Diego Viasus1, José Ramón Paño-Pardo2, Jerónimo Pachón3, Melchor Riera4, Francisco López-Medrano5, Antoni Payeras6, M Carmen Fariñas7, Asunción Moreno8, Jesús Rodríguez-Baño9, José Antonio Oteo10, Lucia Ortega11, Julián Torre-Cisneros12, Ferrán Segura13, Jordi Carratalà14. 1. Departments of Infectious Diseases from the Hospital Universitari de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain. 2. Hospital Universitario La Paz-IDIPAZ, Madrid, Spain. 3. Hospital Universitario Virgen del Rocío, Sevilla, Spain. 4. Hospital Universitario Son Dureta, Palma de Mallorca, Spain. 5. Hospital Universitario 12 de Octubre, Madrid, Spain. 6. Hospital Son Llàtzer, Palma de Mallorca, Spain. 7. Hospital Universitario Marqués de Valdecilla, Santander, Spain. 8. Hospital Universitario Clinic, Barcelona, Spain. 9. Hospital Universitario Virgen Macarena, Sevilla, Spain. 10. Hospital San Pedro-CIBIR, Logroño, Spain. 11. SCIAS-Hospital de Barcelona, Barcelona, Spain. 12. Hospital Universitario Reina Sofía-IMIBIC, University of Córdoba, Córdoba, Spain. 13. Hospital Parc Tauli, Sabadell, Spain. 14. Departments of Infectious Diseases from the Hospital Universitari de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain. Electronic address: jcarratala@ub.edu.
Abstract
BACKGROUND: Data on the clinical effectiveness of oseltamivir in patients with pandemic 2009 influenza A(H1N1) (A[H1N1]) virus infection are scarce. We aimed to determine the effect of timing of oseltamivir administration on outcomes in hospitalized adults with A(H1N1). METHODS: Observational analysis of a prospective cohort of adults hospitalized with laboratory-confirmed A(H1N1) was performed at 13 Spanish hospitals. Time from onset of symptoms to oseltamivir administration was the independent variable. Outcomes were duration of fever, hospital length of stay (LOS), need for mechanical ventilation, and mortality during hospitalization. Multivariate logistic regression was used to describe the association between the independent variable and the outcomes. RESULTS: Five hundred thirty-eight hospitalized patients with A(H1N1) were studied. The median time from onset of symptoms to oseltamivir administration was 3 days (interquartile range [IQR], 2-5 days). With regard to outcomes, the median duration of fever was 2 days (IQR, 1-3 days), the median LOS was 5 days (IQR, 3-8 days), 49 patients (9.1%) underwent mechanical ventilation, and 11 patients (2%) died during hospitalization. In univariate analysis, prolonged duration of fever (above the median), prolonged LOS (above the median), need for mechanical ventilation, and mortality all increased with time to oseltamivir administration (χ(2) test for trend P = .001, P ≤ .001, P = .008, and P = .001, respectively). After adjustment for confounding factors, time from onset of symptoms to oseltamivir administration (+ 1-day increase) was associated with a prolonged duration of fever (OR, 1.10; 95% CI, 1.02-1.19), prolonged LOS (OR, 1.07; 95% CI, 1.00-1.15), and higher mortality (OR, 1.20; 95% CI, 1.06-1.35). CONCLUSIONS: Timely oseltamivir administration has a beneficial effect on outcomes in hospitalized adults with A(H1N1), even in those who are admitted beyond 48 h after onset of symptoms.
BACKGROUND: Data on the clinical effectiveness of oseltamivir in patients with pandemic 2009 influenza A(H1N1) (A[H1N1]) virus infection are scarce. We aimed to determine the effect of timing of oseltamivir administration on outcomes in hospitalized adults with A(H1N1). METHODS: Observational analysis of a prospective cohort of adults hospitalized with laboratory-confirmed A(H1N1) was performed at 13 Spanish hospitals. Time from onset of symptoms to oseltamivir administration was the independent variable. Outcomes were duration of fever, hospital length of stay (LOS), need for mechanical ventilation, and mortality during hospitalization. Multivariate logistic regression was used to describe the association between the independent variable and the outcomes. RESULTS: Five hundred thirty-eight hospitalized patients with A(H1N1) were studied. The median time from onset of symptoms to oseltamivir administration was 3 days (interquartile range [IQR], 2-5 days). With regard to outcomes, the median duration of fever was 2 days (IQR, 1-3 days), the median LOS was 5 days (IQR, 3-8 days), 49 patients (9.1%) underwent mechanical ventilation, and 11 patients (2%) died during hospitalization. In univariate analysis, prolonged duration of fever (above the median), prolonged LOS (above the median), need for mechanical ventilation, and mortality all increased with time to oseltamivir administration (χ(2) test for trend P = .001, P ≤ .001, P = .008, and P = .001, respectively). After adjustment for confounding factors, time from onset of symptoms to oseltamivir administration (+ 1-day increase) was associated with a prolonged duration of fever (OR, 1.10; 95% CI, 1.02-1.19), prolonged LOS (OR, 1.07; 95% CI, 1.00-1.15), and higher mortality (OR, 1.20; 95% CI, 1.06-1.35). CONCLUSIONS: Timely oseltamivir administration has a beneficial effect on outcomes in hospitalized adults with A(H1N1), even in those who are admitted beyond 48 h after onset of symptoms.
Authors: Justin J O'Hagan; Karen K Wong; Angela P Campbell; Anita Patel; David L Swerdlow; Alicia M Fry; Lisa M Koonin; Martin I Meltzer Journal: Clin Infect Dis Date: 2015-05-01 Impact factor: 9.079
Authors: Carmen S Arriola; Evan J Anderson; Joan Baumbach; Nancy Bennett; Susan Bohm; Mary Hill; Mary Lou Lindegren; Krista Lung; James Meek; Elizabeth Mermel; Lisa Miller; Maya L Monroe; Craig Morin; Oluwakemi Oni; Arthur Reingold; William Schaffner; Ann Thomas; Shelley M Zansky; Lyn Finelli; Sandra S Chaves Journal: J Infect Dis Date: 2015-03-27 Impact factor: 5.226
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