tetano
Editor, Senior Moderator
Clin Infect Dis
. 2024 Aug 22:ciae427.
doi: 10.1093/cid/ciae427. Online ahead of print. Timing of influenza antiviral therapy and risk of death in adults hospitalized with influenza-associated pneumonia, FluSurv-NET, 2012-2019
Mark W Tenforde[SUP] 1 [/SUP], Kameela P Noah[SUP] 1 [/SUP], Alissa C O'Halloran[SUP] 1 [/SUP], Pam Daily Kirley[SUP] 2 [/SUP], Cora Hoover[SUP] 3 [/SUP], Nisha B Alden[SUP] 4 [/SUP], Isaac Armistead[SUP] 4 [/SUP], James Meek[SUP] 5 [/SUP], Kimberly Yousey-Hindes[SUP] 5 [/SUP], Kyle P Openo[SUP] 6 7 8 [/SUP], Lucy S Witt[SUP] 6 7 [/SUP], Maya L Monroe[SUP] 9 [/SUP], Patricia A Ryan[SUP] 9 [/SUP], Anna Falkowski[SUP] 10 [/SUP], Libby Reeg[SUP] 10 [/SUP], Ruth Lynfield[SUP] 11 [/SUP], Melissa McMahon[SUP] 11 [/SUP], Emily B Hancock[SUP] 12 [/SUP], Marisa R Hoffman[SUP] 12 [/SUP], Suzanne McGuire[SUP] 13 [/SUP], Nancy L Spina[SUP] 13 [/SUP], Christina B Felsen[SUP] 14 [/SUP], Maria A Gaitan[SUP] 14 [/SUP], Krista Lung[SUP] 15 [/SUP], Eli Shiltz[SUP] 15 [/SUP], Ann Thomas[SUP] 16 [/SUP], William Schaffner[SUP] 17 [/SUP], H Keipp Talbot[SUP] 17 [/SUP], Melanie T Crossland[SUP] 18 [/SUP], Andrea Price[SUP] 18 [/SUP], Svetlana Masalovich[SUP] 1 [/SUP], Katherine Adams[SUP] 1 [/SUP], Rachel Holstein[SUP] 1 [/SUP], Devi Sundaresan[SUP] 1 [/SUP], Timothy M Uyeki[SUP] 1 [/SUP], Carrie Reed[SUP] 1 [/SUP], Catherine H Bozio[SUP] 1 [/SUP], Shikha Garg[SUP] 1 [/SUP]
Affiliations
Background: Pneumonia is common in adults hospitalized with laboratory-confirmed influenza, but the association between timeliness of influenza antiviral treatment and severe clinical outcomes in patients with influenza-associated pneumonia is not well characterized.
Methods: We included adults aged ≥18 years hospitalized with laboratory-confirmed influenza and a discharge diagnosis of pneumonia over 7 influenza seasons (2012-2019) sampled from a multi-state population-based surveillance network. We evaluated 3 treatment groups based on timing of influenza antiviral initiation relative to admission date (day 0, day 1, days 2-5). Baseline characteristics and clinical outcomes were compared across groups using unweighted counts and weighted percentages accounting for the complex survey design. Logistic regression models were generated to evaluate the association between delayed treatment and 30-day all-cause mortality.
Results: 26,233 adults were sampled in the analysis. Median age was 71 years and most (92.2%) had ≥1 non-immunocompromising condition. Overall, 60.9% started antiviral treatment on day 0, 29.5% on day 1, and 9.7% on days 2-5 (median 2 days). Baseline characteristics were similar across groups. Thirty-day mortality occurred in 7.5%, 8.5%, and 10.2% of patients who started treatment on day 0, day 1, and days 2-5, respectively. Compared to those treated on day 0, adjusted OR for death was 1.14 (95%CI: 1.01-1.27) in those starting treatment on day 1 and 1.40 (95%CI: 1.17-1.66) in those starting on days 2-5.
Discussion: Delayed initiation of antiviral treatment in patients hospitalized with influenza-associated pneumonia was associated with higher risk of death, highlighting the importance of timely initiation of antiviral treatment at admission.
Keywords: Influenza; antiviral; hospitalization; mortality; oseltamivir.
