RESUMEN
Se describe la preparación y la atención médica durante la epidemia de influenza A(H1N1) (junio 2009) en un hospital general de agudos, público, de alta complejidad; con diagnóstico de laboratorio, internación general y cuidados intensivos (UCI). Se elaboró un plan para aumentar la capacidad asistencial, reasignar recursos y garantizar la bioseguridad. La consulta fue 7.1 ± 3.8 veces mayor que en 2006-2008. La detección de casos de A(H1N1) fue confirmada por PCR-RT en 186/486 (38.3%) pacientes internados y en 56/176 (31.8%) ambulatorios. Internados: mediana de edad 20 años; 75% menores de 45 y 32.3% menores de 15. Mortalidad global: 6.8%; 9.1% en los positivos. Adultos: recepción en un área de atención ambulatoria, internación (aislamiento) y ventilación mecánica. Sala general: ingresaron 110 pacientes (5 veces más que 1999-2006) con saturación de oxígeno < 96% y/o factores de riesgo (65.5% presentaron asma, enfermedad pulmonar obstructiva crónica, obesidad, embarazo, otros). Radiografía con infiltrados y/o consolidación pulmonar: 97.3%. Hipoxemia significativa: 43.5%. En 21/49 se confirmó A(H1N1), sin diferencias clínico-radiológicas significativas con PCR-negativa/pendiente. Tratamiento: oseltamivir, ampicilina-sulbactam y claritromicina. UCI: fueron ingresados 28 pacientes con neumonía grave (21 con condiciones asociadas). Veinticuatro recibieron ventilación mecánica por síndrome de distress respiratorio agudo, 21 presentaron shock y 8/9 requirieron hemodiálisis por fallo renal agudo. Mortalidad: 14/28; con infección A(H1N1) confirmada 7/14. Niños: 70 con A(H1N1) confirmada fueron internados (27 requirieron UCI, 6 fallecieron). La mediana de edad fue 11 meses; 61.8% con comorbilidades (prematurez, asma, displasia broncopulmonar, cardiopatía congénita). Recibieron oseltamivir y antibióticos. Mortalidad en niños: 8.6%.
The preparation and medical care during the influenza A(H1N1) outbreak (June 2009) in a high complexity level, public, general hospital with laboratory diagnosis, general and intensive care (ICU) hospitalization is described. A plan was designed to increase the hospital's surge capacity, reallocate resources and guarantee bio-safety. The number of consultations was 7.1 ± 3.8 times higher than during June 2006-2008. Detection of A(H1N1) cases were confirmed by PCR-RT in 186/486 (38.3%) in-patients and 56/176 (31.8%) out-patients. Median age among in-patients was 20 years; 75% < 45 and 32.3% < 15. Global mortality: 6.8%; 9.1% among confirmed cases. Adults were directed to a reception area of out-patient care, hospitalization (isolation) and mechanical ventilation. General ward: 110 patients with oxygen saturation < 96% and/or risk factors (65.5% had asthma, chronic obstructive pulmonary disease, obesity, pregnancy or other) were admitted (5 times more than in 1999-2006). Chest X-ray showed lung infiltrates and/or lung consolidation in 97.3%. Severe hypoxemia: 43.5%. There were no significant clinical or X-ray differences between 21/49 confirmed and non confirmed A(H1N1) cases. Treatment: oseltamivir, ampicillin-sulbactam, and clarithromycin. ICU: 28 severe pneumonia patients were admitted (21 with associated conditions); 24 with acute respiratory distress syndrome received mechanical ventilation, 21 of them had shock; 8/9 acute renal failure cases required hemodialysis. Mortality: 14/28; 7/14 with confirmed A(H1N1) infection. Seventy A(H1N1) infected children were hospitalized (27 required ICU, 6 of them died). The children's median age was 11 months; 61.8% presented comorbidities (prematurity, asthma, broncho-pulmonary dysplasia and congenital heart disease). Oseltamivir and antibiotics were administered. Children's mortality: 8.6%.