Graz, Österreich
| | - H. Täubl
- Abteilung für Pneumologie, Tirol Kliniken, Landeskrankenhaus Hochzirl-Natters, Natters, Österreich
| | - M. Urban
- Abteilung für Innere Medizin und Pneumologie, Krankenhaus Nord – Klinik Floridsdorf, Wien, Österreich
| | - M. Wagner
- Klinische Abteilung für pädiatrische Pulmonologie und Allergologie, Univ. Klinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Auenbruggerplatz 34/2, 8036 Graz, Österreich
| | - F. Wimberger
- Ordensklinikum Elisabethinen Linz, Linz, Österreich
| | - A. Zacharasiewicz
- Abteilung für Kinder- und Jugendheilkunde, Wilhelminenspital der Stadt Wien, Lehrkrankenhaus der Medizinischen Universität Wien, Wien, Österreich
| | - R. H. Zwick
- Ambulante Pneumologische Rehabilitation, Therme Wien Med, Wien, Österreich
| | - E. Eber
- Klinische Abteilung für pädiatrische Pulmonologie und Allergologie, Univ. Klinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Auenbruggerplatz 34/2, 8036 Graz, Österreich
| |
Collapse
|
10
|
O'Kelly B, Conway A, McNally C, McConkey S, Kelly A, de Barra E. Rapid diagnosis of seasonal Influenza virus and cohorting of hospitalised patients on a 'flu ward'. A prospective analysis of outcomes. J Hosp Infect 2020; 105:S0195-6701(20)30122-5. [PMID: 32311407 DOI: 10.1016/j.jhin.2020.03.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/19/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND The influenza season of 2017/2018 was burdensome in comparison to previous years. In patient management of seasonal influenza patients is poorly described. AIM To assess the impact of managing influenza patients on a dedicated influenza ward on antimicrobial use and duration, and length of stay (LOS). METHODS A prospective cohort study from Jan 1st to Feb 28th 2018. Patients diagnosed with influenza in the Emergency Department (ED) were cohorted under infectious disease (ID) or a general internal medicine (GIM) firms on a 35 bed influenza ward. At times of maximum capacity some patients were managed on other wards by other firms 'non flu ward'. FINDINGS 91 patients were admitted to the influenza ward from ED (64 ID, 27 GIM), 38 had influenza A. Patients managed by ID were more likely to be switched to oral antibiotics sooner median 3 vs 5 days p=.049. Antibiotic duration was shorter for patients managed by the ID firm median 7 vs 9 days p=.016. LOS was shorter for patients managed by the ID firm on the flu ward vs 'non flu ward', median 5 vs 9 days p=.007. No significant difference was seen between ID and GIM LOS on the flu ward, median 5 vs 7 days p=0.30. CONCLUSION Influenza patients managed by an infectious disease service on an influenza ward had reduced length of intravenous (IV) and total antimicrobial use compared to a GIM service and had reduced LOS compared to the standard of care, 'non flu ward' influenza patients.
Collapse
Affiliation(s)
| | | | | | - Samuel McConkey
- Beaumont Hospital, Beaumont Rd, Beaumont; Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin
| | - Adam Kelly
- Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin
| | - Eoghan de Barra
- Beaumont Hospital, Beaumont Rd, Beaumont; Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin
| |
Collapse
|