. 2024 Aug 22:ciae427.
doi: 10.1093/cid/ciae427. Online ahead of print. Timing of influenza antiviral therapy and risk of death in adults hospitalized with influenza-associated pneumonia, FluSurv-NET, 2012-2019
Mark W Tenforde[SUP] 1 [/SUP], Kameela P Noah[SUP] 1 [/SUP], Alissa C O'Halloran[SUP] 1 [/SUP], Pam Daily Kirley[SUP] 2 [/SUP], Cora Hoover[SUP] 3 [/SUP], Nisha B Alden[SUP] 4 [/SUP], Isaac Armistead[SUP] 4 [/SUP], James Meek[SUP] 5 [/SUP], Kimberly Yousey-Hindes[SUP] 5 [/SUP], Kyle P Openo[SUP] 6 7 8 [/SUP], Lucy S Witt[SUP] 6 7 [/SUP], Maya L Monroe[SUP] 9 [/SUP], Patricia A Ryan[SUP] 9 [/SUP], Anna Falkowski[SUP] 10 [/SUP], Libby Reeg[SUP] 10 [/SUP], Ruth Lynfield[SUP] 11 [/SUP], Melissa McMahon[SUP] 11 [/SUP], Emily B Hancock[SUP] 12 [/SUP], Marisa R Hoffman[SUP] 12 [/SUP], Suzanne McGuire[SUP] 13 [/SUP], Nancy L Spina[SUP] 13 [/SUP], Christina B Felsen[SUP] 14 [/SUP], Maria A Gaitan[SUP] 14 [/SUP], Krista Lung[SUP] 15 [/SUP], Eli Shiltz[SUP] 15 [/SUP], Ann Thomas[SUP] 16 [/SUP], William Schaffner[SUP] 17 [/SUP], H Keipp Talbot[SUP] 17 [/SUP], Melanie T Crossland[SUP] 18 [/SUP], Andrea Price[SUP] 18 [/SUP], Svetlana Masalovich[SUP] 1 [/SUP], Katherine Adams[SUP] 1 [/SUP], Rachel Holstein[SUP] 1 [/SUP], Devi Sundaresan[SUP] 1 [/SUP], Timothy M Uyeki[SUP] 1 [/SUP], Carrie Reed[SUP] 1 [/SUP], Catherine H Bozio[SUP] 1 [/SUP], Shikha Garg[SUP] 1 [/SUP]
Affiliations
- PMID: 39172994
- DOI: 10.1093/cid/ciae427
Background: Pneumonia is common in adults hospitalized with laboratory-confirmed influenza, but the association between timeliness of influenza antiviral treatment and severe clinical outcomes in patients with influenza-associated pneumonia is not well characterized.
Methods: We included adults aged ≥18 years hospitalized with laboratory-confirmed influenza and a discharge diagnosis of pneumonia over 7 influenza seasons (2012-2019) sampled from a multi-state population-based surveillance network. We evaluated 3 treatment groups based on timing of influenza antiviral initiation relative to admission date (day 0, day 1, days 2-5). Baseline characteristics and clinical outcomes were compared across groups using unweighted counts and weighted percentages accounting for the complex survey design. Logistic regression models were generated to evaluate the association between delayed treatment and 30-day all-cause mortality.
Results: 26,233 adults were sampled in the analysis. Median age was 71 years and most (92.2%) had ≥1 non-immunocompromising condition. Overall, 60.9% started antiviral treatment on day 0, 29.5% on day 1, and 9.7% on days 2-5 (median 2 days). Baseline characteristics were similar across groups. Thirty-day mortality occurred in 7.5%, 8.5%, and 10.2% of patients who started treatment on day 0, day 1, and days 2-5, respectively. Compared to those treated on day 0, adjusted OR for death was 1.14 (95%CI: 1.01-1.27) in those starting treatment on day 1 and 1.40 (95%CI: 1.17-1.66) in those starting on days 2-5.
Discussion: Delayed initiation of antiviral treatment in patients hospitalized with influenza-associated pneumonia was associated with higher risk of death, highlighting the importance of timely initiation of antiviral treatment at admission.
Keywords: Influenza; antiviral; hospitalization; mortality; oseltamivir.