Neuraminidase Inhibitors and Hospital Length of Stay: A Meta-analysis of Individual Participant Data to Determine Treatment Effectiveness Among Patients Hospitalized With Nonfatal 2009 Pandemic Influenza A(H1N1) Virus Infection.
Adolescent
Adrenal Cortex Hormones
/ therapeutic use
Adult
Aged
Anti-Bacterial Agents
/ therapeutic use
Antiviral Agents
/ therapeutic use
Child
Enzyme Inhibitors
/ pharmacology
Female
Humans
Influenza A Virus, H1N1 Subtype
Influenza, Human
/ drug therapy
Length of Stay
Male
Middle Aged
Neuraminidase
/ antagonists & inhibitors
Pandemics
Treatment Outcome
Young Adult
IPD meta-analysis
Neuraminidase inhibitors
antivirals
length of stay
pandemic influenza
Journal
The Journal of infectious diseases
ISSN: 1537-6613
Titre abrégé: J Infect Dis
Pays: United States
ID NLM: 0413675
Informations de publication
Date de publication:
14 01 2020
14 01 2020
Historique:
received:
25
12
2018
accepted:
16
05
2019
pubmed:
18
7
2019
medline:
22
9
2020
entrez:
18
7
2019
Statut:
ppublish
Résumé
The effect of neuraminidase inhibitor (NAI) treatment on length of stay (LoS) in patients hospitalized with influenza is unclear. We conducted a one-stage individual participant data (IPD) meta-analysis exploring the association between NAI treatment and LoS in patients hospitalized with 2009 influenza A(H1N1) virus (A[H1N1]pdm09) infection. Using mixed-effects negative binomial regression and adjusting for the propensity to receive NAI, antibiotic, and corticosteroid treatment, we calculated incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Patients with a LoS of <1 day and those who died while hospitalized were excluded. We analyzed data on 18 309 patients from 70 clinical centers. After adjustment, NAI treatment initiated at hospitalization was associated with a 19% reduction in the LoS among patients with clinically suspected or laboratory-confirmed influenza A(H1N1)pdm09 infection (IRR, 0.81; 95% CI, .78-.85), compared with later or no initiation of NAI treatment. Similar statistically significant associations were seen in all clinical subgroups. NAI treatment (at any time), compared with no NAI treatment, and NAI treatment initiated <2 days after symptom onset, compared with later or no initiation of NAI treatment, showed mixed patterns of association with the LoS. When patients hospitalized with influenza are treated with NAIs, treatment initiated on admission, regardless of time since symptom onset, is associated with a reduced LoS, compared with later or no initiation of treatment.
Sections du résumé
BACKGROUND
The effect of neuraminidase inhibitor (NAI) treatment on length of stay (LoS) in patients hospitalized with influenza is unclear.
METHODS
We conducted a one-stage individual participant data (IPD) meta-analysis exploring the association between NAI treatment and LoS in patients hospitalized with 2009 influenza A(H1N1) virus (A[H1N1]pdm09) infection. Using mixed-effects negative binomial regression and adjusting for the propensity to receive NAI, antibiotic, and corticosteroid treatment, we calculated incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Patients with a LoS of <1 day and those who died while hospitalized were excluded.
RESULTS
We analyzed data on 18 309 patients from 70 clinical centers. After adjustment, NAI treatment initiated at hospitalization was associated with a 19% reduction in the LoS among patients with clinically suspected or laboratory-confirmed influenza A(H1N1)pdm09 infection (IRR, 0.81; 95% CI, .78-.85), compared with later or no initiation of NAI treatment. Similar statistically significant associations were seen in all clinical subgroups. NAI treatment (at any time), compared with no NAI treatment, and NAI treatment initiated <2 days after symptom onset, compared with later or no initiation of NAI treatment, showed mixed patterns of association with the LoS.
CONCLUSIONS
When patients hospitalized with influenza are treated with NAIs, treatment initiated on admission, regardless of time since symptom onset, is associated with a reduced LoS, compared with later or no initiation of treatment.
