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Clin Infect Dis. 2020 Jan 24. pii: ciaa074. doi: 10.1093/cid/ciaa074. [Epub ahead of print] Association between the Use of Antibiotics, Antivirals, and Hospitalizations among Patients with Laboratory Confirmed Influenza.
Sutton SS1, Magagnoli J1, Cummings T2, Hardin J3.
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Abstract
BACKGROUND:
Clinicians may prescribe antibiotics to influenza patients at high risk for bacterial complications. We explored the association between antibiotics, antivirals and hospitalization among influenza patients.
METHODS:
A retrospective cohort study of confirmed influenza patients with encounters during January 2011-January 2019 was conducted using data from the VA Informatics and Computing Infrastructure (VINCI). We compared inpatient hospitalizations (all-cause and respiratory) within 30 days of influenza diagnosis between four patient cohorts: (1) no treatment (n=4,228); 2) antibiotic only (n=671); 3) antiviral only (n=6,492); and 4) antibiotic + antiviral (n=1,415). We estimate relative risk for hospitalization using Poisson generalized linear model and robust standard errors.
RESULTS:
Among 12,806 influenza cases, most were white males with a mean age between 57 and 60 years. Those with antivirals only, antibiotic + antiviral, and antibiotics only all have a statistically significant lower risk of all-cause and respiratory hospitalization compared to those without treatment. Comparing the antibiotic + antiviral cohort to those who were prescribed an antiviral alone, there was 47% lower risk for respiratory hospitalization (RR=0.53, 95% CI=0.31-0.94) and no other statistical differences were detected.
CONCLUSIONS:
Those prescribed an antiviral, antibiotic, or both had a lower risk of hospitalization within 30 days compared to those without therapy. Furthermore, intervention with both an antibiotic and antiviral had a lower risk of respiratory hospitalization within 30 days compared to those with an antiviral alone. Importantly, the absolute magnitude of decreased risk with antibiotic + antiviral therapy is small and must be interpreted within the context of the overall risk of antibiotic usage.
? The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
KEYWORDS:
Antibiotic; Antiviral; Hospitalization; Influenza
PMID: 31974543 DOI: 10.1093/cid/ciaa074
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