2520. Epidemiology, Clinical Manifestations, and Outcomes of the 2017–2018 Influenza Season Among Hospitalized Patients at a Tertiary Care Center

Abstract

Background2017–2018 Influenza season showed widespread activity and is expected to be of “high severity.”MethodsRetrospective chart review of patients with Influenza admitted from September 1, 2017 to April 1, 2018. Diagnosis was confirmed by Rapid flu test (RIDT) or Target Enriched Multiplex PCR (TEM PCR). Demographic, clinical, lab, treatment, and outcomes data were obtained. Analysis included prevalence and relative risk (RR)Results220 patients were identified (47% males, 73% White). Median age was 70 years (range 18–99). 65% had Flu A and 27% Flu B. 81% came from home, 17% from a facility (nursing home, assisted living). 49% had flu vaccination (Figure 1). Flu strain and vaccination status had no association RR 1.31 (95% CI 0.85–2.01, P = 0.21). Common comorbidities were lung disease 44%, obesity 41%, DM 36%, CAD 34%, CHF 31% (Figure 2). Common presentations were respiratory 79% and constitutional 53%. 68% were hypoxic and 4% hypotensive on arrival. 42% had new CXR/CT finding and 55% had pneumonia. Sensitivity of RIDT was 38%. 91% were treated with oseltamivir (21% within 48 hours of flu detection). Median treatment duration was 5 days. Hospitalizations peaked in January (Figure 3). Median length of hospital stay was 6 days. 23% had severe flu (needed NPPV 13%, intubation 12%, pressor 5%, ICU stay 16%) which showed significant association with arrival from facility RR 2.21 (95% CI 1.36–3.56, P = 0.001), lung disease RR 1.91 (95% CI 1.17–3.14, P = 0.01) and co-detection of respiratory pathogen (TEM PCR/sputum culture/serology) RR 2.65 (CI 1.60–4.38, P = 0.0001), but none with age >65 RR 1.46 (95% 0.83–2.56, P = 0.18), flu type RR 1.59 (95% CI 0.85–2.98, P = 0.14), active smoking RR 1.40 (95% CI 0.79–2.47, P = 0.24) or vaccination RR 1.21 (95% CI 0.70–2.12, P = 0.48). Fatality rate was 6% with significant association with arrival from facility RR 4.56 (95% CI 1.55–13.40, P = 0.006).Conclusion2017–2018 Influenza season among hospitalized patients involved more elderly and peaked in January. Sensitivity of flu swab was 38% calling for better utilization of TEM PCR in hospitalized patients. Severe flu had significant association with arrival from facility, lung disease and co-detection of respiratory pathogen. Fatality had significant association with arrival from facility. Confounders not accounted. Disclosures All authors: No reported disclosures.