Factors affecting the discharge of patients from hospital with seasonal influenza—the role of the Rapid Influenza testing in hospital discharges

A Correction to this article is available

This article has been updated

Abstract

Influenza is a major cause of presentations to the emergency departments. Introduction of the Rapid Influenza tests has assisted with diagnosis and facilitated patient discharges. We designed this study to identify factors affecting hospital discharge and to understand the role of Rapid Influenza testing. A retrospective observational study of patients was done during influenza season in 2017. Clinical data was obtained from electronic medical records. Rapid Influenza testing was performed using Xpert Flu/RSV (Cepheid, USA). Univariate and multivariate analysis was done using SPSS Version 26 (IBM, NY). A total of 665 patients presented with laboratory-confirmed influenza. Patients discharged from the hospital were younger (median age 62 vs 68, p = 0.031). Patients with immunosuppression, chronic obstructive pulmonary disease (COPD) and pneumonia were more likely to be admitted to hospital. Rapid testing done with a turnaround (TAT) of 2 h (27.8% vs 17.8%, p = 0.002) and with a TAT of 6 h (55% vs 46.3%, p = 0.026) of the patient presentation was associated with a higher rate of hospital discharge. Median TAT of the RIT was 6 h (IQR 1–40 h). On multivariable analysis, RIT TAT of ≤ 2 h (OR 1.62, p = 0.013) was associated with higher likelihood of patients being discharged, whereas immunosuppressed patients (OR 2.25, p = 0.011), COPD (OR 2.42, p = 0.001) and pneumonia on presentation (OR 8.10, p < 0.001) were more likely to get admitted. Patients with COPD, pneumonia on presentation and those with immunosuppression are more likely to be admitted. Rapid Influenza tests can facilitate the discharge of patients from hospital.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3

Change history

  • 25 November 2020

    A Correction to this paper has been published: <ExternalRef><RefSource>https://doi.org/10.1007/s10096-020-04105-1</RefSource><RefTarget Address="10.1007/s10096-020-04105-1" TargetType="DOI"/></ExternalRef>

References

  1. 1.

    https://www.cdc.gov/flu/professionals/diagnosis/consider-influenza-testing.htm, CDC Website, accessed 15th May 2019

  2. 2.

    Akers E, Weber R, Sax H, Böni J et al (2017) Influence of time to diagnosis of severe influenza on antibiotic use, length of stay, isolation precautions, and mortality: a retrospective study. Influenza Other Respir Viruses 11(4):337–344

    CAS  Article  Google Scholar 

  3. 3.

    Chertow S, Memoli J (2012) Bacterial coinfection in influenza: a grand rounds review. J Amer Med Assoc 309(3):275–282. https://doi.org/10.1001/jama.2012.194139

    Article  Google Scholar 

  4. 4.

    Nielsen J, Vestergaard LS, Richter L, Schmid D et al ( 2019) European all-cause excess and influenza-attributable mortality in the 2017/18 season: should the burden of influenza B be reconsidered? Clin Microbiol Infect, 25: 1266 - 1276

  5. 5.

    Rogers BB, Shankar P, Jerris RC et al (2015) Impact of a rapid respiratory panel test on patient outcomes. Arch Pathol Lab Med 139:636–641

    Article  Google Scholar 

  6. 6.

    Kakeya H, Seki M, Izumikawa K et al (2014) Efficacy of combination therapy with oseltamivir phosphate and azithromycin for influenza: a multicenter, open-label, randomized study. PLoS One 9:e91293

    Article  Google Scholar 

  7. 7.

    Shiley KT, Lautenbach E, Lee I (2010) The use of antimicrobial agents after diagnosis of viral respiratory tract infections in hospitalized adults: antibiotics or anxiolytics? Infect Control Hosp Epidemiol 31:1177–1183

    Article  Google Scholar 

  8. 8.

    Oosterheert JJ, van Loon AM, Schuurman R et al (2005) Impact of rapid detection of viral and atypical bacterial pathogens by real-time polymerase chain reaction for patients with lower respiratory tract infection. Clin Infect Dis 41:1438–1444

    Article  Google Scholar 

  9. 9.

    van Esso DL, Valente AM, Vilà M, Casanovas JM et al (2019) Rapid Influenza testing in infants and children younger than 6 years in primary care: impact on antibiotic treatment and use of health services. Pediatr Infect Dis J 38(8):e187–e189

    Article  Google Scholar 

  10. 10.

    Garvey MI, Wilkinson MAC, Bradley CW, Biggs M et al (2019) Impact of a PCR point of care test for influenza A/B on an acute medical unit in a large UK teaching hospital: results of an observational, pre and post intervention study. Antimicrob Resist Infect Control 8:120

    Article  Google Scholar 

  11. 11.

    Valentin T, Kieslinger P, Stelzl E, Santner BI et al (2019) Prospective evaluation of three rapid molecular tests for seasonal influenza in patients presenting at an emergency unit. J Clin Virol 111:29–32

    CAS  Article  Google Scholar 

  12. 12.

