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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

Myles, Puja R.; Venkatesan, Sudhir; Leonardi-Bee, Jo; Muthuri, Stella G.; Al Masri, Malak; Andrews, Nick; Bantar, Carlos; Dubnov-Raz, Gal; Koay, Evelyn S.C.; Gérardin, Patrick; Memish, Ziad A.; Loh, Tze Ping; Miller, Elizabeth; Oliva, Maria E.; Rath, Barbara A.; Schweiger, Brunhilde; Tang, Julian W.; Tran, Dat; Vidmar, Tjasa; Waight, Pauline A.; Nguyen-Van-Tam, Jonathan S.

Authors

Puja R. Myles

Sudhir Venkatesan

Jo Leonardi-Bee

Stella G. Muthuri

Malak Al Masri

Nick Andrews

Carlos Bantar

Gal Dubnov-Raz

Evelyn S.C. Koay

Patrick Gérardin

Ziad A. Memish

Tze Ping Loh

Elizabeth Miller

Maria E. Oliva

Barbara A. Rath

Brunhilde Schweiger

Julian W. Tang

Dat Tran

Tjasa Vidmar

Pauline A. Waight

Jonathan S. Nguyen-Van-Tam



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.

Journal Article Type Article
Publication Date May 15, 2017
Journal Clinical Infectious Diseases
Print ISSN 1058-4838
Electronic ISSN 1537-6591
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 64
Issue 10
Pages 1328-1334
APA6 Citation Venkatesan, S., Myles, P. R., Leonardi-Bee, J., Muthuri, S. G., Al Masri, M., Andrews, N., …Nguyen-Van-Tam, J. S. (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), 1328-1334. https://doi.org/10.1093/cid/cix127
DOI https://doi.org/10.1093/cid/cix127
Keywords Influenza, Neuraminidase inhibitors, Individual participant data meta-analyses, Hospitalization, Pandemic
Publisher URL https://academic.oup.com/cid/article/2990224/Impact
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0





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