COL 8-02 - Facteurs de risque de nocardiose après transplantation d'organe :première étude rétrospective cas-témoin européenne

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Estimating severity of influenza epidemics from severe acute respiratory infections (SARI) in intensive care units.

While influenza-like-illness (ILI) surveillance is well-organized at primary care level in Europe, few data are available on more severe cases. With retrospective data from intensive care units (ICU) we aim to fill this current knowledge gap. Using multiple parameters proposed by the World Health Organization we estimate the burden of severe acute respiratory infections (SARI) in the ICU and how this varies between influenza epidemics. We analyzed weekly ICU admissions in the Netherlands (2007-2016) from the National Intensive Care Evaluation (NICE) quality registry (100% coverage of adult ICUs in 2016; population size 14 million) to calculate SARI incidence, SARI peak levels, ICU SARI mortality, SARI mean Acute Physiology and Chronic Health Evaluation (APACHE) IV score, and the ICU SARI/ILI ratio. These parameters were calculated both yearly and per separate influenza epidemic (defined epidemic weeks). A SARI syndrome was defined as admission diagnosis being any of six pneumonia or pulmonary sepsis codes in the APACHE IV prognostic model. Influenza epidemic periods were retrieved from primary care sentinel influenza surveillance data. Annually, an average of 13% of medical admissions to adult ICUs were for a SARI but varied widely between weeks (minimum 5% to maximum 25% per week). Admissions for bacterial pneumonia (59%) and pulmonary sepsis (25%) contributed most to ICU SARI. Between the eight different influenza epidemics under study, the value of each of the severity parameters varied. Per parameter the minimum and maximum of those eight values were as follows: ICU SARI incidence 558-2400 cumulated admissions nationwide, rate 0.40-1.71/10,000 inhabitants; average APACHE score 71-78; ICU SARI mortality 13-20%; ICU SARI/ILI ratio 8-17 cases per 1000 expected medically attended ILI in primary care); peak-incidence 101-188 ICU SARI admissions in highest-incidence week, rate 0.07-0.13/10,000 population). In the ICU there is great variation between the yearly influenza epidemic periods in terms of different influenza severity parameters. The parameters also complement each other by reflecting different aspects of severity. Prospective syndromic ICU SARI surveillance, as proposed by the World Health Organization, thereby would provide insight into the severity of ongoing influenza epidemics, which differ from season to season

ICU respiratory admissions data for influenza severity surveillance?

ObjectiveIntensive Care Unit (ICU) data are registered for quality monitoring in the Netherlands with near 100% coverage. They are a ‘big data’ type source that may be useful for infectious disease surveillance. We explored their potential to enhance the surveillance of influenza which is currently based on the milder end of the disease spectrum. We ultimately aim to set up a real-surveillance system of severe acute respiratory infections.IntroductionWhile influenza-like-illness (ILI) surveillance is well-organized at primary care level in Europe, little data is available on more severe cases. With retrospective data from ICU’s we aim to fill this current knowledge gap and to explore its worth for prospective surveillance. Using multiple parameters proposed by the World Health Organization we estimated the burden of severe acute respiratory infections (SARI) to ICU and how this varies between influenza epidemics.MethodsWe analyzed weekly ICU admissions of adults in the Netherlands (2007-2016) from the national intensive care evaluation (NICE) quality registry (100% coverage of adult ICU in 2016; population size 14 million adults. A SARI syndrome was defined as admission diagnosis being any of 6 pneumonia or pulmonary sepsis codes in the Acute Physiology and Chronic Health Evaluation IV (APACHE IV) prognostic model. Influenza epidemic periods were retrieved from primary care sentinel influenza surveillance data. In recent years NICE has explored and promoted increased timeliness and automation of data transfer.ResultsAnnually, 11-14% of medical admissions to adult ICUs were for a SARI (5-25% weekly). Admissions for bacterial pneumonia (59%) and pulmonary sepsis (25%) contributed most to ICU-SARI. Between influenza epidemics, severity indicators varied: ICU-SARI incidence (between 558-2,400 cumulated admissions nation-wide, rate: 0.40-1.71/10,000 inhabitants), average APACHE score (between 71-78), ICU-SARI mortality (between 13-20%), ICU-SARI/ILI ratio (between 8-17 SARI ICU cases per 1,000 expected medically attended influenza-like-illness in primary care), peak incidence (between 101-188 ICU-SARI admissions nationally in the highest week, rate: between 0.07-0.13/10,000 population).ICUs use different types of electronic health records (EHRs). Data submitted to the NICE registry is mainly based on routinely collected data extracted from these EHRs. The timeliness of data submission varies between a few weeks and three months. Together with ICUs, the NICE registry has recently undertaken actions to increase timeliness of ICU data submission.ConclusionsIn ICU data, great variation can be seen between the yearly influenza epidemic periods in terms of different influenza severity parameters. The parameters also complement each other by reflecting different aspects of severity. Prospective syndromic ICU-SARI surveillance, as proposed by the World Health Organization would provide insight into severity of ongoing influenza epidemics which differ from season to season.Currently a subset of hospitals provide data with a 6-week delay. This can be a worthwhile addition to current influenza surveillance, which, while timelier, is based on milder cases seen by general practitioners (primary care). Future increases in data timeliness will remain an aim

Estimating severity of influenza epidemics from severe acute respiratory infections (SARI) in intensive care units

BACKGROUND: While influenza-like-illness (ILI) surveillance is well-organized at primary care level in Europe, few data are available on more severe cases. With retrospective data from intensive care units (ICU) we aim to fill this current knowledge gap. Using multiple parameters proposed by the World Health Organization we estimate the burden of severe acute respiratory infections (SARI) in the ICU and how this varies between influenza epidemics. METHODS: We analyzed weekly ICU admissions in the Netherlands (2007-2016) from the National Intensive Care Evaluation (NICE) quality registry (100% coverage of adult ICUs in 2016; population size 14 million) to calculate SARI incidence, SARI peak levels, ICU SARI mortality, SARI mean Acute Physiology and Chronic Health Evaluation (APACHE) IV score, and the ICU SARI/ILI ratio. These parameters were calculated both yearly and per separate influenza epidemic (defined epidemic weeks). A SARI syndrome was defined as admission diagnosis being any of six pneumonia or pulmonary sepsis codes in the APACHE IV prognostic model. Influenza epidemic periods were retrieved from primary care sentinel influenza surveillance data. RESULTS: Annually, an average of 13% of medical admissions to adult ICUs were for a SARI but varied widely between weeks (minimum 5% to maximum 25% per week). Admissions for bacterial pneumonia (59%) and pulmonary sepsis (25%) contributed most to ICU SARI. Between the eight different influenza epidemics under study, the value of each of the severity parameters varied. Per parameter the minimum and maximum of those eight values were as follows: ICU SARI incidence 558-2400 cumulated admissions nationwide, rate 0.40-1.71/10,000 inhabitants; average APACHE score 71-78; ICU SARI mortality 13-20%; ICU SARI/ILI ratio 8-17 cases per 1000 expected medically attended ILI in primary care); peak-incidence 101-188 ICU SARI admissions in highest-incidence week, rate 0.07-0.13/10,000 population). CONCLUSIONS: In the ICU there is great variation between the yearly influenza epidemic periods in terms of different influenza severity parameters. The parameters also complement each other by reflecting different aspects of severity. Prospective syndromic ICU SARI surveillance, as proposed by the World Health Organization, thereby would provide insight into the severity of ongoing influenza epidemics, which differ from season to season