    Mertz D, Kim TH, Johnstone J, Lam PP et al (2013) Populations at risk for severe or complicated influenza illness: systematic review and meta-analysis. BMJ. https://doi.org/10.1136/bmj.f5061

  13. 13.

    http://www.health.gov.au/internet/main/publishing.nsw/content/ozflu-surveil-2017-final.htm, accessed March 6th 2019

  14. 14.

    Rappo U, Schuetz A, Jenkins S et al (2016) Impact of early detection of respiratory viruses by multiplex PCR assay on clinical outcomes in adult patients. J Clin Microbiol 54:2096–2103

    CAS  Article  Google Scholar 

  15. 15.

    Linehan E, Brennan M, O’Rourke S et al (2018) Impact of introduction of Xpert Flu assay for Influenza PCR testing on obstetric patients: a quality improvement project. J Matern Fetal Neonatal Med 31:1016–1020

    Article  Google Scholar 

  16. 16.

    Wabe N, Li L, Lindeman R, Yimsung R et al The impact of rapid molecular diagnostic testing for respiratory viruses on outcomes for emergency department patients. Med J Aust. https://doi.org/10.5694/mja2.50049

  17. 17.

    Cantais A, Mory O, Plat A, Bourmard A et al (2018) Clin Microbiol Infect. https://doi.org/10.1016/j.cmi.2018.11.019

  18. 18.

    Benirschke R, McElvanvia E, Thomson R, Kaul K et al Clinical impact of rapid point of care polymerase chain reaction Influenza testing in an urgent care setting: a single centre study. J Clin Microbiol. https://doi.org/10.1128/JCm.01281-18

  19. 19.

    Collins P, Campbell P, Openo K, Farley M et al (2019) Outcomes of immunocompromised adults hospitalized with laboratory-confirmed influenza in the United States, 2011–2015. Clin Infect Dis. https://doi.org/10.1093/cid/ciz638

  20. 20.

    Garvey MI, Wilkinson MAC, Bradley CW, Biggs M et al (2019) Impact of a PCR point of care test for influenza A/B on an acute medical unit in a large UK teaching hospital: results of an observational, pre and post intervention study. Antimicrob Resist Infect Control. https://doi.org/10.1186/s13756-019-0575-6

  21. 21.

    O’Callaghan K, Jones K (2019) Rapid testing for respiratory viruses: impact on antibiotic use and time to patient discharge. Infect Dis Health 24(3):147–151

    Article  Google Scholar 

  22. 22.

    Yandrapalli S, Aronow W, Frishman W (2018) Readmissions in adult patients following hospitalisation for influenza: a nationwide cohort study. Ann Transl Med 6(16):318

    Article  Google Scholar 

  23. 23.

    Bekkat-Berkani R, Wilkinson T, Buchy P, Dos Santos G et al (2017) Seasonal influenza vaccination in patients with COPD: a systematic literature review. BMC Pulm Med 17(1):79. https://doi.org/10.1186/s12890-017-0420-8

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Li-Kim-Moy J, Yin K, Blyth C, Kesson A et al (2017) Influenza hospitalisations in Australian children. Epidemiol Infect 145(7):1451–1460

    CAS  Article  Google Scholar 

  25. 25.

    Wabe N, Li L, Dahm MR, Lindeman R, Yimsung R et al (2019) Timing of respiratory virus molecular testing in emergency departments and its association with patient care outcomes: a retrospective observational study across six Australian hospitals. BMJ Open 9(8):e030104

    Article  Google Scholar 

  26. 26.

    Trabattoni E, Le V, Pilmis B, Pean de Ponfilly G (2018) Implementation of Alere i Influenza A & B point of care test for the diagnosis of influenza in an ED. Am J Emerg Med 36(6):916–921

    CAS  Article  Google Scholar 

  27. 27.

    Youngs J, Marshall B, Farragher M, Whitney L et al (2019) Implementation of influenza point-of-care testing and patient cohorting during a high-incidence season: a retrospective analysis of the impact on infection prevention and control and clinical outcomes. J Hosp Infect 101(3):276–284

    CAS  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Ruchir Chavada.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethics approval was given by CCLHD Clinical Governance unit was as QI study (0518-042C).

Informed consent

Waiver for informed patient consent was granted by CCLHD CGU.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The original online version of this article was revised: In the originally published article, the first names and last names of authors were presented in the wrong order. The names Chavada Ruchir, Clifford Liam, and Weisback Owen should be presented as Ruchir Chavada, Liam Clifford, and Owen Weisback.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Chavada, R., Clifford, L. & Weisback, O. Factors affecting the discharge of patients from hospital with seasonal influenza—the role of the Rapid Influenza testing in hospital discharges. Eur J Clin Microbiol Infect Dis (2019). https://doi.org/10.1007/s10096-019-03752-3

Download citation

Keywords

  • Hospital discharge
  • Influenza
  • Rapid Influenza test