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Clin Infect Dis. 2017 May 15;64(10):1328-1334. doi: 10.1093/cid/cix127.

Impact of Outpatient Neuraminidase Inhibitor Treatment in Patients Infected With Influenza A(H1N1)pdm09 at High Risk of Hospitalization: An Individual Participant Data Metaanalysis.

Author information

1
Division of Epidemiology and Public Health, University of Nottingham, and.
2
MRC Unit for Lifelong Health and Ageing, University College London, United Kingdom.
3
Ministry of Health, Riyadh, Kingdom of Saudi Arabia.
4
Public Health England, United Kingdom.
5
Department of Infection Control, Hospital San Martín de Paraná, Entre Ríos, Argentina.
6
Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Israel.
7
Pôle Femme Mère Enfant, Centre Hospitalier Universitaire de la Réunion.
8
Institut National de la Santé et de la Recherche Médical (INSERM) Centre for Clinical Investigation (CIC1410), Centre Hospitalier Universitaire de la Réunion, Saint Pierre.
9
Unité Mixte 134 PIMIT "Processus Infectieux en Milieu Insulaire Tropical" (Centre National de la Recherche Scientifique 9192, INSERM U1187, Institut Recherche et Développement 249), Université de la Réunion, CYROI "Cyclotron Réunion-océan Indien", Sainte Clotilde, Reunion.
10
Molecular Diagnostic Centre, Department of Laboratory Medicine National University Hospital, and.
11
Department of Pathology, National University of Singapore.
12
College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia.
13
Department of Pediatrics, Charité University Medical Center, and.
14
National Reference Centre Influenza at Robert Koch Institute, Berlin, Germany.
15
University Hospitals Leicester, and.
16
Department of Infection, Immunity and Inflammation, University of Leicester, United Kingdom.
17
Division of Infectious Diseases, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Canada.
18
General Hospital Slovenj Gradec, Slovenia.

Abstract

Background:

While evidence exists to support the effectiveness of neuraminidase inhibitors (NAIs) in reducing mortality when given to hospitalized patients with A(H1N1)pdm09 virus infection, the impact of outpatient treatment on hospitalization has not been clearly established. We investigated the impact of outpatient NAI treatment on subsequent hospitalization in patients with A(H1N1)pdm09 virus infection.

Methods:

We assembled general community and outpatient data from 9 clinical centers in different countries collected between January 2009 and December 2010. We standardized data from each study center to create a pooled dataset and then used mixed-effects logistic regression modeling to determine the effect of NAI treatment on hospitalization. We adjusted for NAI treatment propensity and preadmission antibiotic use, including "study center" as a random intercept to account for differences in baseline hospitalization rate between centers.

Results:

We included 3376 patients with influenza A(H1N1)pdm09, of whom 3085 (91.4%) had laboratory-confirmed infection. Eight hundred seventy-three patients (25.8%) received outpatient or community-based NAI treatment, 928 of 2395 (38.8%) with available data had dyspnea or respiratory distress, and hospitalizations occurred in 1705 (50.5%). After adjustment for preadmission antibiotics and NAI treatment propensity, preadmission NAI treatment was associated with decreased odds of hospital admission compared to no NAI treatment (adjusted odds ratio, 0.24; 95% confidence interval, 0.20-0.30).

Conclusions:

In a population with confirmed or suspected A(H1N1)pdm09 and at high risk of hospitalization, outpatient or community-based NAI treatment significantly reduced the likelihood of requiring hospital admission. These data suggest that community patients with severe influenza should receive NAI treatment.

KEYWORDS:

hospitalization; individual participant data metaanalyses; influenza; neuraminidase inhibitors; pandemic.

PMID:
28199524
PMCID:
PMC5411393
DOI:
10.1093/cid/cix127
[Indexed for MEDLINE]
Free PMC Article

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