Puja R. Myles
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.
Stella G. Muthuri
Malak Al Masri
Evelyn S.C. Koay
Ziad A. Memish
Tze Ping Loh
Maria E. Oliva
Barbara A. Rath
Julian W. Tang
Pauline A. Waight
Jonathan S. Nguyen-Van-Tam
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|
|Publisher||Oxford University Press|
|Peer Reviewed||Peer Reviewed|
|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|
|Keywords||Influenza, Neuraminidase inhibitors, Individual participant data meta-analyses, Hospitalization, Pandemic|
|Copyright Statement||Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0|
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0
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