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Influenza Pneumonia^*

A Descriptive Study

^* From the Division of Critical Care Medicine, Washington Hospital Center, Washington, DC.

Correspondence to: Paul Marik, MD, FCCP, Critical Care Medicine, Mercy Hospital of Pittsburgh, 1400 Locust St, Pittsburgh, PA 15219-5166; e-mail: pmarik{at}mercy.pmhs.org

Objective: To describe the clinical features and complications of patients hospitalized with influenza during the 1999–2000 influenza season.

Methods: We reviewed all cases of patients with influenza admitted to a large metropolitan referral hospital during the 1999–2000 season.

Results: Thirty-five adult patients (15 men and 20 women) tested positive for influenza A by direct enzyme immunoassay. A fourfold to sevenfold increase in the number of influenza cases was observed over previous years. Most patients had serious comorbid illnesses (88%), such as diabetes and chronic respiratory and heart disease. Seventeen patients developed pneumonia; these patients tended to be older (mean ± SD, 63 ± 13 years vs 51 ± 19 years, respectively; p = 0.04) and had a higher incidence of chronic lung disease (41% vs 6%, respectively; p = 0.02) than the patients without pneumonia. Shortness of breath was the only symptom that distinguished patients with pneumonia from those with an upper respiratory tract illness alone. Antiviral treatment was begun 4 ± 3 days from initiation of symptoms in patients with pneumonia and consisted of oseltamivir (35.2%), rimantadine (5.8%), or a combination of both (17.6%). Respiratory and/or blood culture results were positive in five patients (29%), Staphylococcus aureus was isolated in five patients, and Streptococcus pneumoniae was isolated in one patient. Ten of the patients with pneumonia (58.8%) were admitted to the ICU, and 5 patients (29%) died. The length of ICU stay and mechanical ventilation were 28 ± 26 days and 21.5 ± 20.5 days, respectively. Death in most pneumonia patients was attributed to respiratory failure.

Conclusion: The recognized number of hospital admissions for influenza increased fourfold to sevenfold over previous years, most likely due to the implementation of rapid diagnostic tests for influenza. Patients with signs and symptoms of influenza and shortness of breath should undergo chest radiography. Hospitalization of patients with influenza pneumonia occurred in both previously healthy and immunocompromised patients and had a high mortality. S aureus was the most common bacterial isolate in patients with influenza pneumonia. Empiric antibiotics with staphylococcal activity should be used pending culture results in patients with influenza pneumonia. The effectiveness of oseltamivir and rimantadine in treating patients with influenza pneumonia remains to be determined.

Key Words: influenza • pneumonia • mechanical ventilation

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