Venkatesan, S;
Myles, PR;
Leonardi-Bee, J;
Muthuri, SG;
Al Masri, M;
Andrews, N;
Bantar, C;
... Nguyen-Van-Tam, JS; + view all
(2017)
Impact of outpatient neuraminidase inhibitor treatment in patients infected with influenza A(H1N1)pdm09 at high risk of hospitalization: an Individual Participant Data (IPD) meta-analysis.
Clinical Infectious Diseases
, 64
(10)
pp. 1328-1334.
10.1093/cid/cix127.
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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. The objective of this work was to investigate 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 nine clinical centers in different countries collected between January 2009 and December 2010. We standardized data from each study center to create a pooled dataset, then used mixed-effects logistic regression modeling to determine the effect of NAI treatment on hospitalization. We adjusted for NAI treatment propensity and pre-admission antibiotic use, including ‘study centre’ as a random intercept to account for differences in baseline hospitalization rate between centers. RESULTS: We included 3,376 patients with influenza A(H1N1)pdm09 of whom 3,085 (91.4%) had laboratory-confirmed infection. 873 patients (25.8%) received outpatient or community-based NAI treatment, 928 of 2,395 (38.8%) with available data had dyspnea or respiratory distress, and 1,705 (50.5%) hospitalizations occurred. After adjustment for pre-admission antibiotics and NAI treatment propensity, pre-admission NAI treatment was associated with decreased odds of hospital admission compared to no NAI treatment (adjusted OR =0.24; 95% CI: 0.20 to 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.
| Type: | Article |
|---|---|
| Title: | Impact of outpatient neuraminidase inhibitor treatment in patients infected with influenza A(H1N1)pdm09 at high risk of hospitalization: an Individual Participant Data (IPD) meta-analysis |
| Location: | United States |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1093/cid/cix127 |
| Publisher version: | http://doi.org/10.1093/cid/cix127 |
| Language: | English |
| Additional information: | © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
| Keywords: | Influenza, neuraminidase inhibitors, individual participant data meta-analyses, hospitalization, pandemic |
| UCL classification: | UCL |
| URI: | https://discovery.ucl.ac.uk/id/eprint/1542983 |
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