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

Publié le 17 Juillet 2019
Mis à jour le 12 mars 2020

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.

Auteur : Venkatesan Sudhir, Myles Puja R, Bolton Kirsty J, Muthuri Stella G, Al Khuwaitir Tarig, Anovadiya Ashish P, Azziz-Baumgartner Eduardo, Bajjou Tahar, Bassetti Matteo, Beovic Bojana, Bertisch Barbara, Bonmarin Isabelle, Booy Robert, Borja-Aburto Victor H, Burgmann Heinz, Cao Bin, Carratala Jordi, Chinbayar Tserendorj, Cilloniz Catia, Denholm Justin T, Dominguez Samuel R, Duarte Pericles A. D, Dubnov-Raz Gal, Fanella Sergio, Gao Zhancheng, Gérardin Patrick, Giannella Maddalena, Gubbels Sophie, Herberg Jethro, Higuera Iglesias Anjarath Lorena, Hoeger Peter H, Hu Xiao Yun, Islam Quazi T, Jiménez Mirela F, Keijzers Gerben, Khalili Hossein, Kusznierz Gabriela, Kuzman Ilija, Langenegger Eduard, Lankarani Kamran B, Leo Yee-Sin, Libster Romina P, Linko Rita, Madanat Faris, Maltezos Efstratios, Mamun Abdullah, Manabe Toshie, Metan Gokhan, Mickiene Auks&#279;, Miki&#263; Dragan, Mohn Kristin G. I, Oliva Maria E, Ozkan Mehpare, Parekh Dhruv, Paul Mical, Rath Barbara A, Refaey Samir, Rodríguez Alejandro H, Sertogullarindan Bunyamin, Skr&#281;t-Magier&#322;o Joanna, Somer Ayper, Talarek Ewa, Tang Julian W, To Kelvin, Tran Dat, Uyeki Timothy M, Vaudry Wendy, Vidmar Tjasa, Zarogoulidis Paul, Nguyen-Van-Tam Jonathan S
The Journal of Infectious Diseases, 2019, p. 1-11