Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenzaa

Uyeki, Timothy M.; Bernstein, Henry H.; Bradley, John S.; Englund, Janet A.; File, Thomas M.; Fry, Alicia M.; Gravenstein, Stefan; Hayden, Frederick G.; Harper, Scott; Hirshon, Jon Mark; Ison, Michael G.; Johnston, BL; Knight, Shandra L; McGeer, Allison; Riley, Laura E.; Wolfe, Cameron R.; Alexander, Paul; Pavia, Andrew T.

doi:10.1093/cid/ciy874

Cited by 360 publications

(374 citation statements)

References 15 publications

(12 reference statements)

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“…We validated and updated models to predict poor outcome in these patients at the time of RSV diagnosis. This model can be used to develop a risk score or decision tool to guide decisions on treatment with ribavirin, immune globulins, and other antivirals and on site‐of‐care and strict isolation procedure decisions, as is already common practice for influenza virus . These interventions might improve clinical outcomes for patients with life‐threatening disease.…”

Section: Discussionmentioning

confidence: 99%

External validation and update of a prognostic model to predict mortality in hospitalized adults with RSV: A retrospective Dutch cohort study

Vos

Oosterheert

Hoepelman

et al. 2019

Journal of Medical Virology

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Respiratory syncytial virus (RSV) causes significant mortality in hospitalized adults. Prediction of poor outcomes improves targeted management and clinical outcomes. We externally validated and updated existing models to predict poor outcome in hospitalized RSV‐infected adults. In this single center, retrospective, observational cohort study, we included hospitalized adults with respiratory tract infections (RTIs) and a positive polymerase chain reaction for RSV (A/B) on respiratory tract samples (2005‐2018). We validated existing prediction models and updated the best discriminating model by revision, recalibration, and incremental value testing. We included 192 RSV‐infected patients (median age 60.7 years, 57% male, 65% immunocompromised, and 43% with lower RTI). Sixteen patients (8%) died within 30 days. During hospitalization, 16 (8%) died, 30 (16%) were admitted to intensive care unit, 21 (11%) needed invasive mechanical ventilation, and 5 (3%) noninvasive positive pressure ventilation. Existing models performed moderately at external validation, with C‐statistics 0.6 to 0.7 and moderate calibration. Updating to a model including lower RTI, chronic pulmonary disease, temperature, confusion and urea, increased the C‐statistic to 0.76 (95% confidence interval, 0.61‐0.91) to predict in‐hospital mortality. In conclusion, existing models to predict poor prognosis among hospitalized RSV‐infected adults perform moderately at external validation. A prognostic model may help to identify and treat RSV‐infected adults at high‐risk of death.

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Section: Discussionmentioning

confidence: 99%

External validation and update of a prognostic model to predict mortality in hospitalized adults with RSV: A retrospective Dutch cohort study

Vos

Oosterheert

Hoepelman

et al. 2019

Journal of Medical Virology

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“…The diagnosis relies on identification of the virus in various samples. CARVs can be identified by cultures, serology, or rapid diagnostic tests based on enzyme immunoassay (EIA), immunofluorescence, [59].…”

Section: Viral Pneumoniamentioning

confidence: 99%

Diagnosis of severe respiratory infections in immunocompromised patients

et al. 2020

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An increasing number of critically ill patients are immunocompromised. Acute hypoxemic respiratory failure (ARF), chiefly due to pulmonary infection, is the leading reason for ICU admission. Identifying the cause of ARF increases the chances of survival, but may be extremely challenging, as the underlying disease, treatments, and infection combine to create complex clinical pictures. In addition, there may be more than one infectious agent, and the pulmonary manifestations may be related to both infectious and non-infectious insults. Clinically or microbiologically documented bacterial pneumonia accounts for one-third of cases of ARF in immunocompromised patients. Early antibiotic therapy is recommended but decreases the chances of identifying the causative organism(s) to about 50%. Viruses are the second most common cause of severe respiratory infections. Positive tests for a virus in respiratory samples do not necessarily indicate a role for the virus in the current acute illness. Invasive fungal infections (Aspergillus, Mucorales, and Pneumocystis jirovecii) account for about 15% of severe respiratory infections, whereas parasites rarely cause severe acute infections in immunocompromised patients. This review focuses on the diagnosis of severe respiratory infections in immunocompromised patients. Special attention is given to newly validated diagnostic tests designed to be used on non-invasive samples or bronchoalveolar lavage fluid and capable of increasing the likelihood of an early etiological diagnosis.

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“…Recommended antiviral treatments of severe seasonal influenza are currently limited to the neuraminidase inhibitors (NAIs) . While effective at shortening the duration of influenza symptoms when administered early in the course of infection, debate continues as to the extent NAIs are able to prevent progression to severe infection, the development of complications in hospitalised individuals, or reduce mortality …”

Section: Introductionmentioning

confidence: 99%

“…The recent 2018 Infectious Diseases Society of America (IDSA) seasonal influenza guidelines do not recommend any immunomodulatory therapies as adjunctive treatments . This systematic review focuses on immunomodulatory agents other than corticosteroids for the treatment of severe influenza.…”

Section: Introductionmentioning

confidence: 99%

Passive immune therapy and other immunomodulatory agents for the treatment of severe influenza: Systematic review and meta‐analysis

Lim

Car

Leo

et al. 2019

Influenza Resp Viruses

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Background A range of immunomodulatory therapies have been proposed as adjuncts to conventional antivirals to suppress harmful inflammation during severe influenza infection. We conducted a systematic review to assess available data of the effect of adjunctive non‐corticosteroid immunomodulatory therapy and potential adverse effects. Method We searched MEDLINE, Embase, Web of Science and clinical trial databases for published and unpublished studies, and screened the references of included articles. We included RCTs, quasi‐RCTs and observational studies of virologically confirmed influenza infections in hospitalised patients. We did not restrict studies by language of publication, influenza type/subtype or age of participants. Where possible, we pooled estimates of effect using random‐effects meta‐analysis models. Results We identified 11 eligible studies for inclusion: five studies (4 RCTs and 1 observational; 693 individuals) of passive immune therapy; four studies (3 RCTs and 1 observational; 1120 individuals) of macrolides and/or non‐steroidal anti‐inflammatory drugs (NSAIDs), one RCT of mTOR inhibitors (38 individuals), and one RCT of statin therapy (116 individuals). Meta‐analysis of RCTs of passive immune therapy indicated no significant reduction in mortality (OR 0.84, 0.37‐1.90), but better clinical outcomes at Day 7 (OR 1.42, 1.05‐1.92). There was a significant reduction in mortality associated with macrolides and/or NSAIDs (OR 0.28; 0.10‐0.77). Conclusions Passive immune therapy is unlikely to offer substantial mortality benefit in treatment of severe seasonal influenza, but may improve clinical outcomes. The effect of other immunomodulatory agents is uncertain, but promising. There is a need for high‐quality RCTs with sufficient statistical power to address this evidence gap.

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Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenzaa

Cited by 360 publications

References 15 publications

External validation and update of a prognostic model to predict mortality in hospitalized adults with RSV: A retrospective Dutch cohort study

External validation and update of a prognostic model to predict mortality in hospitalized adults with RSV: A retrospective Dutch cohort study

Diagnosis of severe respiratory infections in immunocompromised patients

Passive immune therapy and other immunomodulatory agents for the treatment of severe influenza: Systematic review and meta‐analysis

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