Objectives: To assess uniformity of criteria for hospitalization and management of inpatients with documented 2009 A/H1N1 influenza, at a time when national guidelines for management were issued by the public health authorities.
Methods: This was a prospective observational cohort study. We included all adults with laboratory-confirmed pandemic 2009 A/H1N1 influenza in three hospitals in central Israel admitted between 22/7/2009 and 15/2/2010. We compared baseline data, results and treatment management between the three hospitals. Chi-square, ANOVA and Kruskal-WalLis tests were performed.
Results: Overall, 496 patients with documented 2009 A/H1N1 influenza were included; the mean age was 44 years (range 19-93). Of all the patients sampled, PCR for influenza was positive in 21.2% [178/840], 27.4% [124/453] and 18.6% [194/1043] in the three hospitals. Differences between hospitals in baseline patient characteristics were few. Significant differences were observed with regard to disease characteristics at admission, including temperature, respiratory symptoms, hypoxia, pulmonary infiltrates (33.7% [60/178], 19.4% [24/124] and 38.7% [75/194]), all influenza complications and severity of illness score (p < 0.05 for all). Differences were observed with regard to oseltamivir treatment, ranging from 79.5% to 98.9% of inpatients. Antibiotic treatment was common (overall 71%) but differences between hospitals were observed with regard to the antibiotic regimens used. The ratio of infectious disease physicians to hospital-bed ratio was low and variable (0.35, and 0.35 per 100 beds).
Conclusions: There was significant variability between hospitals in the hospitalization and management of patients hospitalized with 2009 A/H1N1 influenza.