BACKGROUND: Understanding factors affecting length of hospital stay (LOS) in patients with severe influenza may improve their management. METHODS: A retrospective cohort study on laboratory-confirmed, adult influenza patients hospitalized in 2004 and 2005 was conducted. For all influenza cases during that period, immunofluorescence assay on nasopharyngeal aspirate was used for rapid diagnosis, and oseltamivir (75 mg twice daily for 5 days) prescribed if the patient presented within 2 days of symptom onset. Independent factors associated with time to discharge were identified using Cox proportional hazards models. An adjusted hazard ratio (aHR) >1 signifies a higher chance of early discharge. Viral shedding and influenza vaccination history were studied during one 'flu' season. RESULTS: A total of 356 patients (influenza A 93.5%) were studied. The majority of patients were old (70.2 +/- 8.4 years), had > or = 1 comorbid illness (69.1%) and developed respiratory or cardiovascular complications (69.4%). Oseltamivir initiated within 2 days of illness was associated with shorter total LOS (Kaplan-Meier estimated median 4 versus 6 days [-33%]; aHR for discharge 1.54, 95% confidence intervals [95% CI] 1.23-1.92, P < 0.0001). Older age (> or = 70 years), comorbidities and complications were associated with prolonged LOS. Prolonged viral RNA detection >day 4 of illness (23 out of 99 consecutive patients) was also independently associated with longer LOS (aHR 0.36 [95% CI 0.19-0.71], P = 0.003), whereas influenza vaccination within 6 months was associated with shorter LOS (aHR 2.14 [95% CI 1.18-3.85], P = 0.012). CONCLUSION: Our analyses suggest that timely oseltamivir treatment is independently associated with shorter LOS in patients hospitalized for severe influenza. Efforts to ensure early diagnosis and therapeutic intervention are warranted.
BACKGROUND: Understanding factors affecting length of hospital stay (LOS) in patients with severe influenza may improve their management. METHODS: A retrospective cohort study on laboratory-confirmed, adult influenza patients hospitalized in 2004 and 2005 was conducted. For all influenza cases during that period, immunofluorescence assay on nasopharyngeal aspirate was used for rapid diagnosis, and oseltamivir (75 mg twice daily for 5 days) prescribed if the patient presented within 2 days of symptom onset. Independent factors associated with time to discharge were identified using Cox proportional hazards models. An adjusted hazard ratio (aHR) >1 signifies a higher chance of early discharge. Viral shedding and influenza vaccination history were studied during one 'flu' season. RESULTS: A total of 356 patients (influenza A 93.5%) were studied. The majority of patients were old (70.2 +/- 8.4 years), had > or = 1 comorbid illness (69.1%) and developed respiratory or cardiovascular complications (69.4%). Oseltamivir initiated within 2 days of illness was associated with shorter total LOS (Kaplan-Meier estimated median 4 versus 6 days [-33%]; aHR for discharge 1.54, 95% confidence intervals [95% CI] 1.23-1.92, P < 0.0001). Older age (> or = 70 years), comorbidities and complications were associated with prolonged LOS. Prolonged viral RNA detection >day 4 of illness (23 out of 99 consecutive patients) was also independently associated with longer LOS (aHR 0.36 [95% CI 0.19-0.71], P = 0.003), whereas influenza vaccination within 6 months was associated with shorter LOS (aHR 2.14 [95% CI 1.18-3.85], P = 0.012). CONCLUSION: Our analyses suggest that timely oseltamivir treatment is independently associated with shorter LOS in patients hospitalized for severe influenza. Efforts to ensure early diagnosis and therapeutic intervention are warranted.
Authors: W Paul Glezen; Jordana K Schmier; Carrie M Kuehn; Kellie J Ryan; John Oxford Journal: Am J Public Health Date: 2013-01-17 Impact factor: 9.308
Authors: Jonathan Hsu; Nancy Santesso; Reem Mustafa; Jan Brozek; Yao Long Chen; Jessica P Hopkins; Adrienne Cheung; Gayane Hovhannisyan; Liudmila Ivanova; Signe A Flottorp; Ingvil Saeterdal; Arthur D Wong; Jinhui Tian; Timothy M Uyeki; Elie A Akl; Pablo Alonso-Coello; Fiona Smaill; Holger J Schünemann Journal: Ann Intern Med Date: 2012-02-27 Impact factor: 25.391
Authors: Scott A Harper; John S Bradley; Janet A Englund; Thomas M File; Stefan Gravenstein; Frederick G Hayden; Allison J McGeer; Kathleen M Neuzil; Andrew T Pavia; Michael L Tapper; Timothy M Uyeki; Richard K Zimmerman Journal: Clin Infect Dis Date: 2009-04-15 Impact factor: 9.079
Authors: Alejandro Gómez-Gómez; Martin Magaña-Aquino; Christian Garcia-Sepúlveda; Uciel R Ochoa-Pérez; Reynaldo Falcón-Escobedo; Andreu Comas-García; Saray Aranda-Romo; Hugo I Contreras-Treviño; Paulina V Jimenéz-Rico; Mario A Banda-Barbosa; Félix Dominguez-Paulin; J Mario Bernal-Blanco; Luis F Peréz-González; Daniel E Noyola Journal: Emerg Infect Dis Date: 2010-01 Impact factor: 6.883