J Infect Dis. 2019 Jul 17. pii: jiz152. doi: 10.1093/infdis/jiz152. [Epub ahead of print]
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.
Venkatesan S1, Myles PR1, Bolton KJ2, Muthuri SG3, Al Khuwaitir T4, Anovadiya AP5, Azziz-Baumgartner E6, Bajjou T7, Bassetti M8, Beovic B9, Bertisch B10, Bonmarin I11, Booy R12, Borja-Aburto VH13, Burgmann H14, Cao B15, Carratala J16, Chinbayar T17, Cilloniz C18, Denholm JT19, Dominguez SR20, Duarte PAD21, Dubnov-Raz G22, Fanella S23, Gao Z24, G?rardin P25,26,27, Giannella M28,29, Gubbels S30, Herberg J31, Higuera Iglesias AL32, Hoeger PH33, Hu XY34, Islam QT35, Jim?nez MF36, Keijzers G37, Khalili H38, Kusznierz G39, Kuzman I40, Langenegger E41, Lankarani KB42, Leo YS43, Libster RP44,45,46, Linko R47, Madanat F48, Maltezos E49, Mamun A50, Manabe T51, Metan G52, Mickiene A53, Mikić D54, Mohn KGI55,56, Oliva ME57, Ozkan M58, Parekh D59, Paul M60, Rath BA61, Refaey S62, Rodr?guez AH63, Sertogullarindan B64, Skręt-Magierło J65, Somer A66, Talarek E67, Tang JW68,69,70, To K71, Tran D72, Uyeki TM6, Vaudry W73, Vidmar T74, Zarogoulidis P75; PRIDE Consortium Investigators, Nguyen-Van-Tam JS1.
Collaborators (69)
Author information
Abstract
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.
? 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.
KEYWORDS:
IPD meta-analysis; Neuraminidase inhibitors; antivirals; length of stay; pandemic influenza
PMID: 31314899 DOI: 10.1093/infdis/jiz152
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.
Venkatesan S1, Myles PR1, Bolton KJ2, Muthuri SG3, Al Khuwaitir T4, Anovadiya AP5, Azziz-Baumgartner E6, Bajjou T7, Bassetti M8, Beovic B9, Bertisch B10, Bonmarin I11, Booy R12, Borja-Aburto VH13, Burgmann H14, Cao B15, Carratala J16, Chinbayar T17, Cilloniz C18, Denholm JT19, Dominguez SR20, Duarte PAD21, Dubnov-Raz G22, Fanella S23, Gao Z24, G?rardin P25,26,27, Giannella M28,29, Gubbels S30, Herberg J31, Higuera Iglesias AL32, Hoeger PH33, Hu XY34, Islam QT35, Jim?nez MF36, Keijzers G37, Khalili H38, Kusznierz G39, Kuzman I40, Langenegger E41, Lankarani KB42, Leo YS43, Libster RP44,45,46, Linko R47, Madanat F48, Maltezos E49, Mamun A50, Manabe T51, Metan G52, Mickiene A53, Mikić D54, Mohn KGI55,56, Oliva ME57, Ozkan M58, Parekh D59, Paul M60, Rath BA61, Refaey S62, Rodr?guez AH63, Sertogullarindan B64, Skręt-Magierło J65, Somer A66, Talarek E67, Tang JW68,69,70, To K71, Tran D72, Uyeki TM6, Vaudry W73, Vidmar T74, Zarogoulidis P75; PRIDE Consortium Investigators, Nguyen-Van-Tam JS1.
Collaborators (69)
Author information
Abstract
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.
? 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.
KEYWORDS:
IPD meta-analysis; Neuraminidase inhibitors; antivirals; length of stay; pandemic influenza
PMID: 31314899 DOI: 10.1093/infdis/jiz152