Identifiants
pubmed: 31314899
pii: 5533434
doi: 10.1093/infdis/jiz152
pmc: PMC7313925
doi:
Substances chimiques
Adrenal Cortex Hormones
0
Anti-Bacterial Agents
0
Antiviral Agents
0
Enzyme Inhibitors
0
Neuraminidase
EC 3.2.1.18
Types de publication
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
356-366Investigateurs
Nisreen Amayiri
(N)
Robed Amin
(R)
Clarissa Baez
(C)
Carlos Bantar
(C)
Jing Bao
(J)
Mazen Mahmoud Barhoush
(MM)
Ariful Basher
(A)
Julie Bettinger
(J)
Emilio Bouza
(E)
Ilkay Bozkurt
(I)
Elvira Čeljuska-Tošev
(E)
Kenny K C Chan
(KKC)
Yusheng Chen
(Y)
Rebecca Cox
(R)
Maria R Cuezzo
(MR)
Wei Cui
(W)
Simin Dashti-Khavidaki
(S)
Bin Du
(B)
Hicham El Rhaffouli
(H)
Hernan Escobar
(H)
Agnieszka Florek-Michalska
(A)
John Gerrard
(J)
Stuart Gormley
(S)
Sandra Götberg
(S)
Matthias Hoffmann
(M)
Behnam Honarvar
(B)
Edgar Bautista
(E)
Amr Kandeel
(A)
Jianmin Hu
(J)
Christoph Kemen
(C)
Gulam Khandaker
(G)
Marian Knight
(M)
Evelyn S C Koay
(ESC)
Miroslav Kojic
(M)
Koichiro Kudo
(K)
Arthur Kwan
(A)
Idriss Lahlou Amine
(IL)
Win Mar Kyaw
(WM)
Leonard Leibovici
(L)
Hongru Li
(H)
Xiao-Li Li
(XL)
Pei Liu
(P)
Tze Ping Loh
(TP)
Deborough Macbeth
(D)
Magdalena Marczyńska
(M)
Fabiane Pinto Mastalir
(FP)
Allison McGeer
(A)
Mohsen Moghadami
(M)
Lilian Moriconi
(L)
Pagbajabyn Nymadawa
(P)
Bulent Ozbay
(B)
Fernando P Polack
(FP)
Philippe Guillaume Poliquin
(PG)
Wolfgang Pöppl
(W)
Alberto Rascon Pacheco
(AR)
Blaž Pečavar
(B)
Mahmudur Rahman
(M)
Elena B Sarrouf
(EB)
Brunhilde Schweiger
(B)
Fang Gao Smith
(FG)
Antoni Torres
(A)
Selda Hancerli Torun
(SH)
C B Tripathi
(CB)
Daiva Velyvyte
(D)
Diego F Viasus
(DF)
Qin Yu
(Q)
Kwok-Yung Yuen
(KY)
Wei Zhang
(W)
Wei Zuo
(W)
Commentaires et corrections
Type : CommentIn
Informations de copyright
© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
Références
J Clin Epidemiol. 2012 Nov;65(11):1171-80
pubmed: 23017635
Antiviral Res. 2016 Sep;133:85-94
pubmed: 27451343
J Infect Dis. 2013 Feb 15;207(4):553-63
pubmed: 23204175
J Clin Epidemiol. 2008 Dec;61(12):1216-1221
pubmed: 18619803
Expert Opin Pharmacother. 2008 Feb;9(2):151-61
pubmed: 18201141
Clin Infect Dis. 2018 May 2;66(10):1492-1500
pubmed: 29186364
Clin Infect Dis. 2017 May 15;64(10):1328-1334
pubmed: 28199524
Am J Ther. 2002 May-Jun;9(3):199-205
pubmed: 11941379
BMJ. 2010 Feb 05;340:c221
pubmed: 20139215
Chest. 2011 Oct;140(4):1025-1032
pubmed: 21415133
Epidemiol Infect. 2018 Aug;146(11):1350-1358
pubmed: 29880077
PLoS Med. 2011 Jul;8(7):e1001053
pubmed: 21750667
Pediatr Infect Dis J. 2013 Oct;32(10):1066-9
pubmed: 23722530
Emerg Infect Dis. 2010 Aug;16(8):1265-72
pubmed: 20678321
Influenza Other Respir Viruses. 2018 Mar;12(2):267-278
pubmed: 29265727
Infect Control Hosp Epidemiol. 2011 May;32(5):435-43
pubmed: 21515973
Pediatr Infect Dis J. 2011 Nov;30(11):962-6
pubmed: 21997661
J Infect Dis. 2013 Mar 1;207(5):709-20
pubmed: 23230059
Antivir Ther. 2007;12(4):501-8
pubmed: 17668558
Cochrane Database Syst Rev. 2012 Jan 18;1:CD008965
pubmed: 22258996
Antivir Ther. 2011;16(7):1005-10
pubmed: 22024516
J Korean Med Sci. 2014 Apr;29(4):485-93
pubmed: 24753694
Clin Microbiol Infect. 2013 Mar;19(3):E157-62
pubmed: 23305123
Clin Infect Dis. 2007 Dec 15;45(12):1568-75
pubmed: 18190317
Lancet. 2015 May 2;385(9979):1729-1737
pubmed: 25640810
Ann Intern Med. 2012 Apr 3;156(7):512-24
pubmed: 22371849
J Antimicrob Chemother. 2012 Jul;67(7):1739-45
pubmed: 22467633
J Infect Dis. 2011 Jun 15;203(12):1739-47
pubmed: 21606532
Lancet Respir Med. 2014 May;2(5):395-404
pubmed: 24815805
BMC Public Health. 2016 Jun 08;16:481
pubmed: 27278794
Clin Infect Dis. 2013 Nov;57(9):1368-9
pubmed: 23883518
J Clin Epidemiol. 2010 Feb;63(2):136-8
pubmed: 20122500